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NURS 502 > Exam 2 - Dermatology (need to know) > Flashcards

Exam 2 - Dermatology (need to know) Flashcards

1
Q

What is keratosis pilaris?

A

Common finding on the extensor aspects of extremities (posterior upper arms, anterior thighs), buttocks, and cheeks

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2
Q

What does keratosis pilaris look like?

A

“Chicken skin”

  • Small bumps at the hair follicle (stratum corneum)
  • Occasional diffuse eruption with small sterile pustules
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3
Q

Keratosis pilaris risk factors

A
  • Children with atopic disorders
  • Living in cold, dry climates
  • Common in winter months
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4
Q

Keratosis pilaris management
- Mild cases

A

Lubricants and emollients to moisturize skin

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5
Q

Keratosis pilaris management for patients with (+) folliculitis

A

Antibiotics active against s. aureus

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6
Q

If patients would like topical treatment for keratosis pilaris, what can be prescribed?

A

Topical keratolytics combined with lactic acid 12%, salicylic acid, urea creams, retinoids, and lubricants applied several times a day

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7
Q

Keratosis pilaris patient education

A

Chronic condition but benign

  • Treatment takes weeks to months and recurrence common
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8
Q

What is tinea pedis?

A

Athlete’s foot

  • Superficial fungal skin infection found on the feet
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9
Q

What are the three clinical forms of tinea pedis (athlete’s foot)?

A
  1. Vesicles and erosions on instep of one or both feet
  2. Occasional fissure between toes with surrounding scale and erythema
  3. Rare diffuse scaling on weight bearing surface of foot with exaggerated scaling increases often extending to lateral foot margins
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10
Q

What organisms cause tinea pedis (athlete’s foot)?

A

T. rubrum, t. mentagrophytes

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11
Q

Tinea pedis (athlete’s foot) risk factors

A

Uncommon in preadolescence; more common in males

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12
Q

Tinea pedis (athlete’s foot) mode of transmission

A

Direct contact with contaminated surfaces (warm moist environment of showers and locker room floors)

  • Often occurs with tinea cruris (jock itch)
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13
Q

Tinea pedis (athlete’s foot) HPI components

A
  • Sweaty feet
  • Use of nylon socks or non breathable shoes
  • Exposure in family or at school
  • Itching, intense burning, stinging, foul odor
  • Microtrauma to feet
  • Contact with damp areas
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14
Q

Tinea pedis (athlete’s foot) physical exam

A
  • Red, scaly, cracked rash on soles or interdigital spaces (especially between third, fourth, fifth toes)
  • Infection initially presents as white peeling lesions becoming erythematous, vesicular, macerated, fissured, scaly
  • Dorsum of foot remains clear
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15
Q

Are diagnostic tests required for tinea pedis (athlete’s foot)?

A

If treatment failure or questionable diagnosis occurs

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16
Q

If diagnostic testing is indicated for tinea pedis, what tests/labs should be performed?

A
  • KOH treated scrapings of border of lesion reveal hyphae and spores
  • Wood’s lamp will fluoresce
  • Fungal culture
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17
Q

Tinea pedis management

A

Antifungal medication (miconazole, clotrimazole) applied 1 cm beyond border of rash twice daily until 7 days after clearing

  • Usual treatment is 3-6 weeks
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18
Q

What anatomic regions should class I and IV topical corticosteroids never be used?

A

Face, genitals, breasts, axillae

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19
Q

Class I topical corticosteroid examples

A

Superpotent

  • Clobetasol propionate
  • Betamethasone dipropionate
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20
Q

Class II topical corticosteroid examples

A

Potent

  • Mometasone furoate
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21
Q

Class III topical corticosteroid examples

A

Upper mid-strength

  • Fluticasone propionate
  • Halcinonide
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22
Q

Class IV topical corticosteroid examples

A

Mid-strength

  • Triamcinolone
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23
Q

Class V topical corticosteroid examples

A

Lower mid-strength

  • Hydrocortisone valerate 0.2%
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24
Q

Class VI topical corticosteroid examples

A

Mild

  • Desonide
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25
Q

Class VII topical corticosteroid examples

A

Least potent

  • Hydrocortisone 2.5%, 1%, 0.5%
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26
Q

Topical corticosteroid adverse effects

A
  • Hypo-pigmentation
  • Striae
  • Tissue atrophy
  • Telangiectasia
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27
Q

Usual duration of therapy with high potency topical corticosteroids

A

<2 weeks

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28
Q

What is the most common type of eczema?

A

Atopic dermatitis

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29
Q

What is atopic dermatitis?

A

Pruritic inflammatory skin disorder characterized by exacerbations and remissions of dry and itchy red skin

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30
Q

Is atopic dermatitis associated with other atopy conditions?

A

Yes - asthma, allergic rhinitis, urticaria, acute reactions with food

31
Q

Pathophysiology of atopic dermatitis

A
  • Family or personal history of atopy
  • Xerosis or dysfunction of skin barrier
  • IgE reactivity
32
Q

Atopic dermatitis clinical manifestation

A

Pruritic, erythematous, dry patches, often scaling, linear excoriations, crusting, oozing, well defined skin marking (lichenification)

33
Q

Where does eczema present in infants?

A

Cheeks, scalp, forehead, extensor extremities

34
Q

Where does eczema present in adults?

A

Face, neck, flexural folds, wrists, dorsal of feet

35
Q

Non pharmacological treatment for eczema

A
  • Wear soft cotton clothing
  • Maintain cool temperature
  • Use of cool mist humidifier
  • Wash with mild detergents
  • Moisturize (aquaphor)
  • Hydration with tepid water bath
  • Avoid known triggers
36
Q

Pharmacologic treatment of eczema

A
  • Mild to moderate topical corticosteroid (hydrocortisone 1%, triamcinolone 0.1%) to control inflammation
  • Nonsteroidal topical calcineurin inhibitors (tacrolimus) - chronic moderate to severe eczema
  • Antihistamines (benadryl, hydroxyzine) - control pruritus
    • Loratidine (claritin) for daytime use
37
Q

Bacteria that commonly causes superinfection with eczema

A

Group A beta hemolytic strep and staph

38
Q

Treatment of superinfection with eczema

A
  • Cephalexin (Keflex)
  • Dilute bleach baths - quarter cup to half cup regular strength bleach per 1 full bathtub of water twice weekly
  • Intranasal mupirocin
39
Q

What is the most frequent contact dermatitis seen in children and one of the most common skin disorders in infants?

A

Diaper dermatitis

40
Q

Diaper dermatitis clinical manifestation

A
  • Chapped
  • Shiny
  • Erythematous
  • Parchment-like skin with possible erosions on convex surfaces
  • Creases spared
41
Q

Candidiasis (in diaper area) clinical presentation

A
  • Shallow pustules
  • Fiery-red scaly plaques on convex surfaces, inguinal folds, labia, scrotum
42
Q

Diaper dermatitis treatment

A
  • Frequent diaper changes (q1-2h)
  • Gentle cleansing
  • Greasy lubricant
  • Sitz bath, air dry
  • Hydrocortisone 0.5-1% for inflammation
43
Q

What is seborrheic dermatitis?

A

Chronic inflammatory dermatitis

  • Infants - cradle cap
  • Adolescence - dandruff
44
Q

Seborrheic dermatitis clinical manifestation in infants

A
  • Erythematous, flaky to thick crusts of yellow, greasy (waxy appearance) scales
  • Mostly on scalp, but also face, behind ears, neck, trunk, diaper area
45
Q

Seborrheic dermatitis clinical manifestation in adolescence

A
  • Mild flakes with some erythema and yellow, greasy scales on scalp, forehead, nasal bridge, eyebrows
46
Q

Is seborrheic dermatitis itchy?

A

Not pruritic and no pustules

47
Q

Three main pharmacological agents used to treat seborrheic dermatitis

A
  • Antifungals: -azoles
  • Anti inflammatory: topical corticosteroids
  • Keratolytic (remove excess scales): salicylic acid
48
Q

Seborrheic dermatitis treatment in infants

A

Usually self-limiting in first year of life

  • Mineral oil 5-10 minutes before shampooing
  • Remove scales with toothbrush/soft brush
  • Frequent washing with mild shampoo
49
Q

Seborrheic dermatitis treatment in adolescence

A

Facial dermatitis - ketoconazole 2% topical, low potency topical corticosteroid

Scalp dermatitis - medicated shampoo (tar, ketoconazole, salicylic acid, selenium sulfide), topical corticosteroid

50
Q

Rosacea risk factors

A
  • Ages 30-50 years
  • Females (but more severe in men)
51
Q

Rosacea often coexists with ___ and can closely mimic it

A

Acne vulgaris

  • Comedones do not occur with rosacea
52
Q

What are the four types of rosacea?

A
  • Erythematotelangiectatic
  • Papulopustular
  • Phymatous
  • Ocular (medical emergency)
53
Q

Pathophysiology of rosacea

A

Immune-mediated inflammation

54
Q

Rosacea clinical manifestation

A
  • Flushing
  • Facial erythema
  • Inflammatory papules and pustules
  • Telangiectasia
  • Edema
  • Watery or irritated eyes
55
Q

Erythematotelangiectatic and papulopustular rosacea treatment

A

Topical: metronidazole, azelaic acid, sulfacetamide/sulfur

Oral: doxycycline, tetracycline

56
Q

Phymatous rosacea treatment

A

If mild, same as papulopustular (+ ivermectin)

If severe, refer to derm for laser, cryotherapy with isotretinoin, or topical tacrolimus

57
Q

Non pharmacologic management of rosacea

A
  • Mild emollient cleanser with light non greasy moisturizer
  • Neutral pH facial cleanser
58
Q

What is seborrheic keratosis?

A

Most common benign non-melanocytic skin lesion on the body

59
Q

How does seborrheic keratosis present?

A
  • Waxy or verrous appearing papules or plaques that have a “stuck on” appearance on the skin
  • Varies in color
  • Anywhere on body but spares palms and soles
60
Q

Is treatment for seborrheic keratosis warranted?

A

Mostly for cosmetic reasons

  • Cryotherapy
  • Curettage
  • Shave biopsy
61
Q

Pathophysiology of herpes zoster (shingles)

A

Dermatologic eruption caused by reactivation of the varicella-zoster virus that follows, sometimes decades, a primary varicella zoster (chicken pox) infection

62
Q

Herpes zoster (shingles) presentation

A
  • Prodrome of pain, dysesthesia, pruritus
  • Vesicular eruption in unilateral dermatomal distribution
  • Pain (stabbing, burning, aching, excruciating); can progress to postherpetic neuralgia
63
Q

Herpes zoster (shingles) risk factors

A
  • Increasing age
  • Immune suppression
64
Q

Herpes zoster (shingles) transmission

A
  • Contact
  • Air
  • Contagion possible once rash appears and continues until crusted over
65
Q

Pharmacologic therapy of herpes zoster (shingles)

A

Antiviral therapy (-cyclovir) for 7-10 days within 72 hours of rash onset

Oral corticosteroids (prednisone) for pain

66
Q

Preventative therapy of herpes zoster (shingles)

A

Shingrix for people >50 years old

67
Q

Herpes zoster (shingles) patient education

A
  • Keep rash dry and clean
  • Avoid topical antibiotics, dressings with adhesives, clothing that may be irritative
68
Q

Roseola transmission method

A

Respiratory droplets

69
Q

Roseola infectivity period

A

From onset of exposure until 3 days after fever abates

70
Q

Roseola incubation period

A

HHV-6 is 5-15 days, HHV-7 unknown

71
Q

Roseola clinical presentation

A
  • Primarily seen in infants
  • Abrupt high fever 3-7 days that abates followed by abrupt onset of rash that begins at the trunk and spreads to extremities
  • Spares the face
72
Q

Roseola rash characteristics

A

Rose-pink maculopapular rash

73
Q

Roseola treatment

A
  • Acetaminophen (or NSAIDs if >6 months) for fever
  • Adequate hydration

NURS 502 (43 decks)

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