Dermatology - terms and skin problems Flashcards
Rosacea ( who is exposed, tx, presentation)
Fair skinned middle age woman, w/ history of symmetric redness on central area of face. Easy flushing with etoh and spicy food
TX: 1. avoid triggers 2. Metronidazole gel BID
What are Primary Lesions? which are < 1cm and which are >1cm
< 1 cm : Macule, Papule, Vesicle
> 1 cm : Nodule, Plaque, Bullae, Pusule, Wheal
Macule
freckle ( flat and nonpalpable)
Papule
Acne ( palpable solid lesion)
Nodule
Basal cell cancer ( raised solid lesion)
Pustule
acne pustules ( circumscribed elevated lesions containing pus)
Bullae
Bullous impetigo, blister, 2nd degree burn ( elevated superficial blister fluid with serous fluid > 1 cm)
Vesicle
herpes simplez or zoster ( elevated raised skin filled with serous fluid ) < 1 cm
Plaque
Psoriasis ( solid raised lesion with flat top
What are secondary lesions?
changes/ complications of primary lesions
ex. Lichenification, Scale, Crust, Ulceration, Scar, Keloids
Lichenification
thickening of epidermis due to excess itching
Scale
flaking skin
Crust
results from drying exudate
Ulceration
eroding of epidermis and dermis
scar
permanent fibrotic change following damage to the dermis
Keloids
overgrowth of scar tissue
What is the rule of 9’s?
body surface of burn :
Arms and above : 9
Chest and below : 18
Second degree burn
partial thickness
painful red skin, bullae, weepy skin
3rd degree burn
full thickness
pale/white color, charred skin, leather like texture, check ABC
In burn victim, what do you give them if they are allergic to sulfa drugs?
Bacitracin, polysporin
Smoke inhalation presentation and plan?
thermal facial burns, w/ soot around nose and mouth, signed eyebrows, hoarness
send to ED
What is ABA definition of a minor burn?
Age 10-30 < 10 % patrial thickness burn
should not involve feet, face, gentials, hands, does not corss joints
Cellulitis
bacteria ?
presentation?
Strep or Staph
acute skin infection, localized skin redness with defined margins. Feels warm, and tender, look for a point of entry ( bites, trauma)
Lymphangitis
red streaks that follow the lymphatic system. Often from IV antibioitic
Erysipelas
Strep infection, red red plaque or induration with sharp elevated margins around the face or lower leg. Must go to ED if face
Furuncle
Boil or skin abscess. due to an infection of the hair follicle . Purulent drainage when ruptures
carbuncle
cluster of boils connected subcutaneously , common behind neck
What is the tx for mild cellulitis ( nonpurulent)
Keflex
What is first line tx for abscesses
I and D
What is the tx for purulent cellulitis ? MRSA
Wound culture and then Bactrim for 10 days
Impetigo ( presentation and tx)
acute onset of round red rash with honey colored crusts. Very itchy and contagious
tx : Nonbullous type: Bactroban TID 7-10days
bullous : Keflex 7-10days
Acne Vulgaris
Non- inflammed, Mild , Moderate, Severe
abnormal follicular keratinization
TX:
- non inflammatory acne ( open and closed comedones)
- 1 st : topical retinoids ( tretinoin Retin- A)
or Salyicylic Acid
- Mild papulopustular and mixed acne ( mild papules, pustules, comedones)
- Benzoyle peroxide and topical antibiotics and topical retinoid
- Moderate papulopustular and mixed acne
- topical retinoid, ORAL antibiotics and topical benzole peroxide
- nodular acne ( refer to derm)
What are the SE and Safety concerns for topical retinoids?
SE: irrtiation, wait 30 min to apply after washing face
What is the safety concern with Tazarotene, Accutane
can not get pregnant
What is the concern with tetracycline?
tooth enamel staining, do not give to children do not mix with antiacids dairy or iron
Keys to staging pressure ulcers
stage 1 = no broken skin
stage 3 = full thickness, down to fat layer. slough
How do you culture a skin ulcer ?
need to preform a punch biopsy
What is an alginate dressing
from seaweed for exudative ulcers
Who should use foam dressings
stage II and shallow stage III, good for over hips
when should use debris a heel eschar?
only if it looks unstable ( wet, drains, boggy, loose)
Hidradenitis Supportiva * presentation and tx
recurrent episodes of large painful and tender red nodular, abscesses in axille groin, perianal
due to occulusion of hair follicles glands
results in : multiple scars and sinus tracks and odoar
TX: avoid skin trauma, stop smoking, loose weight, if mild or moderate can do antibiotics at night
Psoriasis presentation and tx
immune inflammaotry disease. I
tchy rashes that are red plaques covered with fine silvery scales ,
may see pitted fingernails
First line : Emollients for skin hydration
Topical corticosteriods : can cause HPA in high doses
can use Kenalog
Auspitz sign
in psoriasis pts, meaning = scraping off plaques which results in pinpoint areas of bleeding
Keogner phenomon
in eczema and psoriasis pts = skin injury that produced new psoriatic lesions
Eczema (Atopic Dermatitis )presentation
systemic, symmetrical both sides of body, chronic with flare ups,
locations : hands, flexural side of elbow knees neck and face
itchy and linchenifcation is common
can have a higher incidence of allergic rhinitis and asthma
Contact Dermatitis
acute, located anywhere, one episode, shape can be linear, itchy but no lichenification
What is Rhus dermaitis
contact dermatitis caused by poison ivy
Scabies presentation and tx caused by?
generalized itchiness that is worse at night.
locations include: sides and webs of fingers, wrists, ( flexor aspect) periumblicial area, penis
rash may look : serpenginous excoriacted, crusted, scaly, vesicular
caused by mites feces
TX: Elimite cream leave on for 8-14 hours then rinse and repeat in 1 - 2 weeks
Is Lindane (kwell) lotion nuerotoxic?
yes
Pityriasis Rosea
“herald patch” pink w/ fine scales–> will develop smaller rashes on the trunk area followed by a “ christmas tree” pattern. resolves on own
What is the lab test for tinea fungi infections?
Scrape lesions and send for fungal C/S ( KOH smear will show hypae and spores)
Tinea Capitis * what, presentation and tx
Fungal infection of the scalp
scaly round patches on scalp that itch. Hair breaks, may have permanent alopecia
TX : Systemic only = Griseofulvin, terniafine
Side effects to systemic antifungal therapy?
drug interactions w/ warfarin, statins, benzos, macrolides
Tinea Coporis presentations and tx
Annular red rash w/ scaling that slowly enlarge w/ central clearing, itchy
use topical azole ointment
Tinea Cruris
Groin / topical tx such as
terbinefine ( lamisil)
Butenafine ( Lotrimin)
Tinea Pedis
feet and hands : scaling on soles, use topical
Onychomycosis
nailbed in elderly, thicken nails w/ debris
can use topical penlac or systemic
Tinea Veriscolor
“sunspots” a rash that is hypopigmented or light brown color. Located on shoulder, chest, may itch
use ketoconazole cream
herpes whitlow
caused by wither virus, and its aburpt onset of small papules which becomes vesicular. painful burning sensation, on index finger or thumb
give oral acycloir as topical is too expensive
Paroncyhia w/ abcess
acute infection of cuticle around fingernail. Drain with #11 scapel
How is a subungal hematoma tx?
by terphination ( drain blood out w/ massage using large paperclip or #18 needle
SLE
chronic autoimmune disorder
will have a facial malar rash ( butterfly rash)
ANA = +
can use plaqueninil
Molluscum Contagiosum
caused by poxvirus of the skin. Dome shaped lesion swith central umbilication . can be caused by STD
watchful waiting
Rubella
3 day measles or german measles. can cause birth defects
give pregnant mother w a negative rubella titer MMR after postpartum period or later *
RubeOla
Koplik spots = small white spots appearing on buccal mucosa which occurs 2-3 days prior to rash
rash starts at face and spreads downward
