Exam 1

Question 1

Primary Skin Lesions

Answer 1

Arise de novo in the skin Represents initial cutaneous pathologic changes Uncomplicated lesions Uninfluenced by secondary alterations- Progression of the disease; Scratching; Infection

Question 2

Macule

Answer 2

circumscribed change in skin color without elevation or depression of the surface; < 1 cm in diameter  Examples: erythema; purpura; café au lait; vitiligo; freckles; flat moles (nevi); petechiae; measles; scarlet fever

Question 3

Patches

Answer 3

a flat, nonpalpable irregular shaped macule > 1 cm in diameter  Examples – Vitiligo; port-wine stains; Mongolian spots; café au lait patch

Question 4

Papules

Answer 4

solid, elevated circumscribed area < 1 cm in diameter  Implies pathologic involvement of:  Epidermis – especially if there is scaling or disturbance of the normal surface of the epidermis  Dermis – usually epidermal surface is normal but redness is present Examples – warts; molluscum contagiosum; lichen planus; elevated moles (nevi)

Question 5

Nodules

Answer 5

solid, elevated circumscribed area similar to a papule but 1 to 2 cm in diameter and deeper in the dermis with visible elevation of the skin  Implies pathologic involvement of Epidermis o may be associated with scale, erosion, and loss of skin markings • or Dermis o May be fluctuant (e.g. cyst) or firm (e.g. skin cancer) • Examples – cyst; basal cell carcinoma; erythema nodosum; lipoma

Question 6

Tumors

Answer 6

elevated and solid lesion  may or may not be clearly demarcated  deeper in dermis  > 2 cm in diameter  Examples – neoplasms, benign tumors. lipomas

Question 7

Plaques

Answer 7

elevated, firm, and rough lesion with flat top surface > 1 cm in diameter  evolve from a confluence of papules  Only slightly elevated relative to their large surface area  Examples – psoriasis, urticaria, mycosis, fungoides, seborrheic and actinic keratoses

Question 8

Vesicle

Answer 8

elevated, circumscribed, superficial, not into dermis  filled with serous fluid  < 1 cm in diameter  Examples – varicella (chicken pox); herpes zoster (shingles); pemphigus; pemphigoid

Question 9

Bullae

Answer 9

vesicle > 1 cm in diameter  May evolve within the epidermis in which case the fluid is usually clear serous  Lesions may be flaccid and break easily (thin roof)  May evolve at the DEJ (thick roof) – lesions are tense may contain hemorrhagic fluid. Less likely to rupture.  Examples – blister; pemphigus vulgaris

Question 10

Pustule

Answer 10

elevated, superficial lesion; similar to vesicle but filled with purulent fluid.  Examples – acne vulgaris, folliculitis, impetigo

Question 11

Cyst

Answer 11

Elevated, circumscribed, encapsulated lesion; in dermis or subcutaneous layer; filled with liquid or semi-solid material.  Examples - sebaceous cyst, cystic acne

Question 12

Wheals

Answer 12

 Special type of plaque  A slight elevation caused by movement of fluid out of blood vessels  Elevated, irregular-shaped area of cutaneous edema  Solid, transient, variable diameter  Examples – insect bites, allergic reaction, urticaria (hives)

Question 13

Petechiae

Answer 13

pinpoint, nonraised, round, purplish red spots caused by intradermal of submucous hemorrhage

Question 14

Purpura

Answer 14

Small hemorrhages in the skin, or mucous membranes

Question 15

Ecchymoses

Answer 15

a hemorrhigic spot in the skin or mucous membrane forming a nonelevated, rounded or irregular, blue or purplish patch.

Question 16

Telangiectasias

Answer 16

fine, irregular, red lines produced by capillary dilation

Question 17

Arrangement of lesions

Answer 17

Isolated- MelanomaScattered- Pityriasis rosea, drug eruptionHerpetiform (Grouped vesicles)Zosteriform (dermatomal)Annular (Ring)LinearReticular

Question 18

Distribution of lesions

Answer 18

-Generalized-Acral (Affecting extremities)-Intertriginous (apposed skin surfaces)-Palms and Soles-Lower Extremities-Extensor-Flexor-Circumscribes-Truncal-Hair Bearing-Mucus Membranes-Sites of pressure-Sites of trauma-Unilateral-Follicular

Question 19

Secondary Skin Lesions

Answer 19

o Evolve from the preceding visible lesionso Changes occur because of: Progression of the disease Scratching (trauma) Infection Therapieso These may coexist with primary lesionso Some overlap exists with primary lesions

Question 20

Scales

Answer 20

flakes composed of aggregates of shedding epidermal cells. Secondary Lesion

Question 21

Crusts

Answer 21

-masses that result from drying exudates of serum, blood, sebum, or purulent material-Develop after vesicles or bullae break down to release their content. -Secondary Lesion

Question 22

Ulcers

Answer 22

Loss of epidermis and dermis; concave; varies in size and depth-Area of skin where skin layers are missing

Question 23

Fissures

Answer 23

-Linear crack or break from the epidermis to the dermis; may be moist or dry-Area of skin where skin layers are missing

Question 24

Exoriations

Answer 24

-Loss of the epidermis; linear hollowed-out, crusted areas-Area of skin where skin layers are missing

Question 25

Erosions

Answer 25

-Loss of part of the epidermis; depressed, moist, glistening; follows rupture of a vesicle or bulla.-Area of skin where skin layers are missing

Question 26

Lichenification

Answer 26

• an area of skin that is thickened• increased prominence of skin lines• Often caused by scratching

Question 27

Scars

Answer 27

– indicate deep involvement or trauma, with subsequent repair that incompletely restores normal skin architecture.-Secondary Skin Lesion.

Question 28

Keloids

Answer 28

• Hypertrophic Scars-Secondary Skin Lesion

Question 29

Atrophy

Answer 29

-of epidermis or dermis most often appears as depressions below the level of the surrounding skin. Ex: Stretch marks-Secondary Skin Lesion

Question 30

Antihistamines

Answer 30

Certirzine (Zyrtec)Loratadine (Claritin)lack sedationonce daily

Question 31

Antihistamine - Alternatives

Answer 31

Hydroxyzine (Atarax)Diphenhydramine (Benadryl)

Question 32

Antipruritic Agent

Answer 32

camphormentholphenol

Question 33

Group 1 (Superpotent) Corticosteroid

Answer 33

clobetasol use for: psoriasis, hand eczemanot for face or intertriginous areas - limit use 14 days

Question 34

Group 2 & 3 Corticosteroid

Answer 34

fluocinonideuse for: atopic dermatitis - adultsnot for face, skin folds, - limit use 14-21 days

Question 35

Group 4 & 5 Corticosteroid

Answer 35

triamcinoloneuse for: atopic dermatitis - kidslimit use in skin folds - limit use to 7-21 days

Question 36

Group 6 & 7 Corticosteroid

Answer 36

rx: desonide; otc: hydrocortisoneeyelid dermatitis, atopic dermatitis in young children, Seborrheic dermatitisreevaluate if no response within 28 days, avoid long-term continuous use

Question 37

Intralesional Corticosteroids

Answer 37

Plaques of psoriasisPrurigo nodulesInflamed cystsLocalized patches of alopecia areataKeloid formation

Question 38

Immunomodulators

Answer 38

atopic dermatitisPimecrolimus - elidel (mild to moderate)Tacrolimus - protopic (moderate to severe)

Question 39

Topical Antibiotics

Answer 39

acne vulgaris and rosaceaClindamycinErythromycinMetronidazoleminor skin problems - impetigomupirocin (bactroban ointment)

Question 40

Antiseptic Cleaners

Answer 40

Providone Iodine (Betadine)Hexachlorophene (pHisoHex)Chlorhexadine gluconate (Hibiclens)

Question 41

Oral Systemic Antibiotics

Answer 41

Uses: bacterial skin infections, acne vulgaris, rosacea, hidradenitis suppurativa, folliculitistetracycline family (minocycline, doxycycline)erythromycin

Question 42

Topical Antifungal

Answer 42

Tinea pedis (excluding onychomycosis)Tinea corporisTinea crurisTinea versicolorSeborrheic dermatitis

Question 43

Systemic Antifungal

Answer 43

Tinea corporisTinea capitis - GriseofulvinOnychomycosisfungal infections in HIV patientsTerbinafine (Lamasil) & Itraconazole (Sporanox) useful for onychomycosisFluconazole (Diflucan) - dermatophytes, thrush, vaginal candidiasis

Question 44

Antiviral

Answer 44

Herpesvirus infectionsHerpes zosterAcyclovir (Zovirax)Valacyclovir (Valtrex)Famciclovir (Famvir)Topical Agents for recurrent HSV: Penciclovir (Denavir), Acyclovir (Zovirax)