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MSS > Dermatology in Primary Practice > Flashcards

Dermatology in Primary Practice Flashcards

1
Q

What is the major function of the skin? (She said she wants us to be able to describe these but not identify them. So don’t worry so much about the pictures.)

A
  • HOMEOSTASIS: body fluid boundaries, temperature, protection, and synthesis of vitamin D.
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2
Q

What are the 4 pigments of the skin?

A
  1. melanin
  2. carotene
  3. oxyhemoglobin
  4. deoxyhemoglobin
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3
Q

What do sebaceous glands do?

A
  • produce a fatty substance
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4
Q

What is the difference between eccrine and apocrine sweat glands?

A
  • eccrine= widely distributed and open directly onto the skin surface. These are temperature controlled.
  • apocrine= axillary and genital regions and open into hair follicles. These are stimulated by emotional stress. Bacterial decomposition causes body odor.
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5
Q

What is important to take note in your skin examination?

A
  • color
  • moisture
  • temperature
  • texture
  • mobility or turgor
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6
Q

What is the key to accurate interpretation and description of cutaneous disease?

A
  • identification of the primary lesion
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7
Q

What is a MACULE?

A
  • a circumscribed, FLAT discoloration, which may be brown, blue, red, or hypopigmented (ex. caffe au lait spots, freckles…)
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8
Q

What is a PAPULE?

A
  • an ELEVATED solid lesion LESS THAN 0.5 cm in diameter, color varies. May become confluent and form plaques (ex. atopic dermatitis, melanoma…)
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9
Q

What is a PLAQUE?

A
  • a circumscribed, ELEVATED, superficial, solid lesion MORE THAN 0.5 cm in diameter, often formed by the confluence of papules (ex. pityriasis rosea).
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10
Q

What is a NODULE?

A
  • a circumscribed, ELEVATED, solid lesion MORE THAN 0.5 cm in diameter; a large nodule is referred to as a tumor (ex. basal cell carcinoma or erythema nodosum).
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11
Q

What is a WHEAL (urticaria)?

A
  • a firm EDEMATOUS PLAQUE resulting form infiltration of dermis with fluid. Wheals are TRANSIENT and may last only a few hours (ex. hives or angioedema).
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12
Q

What is a PUSTULE?

A
  • a circumscribed collection of LEUKOCYTES and FREE FLUID that varies in size (ex. folliculitis or impetigo).
  • often implies infection
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13
Q

What is a VESICLE?

A
  • a circumscribed collection of FREE FLUID up to 0.5 cm in diameter (ex. varicella or herpes).
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14
Q

What do you call a vesicle larger than 0.5 cm?

A
  • BULLA (ex. pemphigus)
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15
Q

What are secondary lesions?

A
  • develop during the evolutionary process of skin disease and are created by scratching or infection.
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16
Q

What are SCALES?

A
  • excess dead epidermal cells that are produced by abnormal keratinization and shedding (ex. seborrheic dermatitis or psoriasis).
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17
Q

What are CRUSTS?

A
  • a collection of dried serum and cellular debris; a scab (ex. impetigo or tinea capitis)
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18
Q

What are EROSIONS?

A
  • a focal loss of EPIDERMIS. These do NOT penetrate below the dermoepidermal junction and therefore heal without scarring :)
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19
Q

What are ULCERS?

A
  • a focal loss of EPIDERMIS and DERMIS. These heal with SCARRING :( (ex. aphthous or decubitus ulcers).
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20
Q

What is a FISSURE?

A
  • a LINEAR loss of epidermis and dermis with sharply defined, nearly vertical walls.
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21
Q

What is ATROPHY?

A
  • a DEPRESSION in the skin resulting from thinning of the epidermis or dermis (ex. aging skin).
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22
Q

What is a SCAR?

A
  • an abnormal formation of connective tissue implying dermal damage. After injury or surgery, scars are initially thick and pink, but with time become white and atrophic.
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23
Q

What is PSORIASIS?

A
  • coalescing papules (plaques) with smaller papules in the periphery. Has a THICK SILVERY SCALE appearance to it.
  • often effects the extensor surfaces (elbows and knees), scalp and gluteal cleft. Always check fingernails and toenails for other signs and symptoms.
24
Q

What is SEBORRHEIC DERMATITIS?

A
  • common chronic inflammatory disease caused by a YEAST (pityrosporum or Malassezia ovale), which we all have on our skin.
  • greasy scaling condition that can affect the bridge of the nose, forehead, eyelids, naso-labial folds, sternal area, and pre- and post-auricular areas.
  • looks like fine white scales around the periphery on a base of erythema.
  • pt often complains of itch also.
25
Q

What is often associated with seborrheic dermatitis?

A
  • dandruff of the scalp.
26
Q

What is PITYRIASIS ROSEA?

A
  • benign eruption of itchy circular HERALD patch (usually on the trunk) withc scales in the center.
  • This occurs over a 5 day period, is self-limiting, and resolves around 3 weeks.
  • higher prevalence in WOMEN during the spring months.
  • CHRISTMAS TREE DISTRIBUTION.
  • often mistaken for ring worm (tinea), but tinea has scales in the periphery.
27
Q

How do you treat pityriasis rosea?

A
  • anti-histamines, moisture, and don’t scratch.
28
Q

What is atopic dermatitis?

A
  • erupts as red papules that are extremely itchy.
  • usually in face and cheeks early in babies, and later occurs on flexural surfaces (back of knees) in adolescents.
  • will see lichenification (extenuation of the skin lines).
  • associated with ASTHMA or ALLERGIES
29
Q

What is atopic dermatitis called?

A
  • “the itch that rashes”
30
Q

How do you treat atopic dermatitis?

A
  • topical corticosteroids

- mainly behavioral changes (laundry detergents, no fabric softeners…)

31
Q

What is ICTHYOSIS VULGARIS?

A
  • disorder of keratinization causing rectangular shaped scales.
  • usually affects arms and legs.
  • improves with age.
  • looks like FISH SCALES
  • genetic component
32
Q

What is DIAPER DERMATITIS?

A
  • the diaper forms an artificial intertriginous area (where skin rubs against itself/ or the diaper in this case) with moisture (urination and bowel movements), causing a contact irritant dermatitis, followed by yeast setting in (satellite lesions).
  • if you see scabbed areas, this usually indicates bacterial infection.
33
Q

How do you treat diaper dermatitis?

A
  • frequent diaper changes
  • sensitive baby wipes
  • topical antibiotics or topical antifungal.
  • create a barrier from the moisture with ZINC OXIDE creams.
34
Q

What is KERATOSIS PILARIS?

A
  • non threatening small, rough, follicular papules on the posterior lateral surfaces of the outer arms or anterior thighs.
  • commonly seen in atopic patients and often during adolescence.
35
Q
  • How do you treat keratosis pilaris?
A
  • lactic acid containing moisturizers to help exfoliate the build up of keratin.
36
Q

What is NEONATAL ACNE?

A
  • small papules and pustules often on the cheeks and nose of babies. Occurs due to the sebaceous glands of the baby’s face having been stimulated by maternal androgens.
  • will wane over first 3 months of life.
37
Q

What is MILIA?

A
  • small, superficial keratin cysts with no visible opening or pore often seen in the neonatal period.
  • White in color, usually on the face, eyelids, forehead…
38
Q

What is ACNE?

A
  • disorder of the pilosebaceous unit often during puberty. Propionibacterium acnes is the bacteria that proliferates in the sebaceous glands causing a combination of inflammation, infection, and hormone changes.
  • more commonly on the face we will see open or closed comedones (whiteheads and blackheads).
39
Q

How do you treat ACNE?

A
  • topical benzoyl peroxide containing washes and topical antibiotics.
  • severe cases can use oral treatments like “accutane”
40
Q

What is ROSACEA? (adult acne)

A
  • adult acne usually occurring after the age of 30 on the forehead, nose, cheeks, and skin.
  • erythema, edema, papules and pustules, and superficial telangiectasias (superficial blood vessels).
  • can be triggered by food, wine, heat, sun….
41
Q

What can untreated Rosacea of the nose lead to?

A
  • RHINOPHYMA= permanent skin change of the nose
42
Q

How do you treat Rhinophyma?

A
  • topical or oral Metronidazole
43
Q

What is FOLLICULITIS?

A
  • infection of the hair follicle. Will see where there is hair bearing skin.
  • usually associated with shaving and heals without scaring.
44
Q

How do you treat folliculitis?

A

topical or oral antibiotics

45
Q

What is PSEUDOFOLLICULITIS BARBAE?

A
  • razor bumps due to a foreign body reaction from an ingrown hair.
46
Q

What is TINEA (ringworm)?

A
  • fungal infection of the stratum corneum (top layer of skin), and can also infect the hair and nails.
  • named for location (ex. on the foot is tinea pedis; MOCASIN distribution seen on foot).
47
Q

What is ONYCHOMYCOSIS?

A
  • infection of the toenails with the same fungus as tinea.

* difficult to treat (requires 9 months of antifungals which require liver monitoring bc these drugs are so harsh).

48
Q

What is CANDIDIASIS?

A
  • yeast infection (candida albicans) common in warm moist skin fold areas (intertriginous areas) in elderly or obese patients, especially during the summer months.
  • itchy and painful to pt.
  • requires oral treatment
49
Q

What is TINEA VERSICOLOR?

A
  • common infection of oval to round patches on the chest and back caused by pityrosporum folliculitis , but can not be cured.
  • treat scalp and skin with topical antifungal
50
Q

What is VERRUCA VULGARIS (wart)?

A
  • benign epidermal neoplasm that can spread by autoinoculation. Will see small black dots which are thrombosed capillaries.
51
Q

How do you treat warts (Verruca vulgaris)?

A
  • freeze with liquid nitrogen

- topical salicylic acid

52
Q

What is MULLUSCUM CONTAGIOSUM?

A
  • viral infection of the skin that causes a central umbilicated dome shape spread by autoinoculation.
  • seen on face, trunk, and axilla in CHILDREN.
  • seen in pubic and genital areas in ADULTS.
  • SPREAD LIKE WILDFIRE.!
53
Q

What is HERPES SIMPLEX VIRUS (HSV)?

A
  • grouped vesicles or papules on a red base that become umbilicated and then crust.
  • usually on the lips or face.
  • spread by respiratory droplets or direct contact with an active lesion or inactive disease.
  • usually a prodrome such as paresthesia occurs before outbreak occurs.
  • occurs with sunburn, stress…
  • treat early with antiviral.
54
Q

What is VARICELLA (Chx Pox)?

A
  • tricky bc it can look like moluscum and some papules may crust and erupts over days. Looks like DEW DROPS ON A ROSE PEDAL.
  • begins on trunk and then moves to the face and extremities.
  • associated with fever and respiratory symptoms.
  • highly contagious
  • 2 week inoculation period.
  • don’t scratch bc they will scar.
55
Q

What is HERPES ZOSTER (Shingles)?

A
  • cutaneous infection due to reactivation of herpes hanging out in your sacral ganglion.
  • affects a SINGLE DERMATOME.
  • starts with itch or pain before rash erupts.
  • initiate antivirals EARLY.

MSS (9 decks)

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