EO 002 Flashcards
[EO 002] Tinea Corporis (Ring Worm) Classification:
Dermatophyte (Fungal) Infection
[EO 002] Tinea Corporis (Ring Worm) Patho:
A Fungal infection that survives on dead keratin.
[EO 002] Tinea Corporis (Ring Worm) Transmission:
Autoinoculation from other parts of the body. (from tinea pedis or tinea capitis.)
Skin to skin contact with people or animals.
[EO 002] Tinea Corporis (Ring Worm) Prevalence:
(Geographic) More common in tropical and subtropical regions. All ages. All genders.
[EO 002] Tinea Corporis (Ring Worm) Incubation period:
Days to months since contact with vector.
[EO 002] Tinea Corporis (Ring Worm) Hx Findings:
Other family members who have similar lesions.
Contact with animals. Previous use of Topical steroids.
[EO 002] Tinea Corporis (Ring Worm) O/E:
Scaling, sharply marginated plaques with or without pustules or vesicles. Peripheral enlargement and central clearing, produces annular configuration with concentric rings. Single and occasionally scattered multiple lesions. Mild to severe pruritus.
[EO 002] Tinea Corporis (Ring Worm) Location:
Areas not defined by other tineas i.e., tinea pedis, tinea capitis, tinea cruris, etc.
[EO 002] Tinea Corporis (Ring Worm) DDx:
Psoriasis, Seborrheic dermatitis, Eczema, Contact dermatitis, Lyme disease, Pityriasis rosea
[EO 002] Tinea Corporis (Ring Worm) Tx Plan
Rx: Clotrimazole 1% cream/Canesten Topical BID X 4 weeks
Pt education: Hygiene, avoid skin to skin contact, loose breathable clothes to allow skin to dry.
Monitor Pt / Re evaluate (RTC) in 1 week or if condition worsens
Tests: Fungal Scraping, Woods Lamp (most cases do not fluoresce)
Refer to MO/PA for long term Tx. Suggest Dermatologist referral in worst cases.
[EO 002] Tinea Cruris (Jock Itch) Classification:
Dermatophyte (Fungal) Infection.
[EO 002] Tinea Cruris (Jock Itch) Patho:
Dermatophyte (Fungal) Infection.
[EO 002] Tinea Cruris (Jock Itch) Transmission:
Autoinoculation from other parts of the body, usually Tinea Pedis.
[EO 002] Tinea Cruris (Jock Itch) Prevalence:
Any age, but rare in children. More common in males.
[EO 002] Tinea Cruris (Jock Itch) Onset:
Sub acute/Chronic
[EO 002] Tinea Cruris (Jock Itch) Hx Findings:
Warm, humid environment: Tight clothing worn by men; Possible Obesity.
Chronic topical glucocorticoid application
(because of decreased host immunologic local reaction).
Past or current Hx of Tinea Pedis and/or Tinea Cruris
[EO 002] Tinea Cruris (Jock Itch) O/E:
Usually bilateral, scaly with red-brown centres (well-demarcated dull red/tan/brown plaques)
Large, scaling, central clearing. Papules, pustules may be present at margins.
Clearly defined, raised border. *Pruritus is common (often what has made Pt seek care).
[EO 002] Tinea Cruris (Jock Itch) Location:
Groin, pubic regions and thighs. Unlike yeast infections, the scrotum and penis
are usually spared.
Occasionally the gluteal cleft is affected.
[EO 002] Tinea Cruris (Jock Itch) DDx:
Erythrasma (bacterial)
Candida
Psoriasis
Chafe
[EO 002] Tinea Cruris (Jock Itch) Tx Plan:
Rx: Clotrimazole 1% cream/Canesten Topical BID X 4 weeks, including at least 1 week after lesions have cleared.
Tx co-existing locations of fungal infections (ring worm, tinea unguium and athlete’s foot)
Pt education: Hygiene, avoid skin to skin contact, loose breathable clothes to allow skin to dry.
Dry off before putting on clothes.
Put on your socks before you put on your underwear.
Monitor Pt / Reevaluate (RTC) in 1 week or if condition worsens
Tests: Fungal Scraping, Woods Lamp (most cases do not fluoresce)
Refer to MO/PA for long term Tx. Suggest Dermatologist referral in worst cases.
[EO 002] Tinea Pedis (Athletes Foot) Classification:
Dermatophyte (Fungal) Infection
[EO 002] Tinea Pedis (Athletes Foot) Patho:
A Fungal infection that survives on dead keratin
[EO 002] Tinea Pedis (Athletes Foot) Transmission:
Barefoot walking on floors
[EO 002] Tinea Pedis (Athletes Foot) Prevalence:
Males more prominent than females,approx. 4% of population,Rare in children/can be common in teens
[EO 002] Tinea Pedis (Athletes Foot) Incubation Period/Onset:
Chronic. Usually between age 20-50
[EO 002] Tinea Pedis (Athletes Foot) Hx Findings:
Months to years
Often prior Hx of tinea pedis, tinea unguium of toenails.
May flare in hot climate
Sweaty feet / Hx of Excessive sweating
Occlusive tightfitting footwear (boots)
Immunosuppression
Prolonged application of topical steroids
[EO 002] Tinea Pedis (Athletes Foot) O/E:
Erythema, scaling, maceration, possible bulla formation and pruritus. Pain with secondary bacterial infection.
[EO 002] Tinea Pedis (Athletes Foot) 4 Clinical Presentations:
Interdigital, Moccasin, Inflammatory/bullous, Ulcerative
[EO 002] Tinea Pedis (Athletes Foot) Location:
Feet (usually bilateral)
[EO 002] Tinea Pedis (Athletes Foot) DDx
Interdigital type: erythrasma (bacterial), impetigo (bacterial)
Moccasin type: psoriasis vulgaris, eczematous dermatitis (including dyshidrotic eczema)
Inflammatory/bullous type: bullous impetigo, contact dermatitis
[EO 002] Tinea Pedis (Athletes Foot) Tx Plan:
Rx: Clotrimazole 1% cream/Canesten Topical BID X 4 weeks
Pt education: Hygiene, wear footwear in public showers, washing feet with benzoyl peroxide bar after shower, using antifungal foot powders.
Dry feet. Dry shoes. Change Socks.
Monitor Pt / Reevaluate (RTC) in 1 week or if condition worsens
Tests: Fungal Scraping, Woods Lamp (to rule out erythrasma)
Refer to MO/PA for long term Tx. Suggest Dermatologist referral in worst cases.
[EO 002] Tinea Unguium/Onychomycosis (Infected Toe Nail) Classification:
Dermatophyte (Fungal) Infection
[EO 002] Tinea Unguium/Onychomycosis (Infected Toe Nail) Patho:
A fungal infection that survives on dead keratin
[EO 002] Tinea Unguium/Onychomycosis (Infected Toe Nail) Transmission:
Transmission from one individual to another, by fomite
or direct contact, commonly among family members
[EO 002] Tinea Unguium/Onychomycosis (Infected Toe Nail) Prevalence:
In the US and Europe, up to 10% of the adult population affected
[EO 002] Tinea Unguium/Onychomycosis (Infected Toe Nail) Onset:
Children or adults. Chronic without therapy
[EO 002] Tinea Unguium/Onychomycosis (Infected Toe Nail) Hx Findings:
Other family members with similar findings.
Risk factors: atopy, diabetes mellitus, Immunosuppressive drugs, HIV/AIDS.
For toenail onychomycosis, most important factor is wearing of occlusive footwear
[EO 002] Tinea Unguium/Onychomycosis (Infected Toe Nail) Risk Factors:
Nail plates may be chalky white or yellow, thickened, cracked, friable and raised by underlying hyperkeratotic debris. Check for concomitant tinea pedis
[EO 002] Tinea Unguium/Onychomycosis (Infected Toe Nail) O/E:
Approximately 80% of onychomycosis occurs on the feet. Simultaneous occurrence on toenails and fingernails is not common
[EO 002] Tinea Unguium/Onychomycosis (Infected Toe Nail) Location:
Approximately 80% of onychomycosis occurs on the feet. Simultaneous occurrence on toenails and fingernails is not common
[EO 002] Tinea Unguium/Onychomycosis (Infected Toe Nail) DDx:
Psoriasis, Eczema, Onychogryphosis,
Pincer Nails, Congenital Nail Dystrophies
[EO 002] Tinea Unguium/Onychomycosis (Infected Toe Nail) Tx Plan:
MO Rx: Topical agents (usually ineffective)
Systemic agents (terbinafine).
MO Rx Tests: Nail clipping. Direct microscopy / fungal culture.
Refer to MO/PA for long term Tx.
Suggest Dermatologist referral in worst cases.
Pt Education: Pt should debride dystrophic nails weekly. Put on socks before underwear to avoid self-transmission.
[EO 002] Tinea Capitis:
Dermatophyte infection of the scalp
[EO 002] Tinea Manuum:
Dermatophyte infection of the hand(s)
[EO 002] Tinea Facialis:
Dermatophyte infection of the glabrous facial skin
[EO 002] Tinea Barbae:
Dermatophyte infection of the androgen-sensitive beard and moustache areas
[EO 002] Cutaneous Candidiasis Classification:
Yeast Infection
[EO 002] Cutaneous Candidiasis Patho:
Candidiasis is most frequently caused by the yeast Candida Albicans.
[EO 002] Cutaneous Candidiasis Transmission:
Normal inhabitant of mucosal surfaces.
[EO 002] Cutaneous Candidiasis Prevalence:
Young and old
[EO 002] Cutaneous Candidiasis Incubation period/Onset
Chronic
[EO 002] Cutaneous Candidiasis Hx Findings:
Many patients have predisposing factors, such as diabetes, poor hygiene and/or obesity.
May be individuals who immerse their hands in water (cleaners, health care workers, bartenders, florists)
[EO 002] Cutaneous Candidiasis O/E:
Intertrigo. Occluded skin.
Erythema, Pruritus, tenderness, pain.
Initial inflammatory papules and pustules on erythematous base become eroded and confluent. Progressing to sharply demarcated erythematous eroded patches with peripheral inflammatory papules and pustules.
[EO 002] Cutaneous Candidiasis Location:
Occurs in moist, occluded cutaneous sites.
Inframammary, perineal, intergluteal, interdigital (on feet and hands), under/inside diapers or casts.
[EO 002] Cutaneous Candidiasis DDx:
Interdigital: consider scabies
Intertrigo/occluded skin: erythrasma, dermatophytosis and tinea versicolor.
Diaper dermatitis: atopic dermatitis, psoriasis, irritant and seborrheic dermatitis.
[EO 002] Cutaneous Candidiasis Tx Plan:
Lab: Fungal Culture - IOT identify the species of Candida.
Lab: Bacterial Culture - IOT rule out bacterial infection.
Pt Education; keep areas dry, loose clothing
Rx: Clotrimazole topical cream BID x 2-3 weeks; (clinical improvement and relief of pruritus usually within first week.)
Refer to MO/PA
RTC if condition worsens or doesn’t improve
[EO 002] Pityriasis Versicolor Classification:
Overgrowth of normal flora (yeast)
[EO 002] Pityriasis Versicolor Patho:
Resident cutaneous flora: Malassezia (Pityrosporum Ovale)
[EO 002] Pityriasis Versicolor Prevanlence/Onset:
Temperate climates; appears in summertime, affecting 2% of pop; may regress during cooler months. Subtropical and tropical climates: year around in 20% of pop.
[EO 002] Pityriasis Versicolor Duration:
Months to years
[EO 002] Pityriasis Versicolor Hx Findings:
High temperature environment/relative humidity
Hx of oily skin, hyperhidrosis, hereditary factors
Current Rx of glucocorticoid Tx
Immunodeficiency
[EO 002] Pityriasis Versicolor O/E:
Well demarcated scaling macules and patches
Variable pigmentation
Occurring most commonly on the trunk
Occasionally, mild pruritus
Macules are sharply marginated, round or oval, varying in size. In untanned skin, lesions are light brown. On tanned skin, white. Can be red.
Pt usually presents @ clinic due to cosmetic concerns
[EO 002] Pityriasis Versicolor Location:
Most commonly on the trunk
[EO 002] Pityriasis Versicolor DDx:
Vitiligo, pityriasis alba
(Scaling lesions) Tinea corporis, seborrheic dermatitis, pityriasis rosea
[EO 002] Pityriasis Versicolor Treatment Plan:
Woods Lamp Test: Blue-green fluorescence of scales. May be negative in pts who have showered recently because the fluorescent chemical is water soluble. May be false positive if pt has applied creams. If done properly can detect sub clinical presentation.
PT education: hygiene, dyspigmentation persists for months after infection has been eradicated. Avoid applying skin oils
Refer to MO/PA for long term management of condition. Suggest Derm referral.
Med Tech Rx: Clotrimazole 1% cream/Canesten Topical BID X 4 weeks
Med Tech Rx: Selenium sulfide 2.5% lotion or shampoo (Versel)
RTC if condition worsens or doesn’t improve.
[EO 002] Herpes Simplex/Herpes Labialis Classification:
Viral
[EO 002] Herpes Simplex/Herpes Labialis Patho:
HSV persists in sensory ganglia for the life of the Pt.
[EO 002] Herpes Simplex/Herpes Labialis Transmission:
Mostly occurs when persons shed virus but lack symptoms or lesions. Usually skin-skin, skin-mucosa, mucosa-skin contact.
[EO 002] Herpes Simplex/Herpes Labialis Duration:
Resolve in 2-4 weeks..
[EO 002] Herpes Simplex/Herpes Labialis Recurrence:
1/3 of persons with herpes labialis will have a recurrence; of these, ½ will have 2 recurrences annually.
[EO 002] Herpes Simplex/Herpes Labialis Hx Findings:
Skin/mucosal irritation, fever common cold, altered hormones (menstruation), altered immune state
[EO 002] Herpes Simplex/Herpes Labialis O/E:
Primary infections; usually asymptomatic or have trivial symptoms.
Characterized by vesicles at the site of inoculation
Regional lymphadenopathy,
Fever, H/A, malaise.
Recurrent; Prodrome of tingling, itching, or burning usually precedes any signs by 24hrs.
Systemic symptoms are usually absent. Erythema initially, pustules, erosions (may enlarge into ulcerations), which may be crusted or moist. Grouped vesicles on erythematous base – erosions and crusts.
[EO 002] Herpes Simplex/Herpes Labialis Location:
Usually, the original site of inoculation
Labial (lips), periorbital, distal fingers, genitalia
[EO 002] Herpes Simplex/Herpes Labialis DDx:
Primary intraoral HSV infection;
Aphthous stomatitis
Hand-foot-mouth disease
Recurrent lesion;
Fixed drug eruption
[EO 002] Herpes Simplex/Herpes Labialis Tx Plan:
Test: viral culture or antigen detection
PT education: Prevention; skin-skin contact should be avoided during outbreak.
Refer to MO/PA
Antiviral Rx: Valacyclovir (Valtrex). Topical antiviral therapy is minimally effective.
Rx: Analgesics
Wet dressings (water, saline, burrow’s sol.) for pt discomfort.
RTC PRN
[EO 002] Herpes - Varicella Zoster Virus (Shingles) Classification:
Dermatomal viral infection
[EO 002] Herpes - Varicella Zoster Virus (Shingles) Patho:
Reactivation of the varicella-zoster virus due to diminished immunity to it.
The virus establishes latent infection in ganglia lasting for life.
[EO 002] Herpes - Varicella Zoster Virus (Shingles) Transmission:
99.999% of population infected.
[EO 002] Herpes - Varicella Zoster Virus (Shingles) Prevalence:
66% are >50 years of age.
[EO 002] Herpes - Varicella Zoster Virus (Shingles) Onset:
Acute. Triggered by immunosuppression, trauma, tumor, or irradiation
[EO 002] Herpes - Varicella Zoster Virus (Shingles) Duration:
Chronic
[EO 002] Herpes - Varicella Zoster Virus (Shingles) O/E:
Unilateral
Papules within 24 hrs
Vesicles-bullae appear in 48 hrs,
Pustules in 96 hrs,
Crust in 7-10 days.
New lesions will continue to appear for up to 1 week.
Erythematous, edematous base with superimposed clear vesicles, sometimes hemorrhagic.
Pain
[EO 002] Herpes - Varicella Zoster Virus (Shingles) Location:
Dermatomal: 2 or more neighbouring dermatomes may be involved
Thoracic (>50%),
Trigeminal (10-20%),
Lumbosacral (10-20%)
Cervical (10-20%).
Non-adjacent dermatomal zoster is rare.
[EO 002] Herpes - Varicella Zoster Virus (Shingles) DDx:
Prodromal stage: mimics migraine, cardiac or pleural disease
Active vesiculation: HSV, ACD (poison ivy/oak), ICD.
[EO 002] Herpes - Varicella Zoster Virus (Shingles) Tx Plan:
Refer to MO/PA
ECG; to rule out cardiac if chest pain is present.
Imaging; to rule out organic, pleural, pulmonary, or abdominal diseases.
Relieve constitutional symptoms, minimize pain, prevent secondary infection, speed crusting of lesions and healing and ease discomfort.
Rx: Antiviral therapy for Valacyclovir (Valtrex) 1000mg PO tid for 7 days
Rx: Analgesics PRN; NSAIDs, (T3),
Moist dressings (Water, saline, Burrow’s sol.)
Bed rest, sedatives PRN
RTC for follow up
[EO 002] Human Papilloma Virus (HPV) Classification:
Viral
[EO 002] Human Papilloma Virus (HPV) Patho:
Infect squamous epithelia of skin and mucous membranes.
[EO 002] Human Papilloma Virus (HPV) Transmission:
Skin-to-Skin.
Breaks in the stratum corneum facilitate transmission.
[EO 002] Human Papilloma Virus (HPV) Prevalence: Widespread to ubiquitous.
Widespread to ubiquitous.
[EO 002] Human Papilloma Virus (HPV) Duration:
Chronic. Persists for several years if untreated.
[EO 002] Human Papilloma Virus (HPV) Hx Findings:
Close contact to others with an infection
Exposure to floors/surfaces and others with HPV
A hx of skin/derm trauma
[EO 002] HPV - Verrucae Vulgaris (Common Warts) O/E:
Firm papules
1 to 10 mm or rarely larger
Hyperkeratotic
Clefted surface
Palmar lesions disrupt the normal line of fingerprints
Characteristic “red or brown dots” are thrombosed capillary loops
Isolated lesion, scattered discrete lesions
Annular at sites of prior therapy
[EO 002] HPV - Verrucae Vulgaris (Common Warts) Location:
Occur at sites of trauma;
Hands
Fingers
Knees
[EO 002] HPV - Verrucae Plantaris (Plantar Warts) O/E:
Early small, shiny, sharply marginated hyperkeratotic papule/plaque with brown-black dots (thrombosed capillaries).
Confluence of many small warts results in a mosaic wart.
Lesions may occur on opposing surfaces of two toes.
Tenderness may be marked, especially lesions over pressure points.
[EO 002] HPV - Verrucae Plantaris (Plantar Warts) Location:
Plantar aspect of feet
Often at heads of metatarsals
Heels and toes
[EO 002] Human Papilloma Virus (HPV) DDx:
Hands: molluscum contagiosum, seborrheic keratosis.
Feet: callus, corn (clavus) have no thrombosed capillary loops
[EO 002] Human Papilloma Virus (HPV) Tx Plan:
Plantar wart pads help relieve pressure and pain
Med Tech Rx: Liquid Salicylic acid (Soluver Plus) applied directly to lesion daily with close monitoring and in combination with debriding the wart with an emery board or pumice stone to improve effectiveness of Tx.
Med Tech Rx: Cryogenic Tx done on wart parade by Med Tech or MO, aggressive Tx can resolve the matter in 1-2 applications.
MO must do initial Dx.
RTC for re-assessment
Pt education: Footwear in public showers. Change socks if plantar. Don’t pick at warts with fingernails.
[EO 002] Impetigo Classification:
Bacterial
[EO 002] Impetigo Patho:
Group A streptococcus or Staphylococcus aureus infection of epidermis.
[EO 002] Impetigo Transmission:
From shared towel, cup or glass . Family members. Pets.
[EO 002] Impetigo Prevalence:
Primary infections are most common in children.
Secondary infection, common at any age.
[EO 002] Impetigo Duration:
Lesions last days to weeks
[EO 002] Impetigo Hx Findings:
Living and working in high humidity.
Pre-existing skin cond. (scabies, atopic dermatitis, etc.)
Elderly, Soldier, Alcoholic, diabetic
Poor hygiene
Crowded living conditions
Neglected minor traumas
Other family members with Impetigo.
Other children at daycare/school.
[EO 002] Impetigo O/E:
Variable pruritus
Especially associated with atopic dermatitis.
Vesicles and bullae containing clear yellow or slightly turbid fluid
Little to no surrounding erythema
Bullous arising on normal-appearing skin.
With rupture, bullae decompress.
If roof of bullae is removed, shallow moist erosions form.
Honey golden-yellow crusting
Often non painful
[EO 002] Impetigo Location:
Site of neglected wounds
Traumatic breaks in epidermis
Bug bites
[EO 002] Impetigo DDx:
ACD
ICD
Seborrheic dermatitis
Herpes
Scabies
Insect bites
[EO 002] Impetigo Tx Plan:
Test: Gram stain, culture
Pt education: recurrence can occur by recolonization from a family member or a family dog. Daily bath. Bedding, clothing, towel changes each day for first two days of Rx use. Frequently use ethanol or isopropyl hand sanitizer. Don’t pick at wound.
MO Rx: Benzoyl peroxide wash (bar).
MO Rx: Topical antibiotics; Mupirocin TID 7-10 days.
MO Rx: Oral antibiotics; type according to test results
Check family members for signs of impetigo.
Refer to MO/PA for Rx and Test Req.
RTC if condition worsens or does not resolve with Tx
[EO 002] Cellulitis Classification:
Bacterial
[EO 002] Cellulitis Patho:
Infection of dermal and subcutaneous tissues.
Often Group A Streptococcus (Can be many others)
[EO 002] Cellulitis Transmission:
Usually penetrating injury or Hx of break in skin barrier.
[EO 002] Cellulitis Prevalence:
Any age
[EO 002] Cellulitis Incubation Period:
Acute onset. Incubation period of a few days
[EO 002] Cellulitis Hx Findings:
Underlying dermatological disorders
Trauma (bites, abrasion, burns, laceration, etc.)
Surgical wound
Mucosal infection
Injection drug use
Malaise
Anorexia
Fever
Chills can develop rapidly before cellulitis is apparent.
[EO 002] Cellulitis O/E:
Tissue feels hard on palp
Extremely painful
Red, Hot, edematous
Shiny plaque, and very tender.
Migratory borders as infection spreads, irregular, and slightly elevated.
Vesicles, bullae, erosions, abscesses, hemorrhage and necrosis may be present
Usually unilateral on limbs
Fever
Signs of sepsis
[EO 002] Cellulitis Location:
Lower leg most common site
Following interdigital tinea
Arm in young males
IV drug use site
Post mastectomy site
Trunk operative wound site
Eye (complication of conjunctivitis)
[EO 002] Cellulitis DDx:
Deep vein thrombosis
Stasis dermatitis
Contact dermatitis
Insect bite
Fixed drug eruption.
[EO 002] Cellulitis Tx Plan:
REFER TO MO/PA: Condition must be referred promptly.
Rx: Antibiotics in accordance with diagnostic test results.
Marking size with surgical pen to monitor changes
[EO 002] 3 Types of Lice
Pediculosis Capitits (Head lice)
Pediculosis Corporis (Body lice)
Pediculosis Pubis (Pubic lice)
[EO 002] Pediculosis (Lice) Classification:
Parasite
[EO 002] Pediculosis (Lice) Patho:
Infestation of sucking lice (1-3mm in size) (nits <1 mm)
Lay their eggs on hair shafts or in seams of clothing
Female lives for up to 3 months
Can lay 300 eggs (nits) in her lifetime
Feed multiple times daily
[EO 002] Pediculosis (Lice) Transmission:
Most commonly by direct contact with bedding, brushes, or clothing, according to the type of louse.
[EO 002] Pediculosis (Lice) Prevalence:
Hundreds of millions of cases worldwide yearly.
[EO 002] Pediculosis (Lice) Hx Findings:
Pt may be aware symptoms in close contacts.
[EO 002] Pediculosis (Lice) Common S/S:
Pruritus
[EO 002] Pediculosis Capitits (Lice) Prevalence:
Girls > boys, 3-11 years, but can infect all ages.
More common in Caucasian vs African American
Uncommon in Africa
[EO 002] Pediculosis Capitits (Lice) Location:
Head Hair
[EO 002] Pediculosis Capitits (Lice) Transmission:
Shared hats, brushes.
Direct contact.
Schools are the most common areas for infestations.
[EO 002] Pediculosis Capitits (Lice) O/E:
Lice are identified by eye or with a lens.
Lay eggs(Nits) 1-2mm from scalp on hair shaft
Longer standing infestations may be 15cm from the scalp
New eggs are a creamy-yellow colour, and empty eggshells are white.
Lesions apparent on the neck
Pruritus of the back and sides of scalp.
Rarely infect beards
Can infect eye lashes (rare)
Often symptomless aside from Pt Mental health/Consternation.
[EO 002] Pediculosis Capitits (Lice) Unique Symptoms:
Pruritus of the back and sides of scalp.
[EO 002] Pediculosis Capitits (Lice) Survival Time:
Pediculosis capitis survive for up to 55 hrs off of scalp.
[EO 002] Pediculosis Capitits (Lice) Vector for:
Not a significant vector of disease in humans.
[EO 002] Pediculosis Corporis (Lice) Location:
Body/Clothing/bedding
[EO 002] Pediculosis Corporis (Lice) Prevalence:
Homeless and alcoholism, poor hygiene
[EO 002] Pediculosis Corporis (Lice) Transmission:
Direct contact. Bedding
[EO 002] Pediculosis Corporis (Lice) O/E:
Red macules
Papules
Papular urticaria with central hemorrhagic punctum.
Excoriations
Eczematous dermatitis
Clothing may be stained with blood/serum (louse feeds).
[EO 002] Pediculosis Corporis (Lice) Unique Symptoms:
Lice in seams of clothing
[EO 002] Pediculosis Corporis (Lice) Survival Time:
Pediculosis Corporis survive for up to 3 days off body.
[EO 002] Pediculosis Corporis (Lice) Vector For:
Trench fever
Epidemic typhus
[EO 002] Pediculosis Pubis (Lice) Location:
Pubic area, axillary, Perineum, thighs, nipple area (hairy males), lower legs, trunk,eyelashes and eyebrows.
[EO 002] Pediculosis Pubis (Lice) Prevalence:
Young adults. Males
[EO 002] Pediculosis Pubis (Lice) Transmission:
Close physical contact. Coitus. Shared towels.
[EO 002] Pediculosis Pubis (Lice) O/E:
Lice appear as grey-brown specks.
Papular urticaria at sites of feeding
Slate gray or bluish gray macules
Possible signs of secondary infection in lesions
Serous crusts and edema of eyelids.
Lice (1-2mm) stationary for days
Patient may have detected a nodularity to hairs (nits).
[EO 002] Pediculosis Pubis (Lice) Unique Symptoms:
Lives exclusively on humans.
May be asymptomatic.
Mild to moderate pruritus for months.
[EO 002] Pediculosis (Lice) Method of Dx:
Woods Lamp Test: Live nits Fluoresce / Dead Nits do not
Inspection of seams of clothes and hair
Detection Combs on haired area of infection (lashes, pubic, axillae, head)
Microscopy: IOT confirm physical finding.
[EO 002] Pediculosis (Lice) DDx:
Head lice: Hair residue, dandruff, impetigo.
Body lice: Atopic dermatitis, contact dermatitis, scabies, adverse drug reaction.
Pubic Lice: atopic dermatitis, seborrheic dermatitis, tinea cruris, folliculitis and scabies.
[EO 002] Pediculosis (Lice) Tx Plan:
Nit Comb: with a louse comb or fine-toothed comb to remove majority of infestation.
Petroleum jelly applied to hair/eyelashes for a up to 8 days may aid in mechanical removal of persistent nits.
Rx: Permethrin 1% or 5% (Nix) apply to infested area and wash off after 10 min, reapply in 7-14 days
Patient hygiene instructions: wash all clothes, clean/dispose of brushes, bedsheets, bathe regularly,
RTC if condition worsens, re-occurs or does not resolve in 10 days after Rx.
Refer to MO or PA
[EO 002] Scabies Classification:
Parasite
[EO 002] Scabies Patho:
Mite Infestation
[EO 002] Scabies Transmission:
Spread by skin-to-skin contact.
Indirect (via clothing/bedding)
Remain alive >2 days on clothing or bedding
[EO 002] Scabies Prevalence:
Epidemic in 3rd world countries.
Approx. 1/24 people worldwide
[EO 002] Scabies Incubation:
Onset of pruritus varies with immunity to mite.
1st infestation, about 21 days;
re-infestation, 1-3 days
[EO 002] Scabies Duration:
Weeks to months unless treated
[EO 002] Scabies Incubation period/Onset:
Acute
[EO 002] Scabies Hx Findings:
Pruritus. Symptoms in close contacts.
[EO 002] Scabies O/E:
Uncontrolled pruritus (intense widespread)
Often with minimal cutaneous findings apart from secondary excoriations.
Itching often interferes with or prevents sleep.
Often present in family members or troops living in close quarters.
Rash; ranges from no rash to generalized erythroderma
Gray or skin-colored ridges 0.50-1cm in length, either linear or wavy with a minute papule or vesicle at the end of the tunnel (burrow).
Pustules if secondary infection.
[EO 002] Scabies Location:
Commonly webspaces at hands, wrists, axillae, buttocks, waistline.
[EO 002] Scabies DDx:
Adverse cutaneous drug reaction
Atopic dermatitis
Contact dermatitis
[EO 002] Scabies Tx Plan:
Test: skin scraping for visual confirmation under microscope
PT Education: Treat spouse/sexual partner, children, anyone who has close physical contact. Pruritus often persists up to several weeks after successful eradication of mite infestation.
Refer to MO/PA, inform PMed
Rx: Permethrin 5% cream (Nix) to apply neck to toe, leave on for 8-12 hrs, then wash thoroughly. (Retreat in 1 week)
RTC if condition worsens or doesn’t improve
[EO 002] Eczema 3 Types:
Eczema – there are many etiologies and a wide range of clinical findings
Acute Eczema – characterized by pruritus, erythema and vesiculation
Chronic Eczema – characterized by pruritus, xerosis, lichenification, hyperkeratosis/scaling +/- fissuring
[EO 002] Eczema - Atopic Dermatitis (AD) Classification:
Hypersensitivity Reaction
[EO 002] Eczema - Atopic Dermatitis (AD) Patho:
IgE mediated/Hypersensitivity reaction.
[EO 002] Eczema - Atopic Dermatitis (AD) Transmission:
Genetic. 60% of adults with AD had children
with AD and 81% when both parents had AD.
[EO 002] Eczema - Atopic Dermatitis (AD) Prevalence:
7-15% of Scandinavian/German.
[EO 002] Eczema - Atopic Dermatitis (AD) Onset:
2-12mo: 60%
1-5 yr.: 30%
5yr – adult: 10%
[EO 002] Eczema - Atopic Dermatitis (AD) Duration:
Months or years (untreated)
[EO 002] Eczema - Atopic Dermatitis (AD) Hx Findings:
Family and/or personal Hx of AD.
Allergic rhinitis and/or asthma
[EO 002] Eczema - Atopic Dermatitis (AD) Eliciting Factors:
Skin dehydration (bathing/hand washing) inhalants, foods, skin barrier disruption, infections, season, clothing, emotional stress, sweating, pregnancy, menstruation, thyroid
[EO 002] Eczema - Atopic Dermatitis (AD) O/E:
Dry skin
Pruritus
In Acute cases: poorly defined erythematous patches, papules, and plaques +or- scale. Edema with widespread involvement; skin appears puffy. Erosions: moist, crusted.
In Chronic cases: lichenification; from repeated rubbing or scratching. Fissures: painful, especially in flexures, on palms, fingers, and soles. Alopecia from scratching and rubbing.
[EO 002] Eczema - Atopic Dermatitis (AD) Location:
Flexures, front and sides of neck, eyelids, forehead, wrists, and dorsa of the feet and hands. Generalized in severe cases
[EO 002] Eczema - Atopic Dermatitis (AD) DDx:
Seborrheic dermatitis
Irritant and allergic contact dermatitis
Psoriasis
Dermatophytosis (tineas)
[EO 002] Eczema - Atopic Dermatitis (AD) Tx Plan:
Tests: Bacterial and viral cultures: rule out herpes simplex virus in crusted lesions.
Blood work
Pt education:
Avoid exacerbating factors; avoid rubbing and scratching.
Use mild soaps, emollients PRN several times daily, barrier cream, wet compresses 20 mins 4-6/day (water, saline, Burrow’s)
Refer to MO/PA
Rx: Topical steroids; betamethasone (Betaderm) or hydrocortisone.
Rx: Diphenhydramine for difficulty sleeping due to pruritus
RTC PRN
[EO 002] Eczema - Contact Dermatitis - Irritant Contact Dermatitis (ICD) Classification:
Acute or chronic inflammatory reaction
[EO 002] Eczema - Contact Dermatitis - Irritant Contact Dermatitis (ICD) Patho:
Exposure of the skin to a chemical or other physical agents that can irritate the skin, acutely or chronically. Chronic cumulative exposure to one or more irritants.
[EO 002] Eczema - Contact Dermatitis - Irritant Contact Dermatitis (ICD) Transmission:
Chemical/Agent contact with skin.
[EO 002] Eczema - Contact Dermatitis - Irritant Contact Dermatitis (ICD) Prevalence:
Most common form of occupational skin disease (80%)
[EO 002] Eczema - Contact Dermatitis - Irritant Contact Dermatitis (ICD) Onset:
Immediate or delayed onset after exposure
[EO 002] Eczema - Contact Dermatitis - Irritant Contact Dermatitis (ICD) Duration:
Days/Weeks
[EO 002] Eczema - Contact Dermatitis - Irritant Contact Dermatitis (ICD) Hx Findings:
Application of a substance
Hx of atopic dermatitis
Possible mechanical irritation
Occlusion
[EO 002] Eczema - Contact Dermatitis - Irritant Contact Dermatitis (ICD) O/E:
Lesions
Sharply demarcated erythema and superficial edema
Range from erythema to vesiculation and caustic burn with necrosis
Burning, stinging, painful at site.
[EO 002] Eczema - Contact Dermatitis - Irritant Contact Dermatitis (ICD) Location:
The hands are the most affected area.
Cutaneous findings depend on contact with irritant
Lesions do not spread beyond the site of contact
[EO 002] Eczema - Contact Dermatitis - Irritant Contact Dermatitis (ICD) DDx:
Allergic Contact Dermatitis (ACD)
[EO 002] Eczema - Contact Dermatitis - Irritant Contact Dermatitis (ICD) Tx Plan:
Identify and avoid irritant. Wet compresses 20 mins 4-6/day (water, saline, Burrow’s) Vesicles/bullae may be drained, tops shouldn’t be removed.
Test: Patch test to rule out Allergic Contact Dermatitis
Pt Education: Avoid irritant; PPE (mask, goggles, gloves, apron), wash immediately after accidental exposures IOT neutralize. Avoid touching and scratching affected area.
Rx: Barrier creams, if occupational ICD persists despite adherence to preventative measures, change of job may be required.
Rx: Topical steroids; Betamethasone (Betaderm) or Hydrocortisone.
Refer to MO/PA
Rx: Diphenhydramine for difficulty sleeping due to pruritus
RTC if condition worsens or doesn’t improve
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Classification:
Cell-mediated hypersensitivity.
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Patho:
1st exposure will not result in lesions; however after the required amount of time for sensitization has passed subsequent exposures will result in ACD.
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Transmission:
Allergen Specific
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Prevalence:
Allergen Specific
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Onset:
48h to days after exposure
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Hx Findings:
A recent exposure to an allergen.
A previous exposure with a now increased response.
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) O/E:
Pruritus, stinging and pain.
Site of the eruption is limited to the site of exposure. However, it spreads beyond the actual site of exposure with increased sensitivity .
Acute: Well-demarcated erythema and edema, closely spaced vesicles, and/or papules; severe reactions: bullae, confluent erosions exuding serum, and crusts.
Sub-acute: plaques or mild erythema showing small, dry scales, sometimes with red, pointed or rounded, firm papules.
Chronic: plaques of lichenification, scaling with satellite, small, firm, rounded or flat-topped papules, excoriations, erythema, and pigmentary
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Location:
Depends of exposure
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Poison Ivy/Poison Oak/ Wild Parsnip Classification:
Toxicodendron/Rhus genus plants
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Poison Ivy/Poison Oak/ Wild Parsnip Pathology:
Urushiol creates a complex protein in the skin.
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Poison Ivy/Poison Oak/ Wild Parsnip Duration:
Indefinitely antigenic!
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Poison Ivy/Poison Oak/ Wild Parsnip Prevalence:
50% of people develop S/S. Severity varies.
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Poison Ivy/Poison Oak/ Wild Parsnip Onset:
Immediate: 4hrs-4days Sensitization after 7-10 days.
Re-exposure: 8 hours to 2 days.
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Poison Ivy/Poison Oak/ Wild Parsnip O/E:
Characterized by linear arrangement of erythema, papules, vesicles/bullae. Pruritus and edema.
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Poison Ivy/Poison Oak/ Wild Parsnip Location:
Depends on exposure. Military members often get this on ungloved hands, forearms, chest, abdomen, groin, knees from lying down in the dark.
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Poison Ivy/Poison Oak/ Wild Parsnip Tx Plan:
Wash kit separately from others. Avoid public washing machines. Use regular laundry detergent and hottest water possible.
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Poison Ivy/Poison Oak/ Wild Parsnip DDx:
Shingles (may appear to follow a dermatome) any CD
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) DDx:
Atopic dermatitis
Irritant Contact Dermatitis (ICD)
Seborrheic dermatitis
Psoriasis
Fixed drug eruptions
[EO 002] Eczema - Allergic Contact Dermatitis (ACD) Tx Plan:
Patch Test to verify allergen
Pt education: Identify and avoid allergen, to avoid touching and scratching. Wash area: Use mild soaps, Wet compresses 20 mins 4-6/day (water, saline, Burrow’s),
Vesicles may be drained; tops shouldn’t be removed.
Refer to MO/PA
Rx: emollients PRN several times daily, barrier cream in mild cases.
Rx: Topical steroids; Betamethasone (Betaderm) or Hydrocortisone.
Rx: Diphenhydramine for difficulty sleeping due to pruritus
RTC if condition worsens or doesn’t improve
[EO 002] Eczema - Seborrheic dermatitis Classification:
A chronic eczematous dermatitis associated with lipophilic yeast (pityrosporum ovale).
[EO 002] Eczema - Seborrheic dermatitis Patho:
Normal human cutaneous flora
[EO 002] Eczema - Seborrheic dermatitis Transmission:
Non contagious.
[EO 002] Eczema - Seborrheic dermatitis Prevalence:
Hereditary, stress increases flares,
HIV infected pers. 2-5% of population.
More common in males.
More common in winter/ less in summer
[EO 002] Eczema - Seborrheic dermatitis Incubation period/Onset:
Gradual onset.
Infancy (Within first month), puberty,
most between 20-50yrs or older.
[EO 002] Eczema - Seborrheic dermatitis Hx Findings:
Pruritus is variable, often increased with perspiration.
[EO 002] Eczema - Seborrheic dermatitis O/E:
Orange-red or grey-white sharply marginated macules or papules/patches or plaques with ‘greasy’ yellow-white scale.
Sticky crusts and fissures are common in the folds behind the ears.
On the scalp there is mostly marked scaling. Scattered, discrete on the face and trunk.
[EO 002] Eczema - Seborrheic dermatitis Location:
Scalp, hairy areas of face and trunk (sternal) and or behind ears.
Sub mammary
Umbilicus
Genitalia
[EO 002] Eczema - Seborrheic dermatitis DDx:
Mild psoriasis vulgaris,
Impetigo,
Tinea (capitis, corporis, versicolor, faciei)
[EO 002] Eczema - Seborrheic dermatitis Tx Plan:
Chronic disorders require initial and maintenance therapy.
Pt education;
Frequent cleansing with shampoo IOT to eliminate dirt and oil.
Dandruff: May improve in moist environment
Seborrhea: Discontinue aggravating factors and reduce stress.
Rx: 2.5% selenium sulfide shampoo/lotion (Selsun Blue) twice a week or as directed. Can be used on areas other than hair.
UV Radiation (sunlight)
Refer to MO/PA for Rx of corticosteroids (2.5% hydrocortisone)
RTC if condition worsens or doesn’t improve.
[EO 002] Psoriasis Classification:
Immune mediated disorder
[EO 002] Psoriasis Patho:
Abnormality of cell kinetics of keratinocytes, resulting in 28 X the production of epidermal cells.
[EO 002] Psoriasis Transmission:
Noncontagious. Hereditary
[EO 002] Psoriasis Prevalence:
1.5-2% of western population. Nonspecific to gender
[EO 002] Psoriasis Onset:
Usually age 20-30 and 50-60. (in children the mean age of onset is 8).
[EO 002] Psoriasis Hx Findings:
Chronic, recurring, scaling papules and plaques.
Family history
Trigger Factors: physical trauma is a major factor in eliciting lesions (rubbing and scratching), stress a factor in flares as high as 40% in adults and higher in children, infections, drugs and alcohol ingestion.
[EO 002] Psoriasis O/E:
Clinical presentation varies in individuals from presenting with only a few localized plaques or with generalized skin involvement. Lesion is sharply marginated erythematous papule (or dull-red plaques)with a silver-white scale. Scales are lamellar, loosely adherent, and easily removed by scratching.
[EO 002] Psoriasis Location:
Elbows, knees, sacral-gluteal region, scalp, palms/soles.
[EO 002] Psoriasis DDx:
Small scaling plaques: Seborrheic
Dermatitis, Tinea Corporis.
Large geographic areas: Tinea Corporis.
Scalp psoriasis; Seborrheic Dermatitis, Tinea Capitis.
Nails: Onychomycosis.
[EO 002] Psoriasis Tx Plan:
Refer to Dermatologist
Pt education; Avoid triggers (stress)
Refer to MO/PA (non self limiting)
Photo therapy (get sun… but avoid a sun burn!)
Trunk and extremities: Topical corticosteroid such as betamethasone.
Scalp mild: Medicated shampoos and lotions
Derm consult for additional topicals, phototherapy, oral agents, immunobiologics.
[EO 002] Acne Classification
Inflammatory / foreign body response
[EO 002] Acne Patho:
Inflammation of the pilosebaceous units of face and trunk.
[EO 002] Acne Transmission:
Non Contagious.
[EO 002] Acne Prevalence:
Very common, affecting approx. 85% of young people.
[EO 002] Acne Onset:
Puberty
[EO 002] Acne O/E:
Comedones (closed / open), pustules, papules, nodules, cysts
[EO 002] Acne DDx:
Folliculitis
Rosacea
Acne-like conditions (steroid acne, drug-induced acne)
[EO 002] Acne Possible Hx Findings:
Drugs; Lithium, glucocorticoids, oral contraceptives, androgens (testosterone).
Emotional stress.
Occlusion and pressure on the skin; very important and often overlooked exacerbating factor (acne mechanica)
Background scarring may be present (Face, neck, shoulders, chest back)
[EO 002] Acne Tx Plan (Mild Acne)
The goal is to remove the plug, reduce sebum production and treat bacterial colonization.
PT education; Advise no cure for acne, only treatment for lesions, wash BID with mild soaps,
Rx: Benzoyl peroxide gel 5% once daily or BID (Consult with MO/PA for long term Tx plan)
RTC PRN for booked appt
Refer to MO/PA for (Mild Acne) following suggested Rx :
MO Rx:Topical Antibiotics and Topical Retinoids
Refer to MO/PA for (Moderate to Severe Acne) following suggested Rx :
MO Rx: Oral antibiotics or Accutane
[EO 002] Seborrheic Keratosis Classification:
Suspicous Lesion
[EO 002] Seborrheic Keratosis Patho:
Proliferation of monomorphous keratinocytes and melanocytes
[EO 002] Seborrheic Keratosis Prevalence/Onset:
Hereditary, onset around age 30, vary from a few scattered lesions to hundreds
[EO 002] Seborrheic Keratosis Hx Findings:
Evolve over months to years, warty generally pigmented ‘stuck on’ greasy papules and plaques, rarely pruritic
[EO 002] Seborrheic Keratosis O/E:
(Isolated or generalized. Face, trunk, extremities.)
Early; Small 1-3mm, barely elevated, later a larger plaque with or without pigmentation. Surface has a greasy feel; often stippling texture like a thimble is noticeable with a hand-lens.
Late; plaque with warty surface and “stuck-on” appearance, “greasy”. Size 1-6cm, brown, gray, black, skin-coloured, round or oval.
[EO 002] Seborrheic Keratosis DDx:
Pigmented basal cell carcinoma or malignant melanoma
[EO 002] Seborrheic Keratosis Tx Plan:
Refer to MO/PA
[EO 002] Nevus (Mole) Classification
Suspicious Lesion
[EO 002] Nevus (Mole) Patho:
Proliferation of melanocytes within the epidermis, dermis or both
[EO 002] Nevus (Mole) Clinical Features:
Symptomatic, appear in childhood, some may arise in adulthood
[EO 002] Nevus (Mole) 3 Subtypes:
Junctional (melanocytic proliferation is intraepidermal)
Compound (melanocytic proliferation is both intraepidermal and dermal)
Dermal (melanocytic proliferation is intradermal)
[EO 002] Nevus (Mole) Specific Tests:
Apply the ABCDE’s
[EO 002] Nevus (Mole) DDx:
Solar Lentigo/Seborrheic Keratosis
Dysplastic Nevus
Melanoma
Pigmented Basal Cell Carcinoma
[EO 002] Nevus (Mole) Tx Plan:
Refer to MO/PA
In case of doubt when malignancy cannot be excluded, excise lesion with a narrow margin
[EO 002] Actinic Keratosis Classification:
Suspicious Lesion
[EO 002] Actinic Keratosis Patho:
Keratinocyte damage by UVR
[EO 002] Actinic Keratosis Prevalence:
Males
[EO 002] Actinic Keratosis Onset:
Months to years
[EO 002] Actinic Keratosis Hx Findings:
Habitually sun-exposed skin , Adult Pt
[EO 002] Actinic Keratosis O/E:
(Face, ears, neck, forearms, hands, shins and scalp)
Adherent hyperkeratotic scale, which is removed with difficulty and pain.
May be papular. Skin-coloured, yellow-brown, or brown; often there is a reddish tinge. Rough like sandpaper. Usually less than 1cm diameter, oval or round.
[EO 002] Actinic Keratosis DDx:
Seborrheic keratosis, flat warts, SCC, BCC
[EO 002] Actinic Keratosis Tx Plan:
Prevention: Sunscreen. Refer to MO/PA
[EO 002] Squamous Cell Carcinoma Classification:
Suspicious Lesion
[EO 002] Squamous Cell Carcinoma Prevalence:
Increased incidence with UVR, HPV, arsenic, tar, chronic heat exposure, chronic radiation dermatitis
[EO 002] Squamous Cell Carcinoma Hx Findings:
Non-healing generally slowly evolving keratotic or eroded papule/plaque/nodule; especially when occurring on sun damaged skin, on the lower lip, in areas of radiodermatitis or in old burn scars
[EO 002] Squamous Cell Carcinoma O/E:
Sharply demarcated solitary papules or plaques, which may be scaling or hyperkeratotic . Lesions are pink or red. Often asymptomatic but may bleed. May have small erosions and can be crusted.
[EO 002] Squamous Cell Carcinoma DDx:
Eczema, psoriasis, seborrheic keratosis
[EO 002] Squamous Cell Carcinoma Tx Plan:
Refer to MO/PA; surgical excision, cryosurgery
[EO 002] Basal Cell Carcinoma Classification:
Suspicious Lesion
[EO 002] Basal Cell Carcinoma Prevalence:
> Than 400, 000 new cases/year in USA
rare in brown or black skinned persons.
[EO 002] Basal Cell Carcinoma Hx Findings:
> 40 yrs. Male > Female, Caucasian. Heavy sun exposure in youth or x-ray therapy for acne increases risk for BCC.
[EO 002] Basal Cell Carcinoma O/E
Nodular, ulcerating, sclerosing, superficial multicentric or pigmented subtypes.
[EO 002] Basal Cell Carcinoma DDx:
If pigmented type – melanoma
If nodular or superficial multicentric type – SCC
If ulcerated type – other ulcer etiologies
[EO 002] Basal Cell Carcinoma Tx Plan:
Refer to MO/PA
[EO 002] Melanoma Classification:
Suspicious Lesion
[EO 002] Melanoma Patho:
Malignant transformation of melanocytes
[EO 002] Melanoma Prevalence:
Lifetime risk is 1-50
[EO 002] Melanoma Incubation period/Onset:
Epidemiologic studies demonstrate a role for genetic predisposition and sun exposure in melanoma development. Melanoma is among the most common type of cancer in young adults
[EO 002] Melanoma Hx Findings/Risk factors:
Genetics
Light/fair skin
Family history of dysplastic nevi or melanoma
Personal history of melanoma
UV radiation
Number and size of melanocytic nevi
Congenital nevi
Dysplastic nevus syndrome
[EO 002] Melanoma O/E:
Apply the ABCDE’s
[EO 002] Melanoma DDx:
Seborrheic Keratosis
Pigmented BCC
Melanocytic Nevus/Dysplastic Nevus
Hemangioma
[EO 002] Melanoma Tx Plan:
Refer to MO/PA; Biopsy and surgical tmt.
[EO 002] Melanoma Recognition ABCDE’s Rule:
Six Signs of Malignant Melanoma (ABCDE Rule)
Asymmetry: in shape – One-half unlike the other half.
Border: is irregular-edges irregularly scalloped, notched.
Color: is not uniform; mottled-haphazard display of colors; all shades of brown, black, gray, blue, red and white.
Diameter: is usually large-greater than the tip of a pencil eraser ( 6 ;mm).
Evolution: A history of an increase in the size of lesion is one of the most important signs of malignant melanoma.
[EO 002] Sunburn Patho:
An acute, delayed and transient inflammatory response of normal skin after exposure to ultraviolet radiation or artificial s
[EO 002] Sunburn Clinical Features:
Characterized by erythema, and if severe, by vesicles and bullae, edema, tenderness and pain. Strictly confined to areas of exposure (can occur in areas covered with clothing depending on the degree of UV transmission through fabric). In severe cases, the patient may exhibit weakness, lassitude and a rapid pulse.
[EO 002] Sunburn Management:
Topical – cool wet compress and topical corticosteroids
Systemic – NSAIDs
*If very severe, patient may require hospitalization for fluid replacement and prophylaxis of infection
[EO 002] Ingrown Toenail (Onychocryptosis) Patho:
Nail edges that curve and grow into the surrounding tissues.
Soft tissue that has been penetrated becomes irritated and inflamed.
[EO 002] Ingrown Toenail (Onychocryptosis) Prevalence:
Predominant between 10-30yrs of age.
[EO 002] Ingrown Toenail (Onychocryptosis) Onset:
Chronic
[EO 002] Ingrown Toenail (Onychocryptosis) Hx Findings:
Heredity
Improper trimming
Trauma
Toe crowding in footwear
[EO 002] Ingrown Toenail (Onychocryptosis) O/E:
Localized pain of the soft tissue surrounding the toenail.
Tenderness.
Erythema
Inflammation
Abscess formation may also be present.
Possible signs of infection.
Toe box of usual footwear may be confined.
Shoes may be improper size.
[EO 002] Ingrown Toenail (Onychocryptosis) Location:
Usually the big toes
[EO 002] Ingrown Toenail (Onychocryptosis) DDx:
Localized Cellulitis
[EO 002] Ingrown Toenail (Onychocryptosis) Tx plan:
Non-surgical TMTs; If infection is not present at the time of presentation, elevation of nail and place cotton or a splint between nail and fold or apply a nail brace.
Pt Education: Cut nails straight across; allow corners of nails to extend beyond the skin and stretch skin folds daily. Avoid tight footwear.
Rx: Epsom foot baths may reduce pain and swelling.
Rx: Analgesics PRN
Rx: Topical Polysporin TID x 7days
Refer to MO/PA for surgical Tx (remove a small spicule of the nail or a nail recession.)
Refer to MO/PA for referral to Specialist(Podiatrist)
RTC if condition worsens or doesn’t improve.
[EO 002] Define Alopecia:
The loss of some or all hair in an area.
[EO 002] Define Bulla:
A circumscribed elevated superficial cavity containing fluid.
[EO 002] Define Edema:
Swelling caused by excess fluid trapped in the body’s tissues.
[EO 002] Define Erythema:
Flushing of the skin due to the dilation of blood capillaries in the skin
[EO 002] Define Erosion:
An eating away of a surface due to physical or chemical process including those associated with inflammation.
[EO 002] Define Excoriation:
Lesions caused by scratching or picking at skin.
Areas where the skin has been scraped off or abraded
[EO 002] Define Carbuncle:
Clusters of furuncles connected subcutaneously, causing deeper suppuration and scarring.
[EO 002] Define Comedones (open):
Blackheads
[EO 002] Define Comedones (closed)
Whiteheads
[EO 002] Define Crusting:
Varying colors of liquid debris (serum or pus) that has dried on the surface of the skin.
[EO 002] Define Follicultis:
Red papule or pustule may be present around hair
[EO 002] Define Fissure:
A linear cleavage of skin, often extending into dermis. Often from cracked dry skin.
[EO 002] Define Furuncle:
(Boils) are skin abscesses caused by staphylococcal infection, which involve a hair follicle and surrounding tissue
[EO 002] Define Induration:
Dermal thickening that clinically presents as skin that feels thicker and firmer than normal.
[EO 002] Define Lichenification:
Epidermal thickening with exaggeration of the normal creases.
[EO 002] Define Necrosis:
The death of some or all of the cells in an organ or tissue, caused by disease, physical or chemical injury or interference with the blood supply.
[EO 002] Define Papule:
A palpable solid lesion elevated above (rather than deep within) the plane of the surrounding skin (< 10 mm).
[EO 002] Define Plaque:
A palpable solid lesion elevated above (rather than deep within) the plane of the surrounding skin ( > 10 mm).
[EO 002] Define Pruritus:
Itching sensation in the skin
[EO 002] Define Scaling:
Any of the flakes of dead epidermal cells shed from the skin
[EO 002] Define Suppuration:
The formation of pus.
[EO 002] Define Vesicle:
A circumscribed elevated superficial cavity containing fluid.
