Dermatology I Flashcards
1
Q
What is laceration vs an abrasion?
A
- Abrasions: result from rubbing or friction applied to the epidermal layer of the skin, extending to the uppermost portion of the dermis.
- Laceration: result from a sharp edged object cutting through various skin layers
2
Q
What are the 3 steps to wound healing?
A
- Inflammatory phase
- Proliferative phase
- Remodeling phase
3
Q
Describe the inflammatory phase.
A
The body’s immediate response to injury
* Characterized by hemostasis and inflammation
4
Q
Describe the proliferative phase.
A
The wound is filled with new connective tissue and covered with new epithelium
5
Q
Describe the remodeling phase.
A
Continual collagen synthesis and breakdown.
6
Q
What are local factors that delay healing?
A
- Poor tissue perfusion/oxygenation
- Inadequate moisture
- Presence of foreign bodies
- Presence of necrotic tissues or infection
7
Q
What are systemic factors that delay the healing process?
A
- Advanced age over 60 years
- Stress
- Inadequate nutrition
- Medical conditions such as diabetes or obesity
- Immunocompromising conditions
- Medications (corticosteroids, NSAIDS, blood thinners, immunosuppressants)
8
Q
What is the first aid checklist?
A
Assess the injury
* Cause (refer if animal or human bite or if not accidental)
* Timing (refer if chronic)
* Depth (refer if deep partial thickness or full thickness)
* Size (refer if greater than 1/2 an inch)
9
Q
What are supportive measures for wound care?
A
- Cleanse the wound
- Apply moist wound care
- Relieve pain and/or discomfort
10
Q
How are old ideas of wound dressing different from the new ideas?
A
Old Recommendation: Let it air out!
New Recommendation: Keep it covered
11
Q
What are the types of wound dressings?
A
- Gauze
- Adhesive Bandages
- Hydrocolloid dressing
- Transparent Adhesive Film
- Liquid adhesive bandage
12
Q
When would we recommend using gauze for wound dressing?
A
Burns/wounds that are bleeding, draining, or require debridement.
13
Q
What are some key counseling points for using gauze as a wound dressing?
A
- Must be held in place by a second agent unless using adhesive gauze.
- Must be changed often to prevent the wound from drying out.
14
Q
When would we recommend using adhesive bandages for wound dressing?
A
Minor acute skin injuries
15
Q
What are some key counseling points for using adhesive bandages for wound dressing?
A
- Most do not provide a moist healing environment–> use topical skin protectant
16
Q
When would we recommend using hydrocolloid dressings for wound dressing?
A
Partial thickness wounds with minimal to moderate exudate, minor burns, or blisters
17
Q
What are some key counseling points for hydrocolloid dressings for wound dressing?
A
- After contact with moisture, forms gels and helps protect the wound by absorbing excess exudate and maintaining moisture.
18
Q
When would we recommend using transparent adhesive films for wound dressing?
A
Superficial-thickness and superficial partial-thickness wounds with minimal exudate.
19
Q
What are the key counseling points for transparent adhesive films for wound dressing?
A
- Flexibility is helpful with wounds on/around the joints
- Transparency allows easy wound inspection
20
Q
When would we recommend using liquid adhesive bandages for wound dressing?
A
Simple cuts and lacerations
21
Q
What are the key counseling points for liquid adhesive bandages for wound dressing?
A
- May be preferred for cosmetic considerations or when a more flexible dressing product is needed.
- May stay on for 5-10 days.
22
Q
What are examples of skin protectants?
A
- Emollients
- Moisturizers
23
Q
What do emollients and moisturizers do?
A
Protect the injured area from irritation from friction and rubbing
24
Q
What are common ingredients in skin protectants, such as emollients and moisturizers?
A
- Petrolatum
- White petrolatum
- Dimethicone
- Zinc oxide
- Glycerin
- Lanolin
- Cocoa butter
- Colloidal oatmeal
25
What do first aid antibiotics consist of?
One or more of the following:
1. Bacitracin
2. Neomycin
3. Polymyxin B sulfate
26
What are first aid antibiotics indicated for?
* The prevention of infection in minor skin injuries.
* Many are ointments, which aid in maintaining a moist healing environment.
27
What is a key counseling point for first aid antibiotics?
* Should be applied after cleanising the injury site and before applying the sterile bandage/gauze
28
What are ointments and when do you use them?
* Ointments form protective films that impede water evaportation
* Used to treat minor burns and wounds in which the skin is intact
29
What are creams and when do you use them?
* Allow some fluid to pass though
* Used to treat broken skin
30
What are lotions and when do you use them?
* Spread easily over large surfaces
* Used to treat large burns or wound area
31
What are exclusions for self-treatment for wound dressing?
* Cuts longer than 1/2 inch
* Cut that continues bleeding after 10 mins of applied pressure
* Wound secondary to an animal or human bite
* Deep partial thickness or full thickness
* Any suspected non-accidental injury
* Signs of infection
* Preexisting medical disorders that could complicate management
* Wound containing foreign matter after irrigation
* Chronic wound
* Site of injury: face, hands, feet, major joints, genitals or perineum
* Injury seems to worsen or does not show signs of healing after 7 days.
32
What are the different types of burns?
* thermal burns
* electrical burns
* chemical burns
33
What are thermal burns?
A result from skin contact with flames, scalding liquids, or hot objects.
34
What are electrical burns?
Occur when electricity flows through the body from an entry point to an exit point
* Heat of an electic current damages the skin
35
What are chemical burns?
Occur secondary to exposure to corrosive or reactive chemicals that cause tissue damage
36
What is a superficial burn?
1st degree
37
What is a partial-thickness burn?
2nd degree (can be superficial or deep)
38
What is a full-thickness burn?
3rd degree
39
What are the goals for treating burns?
1. Minimize the extent of the burn
2. Clean the wound
3. Address the pain
40
What are things to note for the general treatment of burns?
* Most patients with burns up to 10% TBSA can be managed as outpatients
* Initial appearance often causes underestimation of severity; reassess burn after 24-48 hours.
* All patients with electrical or chemical burns MUST be referred to a hospital ER for evaluation.
41
What are common ways to treat burns?
* Remove clothing items
* Remove items that can cause a tourniquet effect
* Run under cool tap water for at least 20 mins
* Remove contaminants and necrotic skin with gentle irrigation.
* Apply moisture-retentive dressings (partial thickness), skin protectants, and/or first aid antibiotics
42
What are exclusions for self-care for burns?
* Chemical, electical, or inhalation burns
* Deep partial thickness or full thickness burns
* Circumferential burns
* Patients with preexisting medical disorders
* Burns greater than 3 inches in diameter
* Not healing in 7 days
43
What is the background for head lice?
* Also known as pediculosis
* Affects all socioexonomic groups
* 6-12 million infestations occur each year in the US among children 3-11 years of age
* Outbreaks ussually peak after the opening of schools each year (between August and November)
* Infestation is NOT significantly influenced by hair length or frequent brushing/shampooing
44
What is the life cycle of head lice?
1. Eggs attach to the base of the hair shafts
2. Eggs incubate by body heat and hatch within 7-10 days
3. Nymph undergo three stages (egg, nymph, adult) and the cycle repeats every 3 weejs.
45
How is head lice transmitted?
* Lice cannot jump or hop
* Indirect spread through contact with personal belongings is less likely
* In one study, live lice were only found on 4% of infected individuals pillow cases.
46
How does head lice present clinically?
Lice is difficult to view on the head bc...
1. Lice avoid light and crawl quickly
2. Typical infected scalp will have less than 10 live lice
Many presumed lice and nits are found to be other things like...
* Dandruff
* Hairspray residue
* scabs
* dirt
* other insects
Diagnosis using a louse comb is quicker and more efficent than a standard comb
Some experts suggest using water/oil/conditioner to slow down lice.
47
What is the goal of treatment for head lice?
Goal: rid the infested patient of live by killing adult and nymph lice and removing nits from the patient's hair
48
What medication is the first line of treatment for head lice?
* Pediculicides are first-line treatment
* Applied to the scalp for a designated amount of time
* Hair is then combed with a lice or nit comb to remove nits and dead live from the hair shaft
49
What are non-pharm therapies for head lice?
* No pediculides kill 100% of lice eggs--> visual inspection and combing with an FDA approved nit comb
* Complete head shaving is an option, but invokes stigma
Other methods to prevent transmission:
* Avoid head-to-head contact
* Do not share combs, brushes, towels, caps, or hats
* Wash clothing and bedding in hot water and dry in a clothes dryer to kill lice and nits
* Wash clothing and bedding in hot water, and dry in a clothes dryer to kill lice and nits
* Wash hairbrushes and combs in very hot water
* Vacuum carpets, rugs, and furniture throughly and regularly
50
How does Permethrin 1% lotion work?
* Pyrethroid drug class: extracted from flowers in the chrysanthmum family
* Inhibits Na+ influx through nerve cell membrane channels in parasites--> delayed repolarization--> paralysis and death of the pest
51
What is the recommended dosing for Permethrin 1% lotion?
1. Prior to application, wash hair with conditioner-free shampoo; rinse with water and towel dry (hair should remain damp).
2. Apply a sufficient amount of lotion or cream rinse to saturate the hair and scalp (especially behind the ears and nape of neck).
3. Leave on hair for 10 minutes (but no longer), then rinse off with warm water.
4. Remove remaining nits with nit comb.
5. May repeat 7 days after first treatment if lice or nits are still present
52
What are adverse effects of permethrin 1% lotion?
* Transient pruritus
* Scalp burning, stinging, or irritation
53
What are contraindications for permethrin 1% lotion?
* Age <2 months
* Sensitivity to pyrethrins
54
What is the mechanism for Pyrethrin + Piperonyl Butoxide Shampoo?
* Pyrethroid drug class: extracted from flowers in the chrysanthemum family
* Pyrethrins: block nerve impulse and transmission--> louse paralysis and death
* Piperonyl butoxide: synergizes with pyrethrins by inhibiting pyrethrin breakdown.
55
What is the recommended dosing for Pyrethrin + Piperonyl Butoxide Shampoo?
1. Apply to dry hair, saturating the scalp and work towards the end
2. Leave on hair for 10 mins before rinsing out
3. Do not shampoo hair for 24-48 hours after application
4. Repeat treatment for 7-10 days (necessary to kill newly emerged nymphs)
56
What are adverse effects for Pyrethrin + Piperonyl Butoxide Shampoo?
Scalp irritation, erythema, itching, or swelling
57
What are contraindicatios for Pyrethrin + Piperonyl Butoxide Shampoo?
* Age less than 2 years
* Allergy to pyrethrins or chrysanthemums
* Ragweed-sensitive individuals (risk of cross-sensitivity)
58
What is the mechanism for Ivermectin 0.5% lotion?
* Anthelmintic
* Increase the Cl- permeability of muscle cells--> hyperpolarization--> paralysis and death of lice
59
What is the recommended dosing of Ivermectin 0.5% lotion?
1. Apply to dry hair (saturating the scalp and working out to the ends of the hair).
2. Leave on for 10 mins, then rinse out.
3. Do not shampoo hair for 24-48 hours after application
4. Only 1 application required.
60
What are the adverse effects of Ivermectin 0.5% lotion?
* Scalp irritation
* Eye irritation
61
What are contraindications for Ivermectin 0.5% lotion?
* Age less than 6 months
* Hypersensitivity to ivermectin
62
What are exclusions for self-treatment for head lice?
* Hypersensitivity to chyrssanthemums, ragweed, or pediculicide ingredients
* Presence of secondary skin infection in lice-infested area
* Pyrethrins: age less than 2 years
* Permethrins: age less than 2 months
* Life infestation of the eyelids or eyebrows
* Pregnancy or breastfeeding
* Presence of active tumors
* Regional resistance to pediculicides
63
What is the background for androgenetic alopecia?
* Most common form of hair loss in men and women
* Most prevalent in white men (50% by age 50)
* 38% in white women greater than 70 years
* 14.6% in black men and 3.5% in black women
* 14.1% of Korean men
* Many pts with androgenetic alopecia have a family history
* Psychosocial impact
64
How does male androgenic alopecia represent?
* Bitemporal thinning
* Thinning of the frontal and vertex scalp
* Complete hair loss with residual hair at the occiput and temporal fringes
65
How does female androgenetic alopecia present?
* Diffuse thinning of the vertex
* Sparing of the frontal hairline
66
What are the treatment goals of androgenetic alopecia?
* Achieve an appearance that the patient considers acceptable
* Decrease in emotional distress
67
Is AGA approved for non-prescription therapies?
AGA is only type of alopecia for which FDA-approved nonprescription therapies are available
* Refer for all other types of hair loss
68
If self-treatment is appropriate for AGA, what can you do?
* Nonpharmacologic strategies (e.g. cosmetic camouflage)
* Topical minoxidil
69
What are examples of nonpharmocologic therapies for AGA?
* Cosmetic
* Low-level light
* Microneedling
* Surgical transplant
70
How does topical minoxidil work?
* Increases cutaneous blood flow
* Promotes and maintains vascularization of hair follicles
* Reduces inflammation
* Stimulates release of vascular endothelial growth factors (VEGF)
* May prolong the anagen phase, shorten the telogen phase, or both
71
What is the recommended dosing for males for topical minoxidil?
* 5% foam: apply 1/2 capful BID
* 2% or 5% solution: apply 1 mL BID
72
What is the recommended dosing for females for topical minoxidil?
* 5% foam: apply 1/2 capful once daily
* 2% solution: apply 1 mL BID
73
What are adverse effects of topical minoxidil?
* Contact dermatitis
* Excessive facial hair growth
74
What are contraindications for topical minoxidil?
* Less than 18 years old
* No family history of hair loss
* Hair loss is sudden or patchy
* Hair loss is associated with childbirth
* Red, inflamed, infected, irritated, or painful scalpp
* Concomitant use of other medications on the scalp
75
List things to consider when selecting minoxidil products.
* Lower incidence of adverse effects associated with 2% solution
* Lower incidence of contact dermatitis associated with propylene-glycol-free foam products vs topical solutions
76
What are some exclusions for self-care in AGA?
* Less than 18 years old
* Hair loss in patient with positive hair-pull test
* Scaling, sunburn, or other scalp damage
* Pregnancy or breastfeeding
* Related to endocrine dysfunction, medication, or diet
* Broken off hair that resembles fungal infection or trich infection
* Postpartum women with hair loss
* Sudden or patchy hair oss
* Loss of eyebrows or eyelashes
* Recent discontinuation of oral contraceptives
* Fever or inflammation
* Nail pitting or abnormalities
* Hair loss in pt with no family history of hair loss
* Skin lesions that indicate autoimmune disease or infection
* Women with sudden or severe hair loss
77
What is the background for suncare?
* 1/3 of American adults experience sunburn
* Most prevalent in non-hispanic white adults
* All ethnic groups experience
78
What is the lifetime risk of melanoma?
* Caucasian--> 3% (1 in 33)
* Hispanic--> 0.5% (1 in 200)
* Black--> 0.1% (1 in 1000)
79
What are the characteristics of physical or mineral sunscreen?
* Sits atop the skin and reflects the sun's rays
* Contains titanium dioxide and/or zinc ozide
* Recommended for sensitive skin
80
What are the characteristics of chemcial sunscreens?
* Absorbs UV rays into the skin, converts them into heat, and releases them from the body
* Contains avobenzene, oxtinoxate, and or oxybenzone
* Recommended for swimming and exercise
81
What are the characteristics of hybrid sunscreen?
* Contains one or more active ingredients found in chemical and some physical sunscreens
82
What is the sun protection factor (SPF)?
* Indicates how much UVB light a sunscreen can filter out
* SPF is not linear (SPF 30 does not provide double the protection of SPF 15)
* No sunscreen can filter out 100% of UVB rays; seek shade and weat
83
What does broad spectrum sunscreen do?
* Protects the skin from both UVA and UVB rays
84
What does water resistant sunscreen do?
* FDA no longer permits manufacturers to label a sunscreen as waterproof or sweatproof
* Water resistant: stays effective for 40 mins in the water
* Very water resistant: stays effective for 80 mins in water
85
86
How do we calculate the time to burn (TTB)?
TTB (with sunscreen in minutes)= SPF(TTB) --> without sunscreen
87
What are AAD recommendations for suncare?
1. Apply 15 mins before going outside
2. Apply one ounce of sunscreen to cover exposed areas
3. Reapply every 2 hours
4. Reapply immediately after swimming or sweating
88
How do sunburns present in lighter skin tones?
* Red appearance
* Hot or painful feeling
* Itchiness
89
How do sunburns present in darker skin tones?
* Dry or cracked appearance
* Hot or painful feeling
* Itchiness
90
How do we treat sunburns?
* Take frequent cool baths or showers to relieve pain
* Apply a moisturizer containing aloe vera or hydrocortisone 1% cream to help soothe the skin
* Consider taking aspirin or ibuprofen to reduce swelling/discomfort
* If the skin blisters, do not pop them--> apply pertroleum jelly to protect as they heal
* Drink extra water
91
What are exlusions for self-treatment?
* Large areas of blistering
* Fever
* Extreme pain
* Headache or confusion
* Vision changes
* Severe swelling
* Signs of ingection
92
What is the background for warts?
* Cutaneous warts: benign epidermal proliferations caused by HPV
* Spread via person to person contavt or indirectly by fomites
* Common in children, with peak incidence in teenage years
93
What makes individuals more at risk for warts?
* persons who walk barefoot (plantar warts)
* meat handlers (hand warts)
* nail biter (periungual warts)
* immunosuppressed persons
94
What are the treatment goals for warts?
* Eliminate associated signs and symptoms
* Remove the lesion without scarring
* Prevent recurrence of warts
* Prevent the spread of HPV through autoinocualtion or transmission to others
95
What percent of warts self-resolve after 2 years?
70%
* HW, only 46% of affected persons will remain wart-free
96
When is self-treatment appropriate for warts?
* Use nonpharmacologic methods to prevent spread
* Salicyclic acid and cryotherapy with liquid nitrogen are first-line
97
What are some nonpharm therapies used to alleviate discomfort from plantar warts?
Pad pressure points with lamb's wool or moleskin
98
What are some nonpharm therapies to prevent the development of future warts?
* Avoid cutting, shaving, or picking at warts
* Wash hands before/after treating or touching
* Use a designated towel
99
What are nonpharm ways to prevent the transmission of warts to others?
* Avoid sharing towels, razors, socks, shoes
* Keep wart(s) covered
* Do not walk barefoot
100
What is the mechanism of salicylic acid for wart treatment?
* Keratolytic agent
* Slowly destroys the HPV-infected epidermis
101
What is the recommended dosing for salicyclic acid?
Salicylic acid 17% liquid
1. Soak wart in warm water for 5 mins. Dry area throughly.
2. Apply 1 drop to cover wart. Let dry.
3. Repeat once or twice daily until wart is removed, up to 12 weeks.
Salicyclic acid 40% pads
1. Soak wart in warm water for 5 minutes. Dry area thoroughly.
2. Apply pad over wart and secure firmly.
3. Repeat every 48 hours as needed until wart is removed, up to 12 weeks.
102
What are the adverse effects for salicylic acid?
* Minor skin irritation
* Hypo- or hyperpigmentation
103
What are the contraindications of salicyclic acid?
* Less than 3 years old
* Children who have/are recovering from chickenpox or flu-like symptoms
* Diabetes or poor blood circulation
* Irritated, infected or reddened skin
* Moles, birthmarks, warts with hair
* Warts on genitals, face, or mucous membranes
104
What is the mechanism for cryotherapy?
* OTC products: nitrous oxide (NO) or dimethyl ther and propane (DMEP)
* Freezing tissue creates microthrombi--> ischemic necrosis and destruction of HPV-infected keratinocytes
105
What is the recommended dosing?
1. Prepare and activate the device (refer to product-specific instructions)
2. Apply to the wart until a halo appears around the wart
3. Discard single use applicator
4. Repeat after 2 weeks if needed; may be used for up to 3 treatments
106
What are adverse effects of cryotherapy?
* Blistering
* Scarring
* Hypo or hyperpigmentation
107
What are contraindications for cryotherapy?
* Less than 4 years old
* Diabetes or poor blood circulation
* Pregnancy or breastfeeding
* Irritated, infected, inflamed, itchy or swelling skin
* Moles, birthmarks, warts with hair growing from them
* Warts on the genitals, face, or mucous membranes
108
What is the difference between salicylic acid wart removal and cryotherapy?
Salicylic acid
* Strips or pads may be easier for some patients to apply than the loquid
* Less painful than cryotherapy
* Less risk of damaging surrounding tissues than cryotherapy
Cryotherapy
* May appeal to patients looking for a product with minimal applications
109
What are exclusions for self-treatment for warts?
* For salicylic acid products: age less than 3 years, salicylate allergy, use of medications that contradict use
* Chronic conditions that affect sensitivity or poor blood circulation to the hands/feet
* Painful plantar warts
* For cryotherapy products: age less than 4 years
* Immunocompromised patients
* Warts located on the face, breasts, armpits, nails, genetalia, or mucous membranes
* Pregnancy or breastfeeding
* Large or multiple warts located on one area of the body
* Warts that occur on inflamed, infected, or irritated skin
* Mental or physical conditions that limit/precent the patient from following product directions
* Painful, bleeding, discolored warts
* Warts that have not resolved after 12 weeks of self-treatment
