examination of the skin Flashcards
when looking at a rash, try to determine if it came from ______
outside or inside
if you don’t know what the cells are in a lesion, what should you do?
biopsy
what would biopsy of an outside lesion show?
abnormal stratum corneum, inflammatory cells in the epidermis and sometimes blister – clinically this looks like red, scaley skin ± blister
keys to an outside rash (4)
scaley red thickened skin
Straight lines
Geometic shapes
Spares folds
biopsy of an insider lesion
biopsy – scattered inflammatory cells in the dermis – clinically this looks red – the epidermis is unaffected (no inflammatory cells, no change in stratum corneum, no blisters)
clinical appearance of an inside lesion
clinically flat and smooth – this type of eruption comes from the inside and therefore does not spare folds or have sharp cutoffs –
what can cause an inside rash? (4)
drug eruptions
Rocky Mountain Spotted Fever
Meningococcemia
Hepatitis
what are the keys to an inside lesion?
flat
Does not spare folds
No straight lines
No sharp cutoffs
older skin, particulary on sun exposed area is: TDSB
Thinner
Dryer
Scaley
Bruises more easily
t/f. Almost all aging of the skin is due to photoaging
true
very common benigh lesion tan to pigmented waxey plaques – looks like someone threw mud against a wall
seborrheic keratosis
benigh flesh colored tags usually located in the axilae, sides of the neck and under the breasts
skin tags
benign – red papules and nodules made up of blood vessels
cherry angiomas
dome shaped nodule usually with a hyperpigmented border – feels like a “BB” under the skin
Dermatofibroma
large blue vascular lesion on the lower lip – compressible – benign
venous lake
keratotic horn shaped projection produced by multiple causes such as warts, seborrheic keratoses, and squamous cell carcinoma – must biopsy base for diagnosis
cutaneous horn
due to lower leg swelling-the lower leg is scaley and red
diagnose edema by pressing with finger on the anterior tibial area for 10 seconds – if there is an indentation when you let up – then the patient has edema progression from scaley red to erosions to ulcers without treatment –
ulcers heal with large scars so you can tell a person has had a stasis induced leg ulcer
long term edema and stasis dermatitis can have a brown-orange deposition called hemosiderin
stasis dermatitis
– with aging, nails can become thick, yellow and hard to cut – difficult to distinguish normal aging vs fungal infection – need to culture for fungus
nail description
normal variant of aging – unusually long difficult to cut nails
Onychogryphosis –
black, necrotic area on distal extremities – finger, toes due to something circulating and hammering into vessels of distal extremities – can be due to infectious agent, cholesterol, cancer – need to find cause
infarcts
flat – discolored spot on skin not raised above the surface
macular
small blister contains serous fluid
Vesicle –
pus filled blister
pustule
large bump – greater than 4mm
nodule
well defined elevated area of skin
plaque
scaley, red macules, papules or plaques commonly seen on the elbows and knees
Psoriasis –
– red, scaley rash found on posterior neck, popliteal and antecubital fossae
Atopic dermatitis
multiple scaley, red, oval plaques commonly begins with a single lesion (herald patch) and then days to weeks later multiple lesions develop – lesions are in cleavage lines and have Christmas tree distribution – some lesions have trailing scale (the scale trails behind the edge of the lesion) – usually only on trunk
Pityriasis rosea –
– similar lesions as pityriasis rosea but effects the palm and soles - check RPR
Secondary syphilils
scaley rough lesions on long term sun exposed skin – 1/1000 turn into squamous cell carcinoma
Actinic keratoses –
round pearly lesions with telangicctasias (small blood vessels) – due to long term sun exposure – spreads wide and deep but rare to metastasize
Basal cell carcinoma
Due to long term sun exposure and arising in sun exposed skin acts like a basal cell carcinoma. Keratotic nodule with firm base usually begins as an actinic keratosis and becomes a ____________
squamous cell carcinoma
On non-sun-exposed areas __________ is more likely to metastasize.
squamous cell carcinoma
ABCD of melanoma
Asymmetry
Border irregularity
Color (variations within a single lesion)
Diameter-greater than 6 millimeters
what is RPR?
which is a blood test for syphilis-always positive in secondary syphilis.
The main thing to remember about melanoma is that any ________ in appearance of a pigmented lesion is a clue that it might be malignant. The
change
. The lesion must undergo at least _______ growth for the patient to notice it.
30%
t/f. Increased educational status correlates with increased risk of developing melanoma.
true
lifetime risk of melanoma in men? women?
Lifetime risk of melanoma: Men 1:36; Women 1:55
increase in risk of melanoma
Over the past 40 years people aged 18-39 - 800% increase in young women; 400% in young men.
what are three clues that a rash is getting better?
decreased redness, desquamation, wrinkling
redness clue
If the redness decreases (goes from bright to dull to light red), the rash is getting better.
what does desquamation tell you about a rash?
The skin peels off in sheets. It tell us that the rash is getting better
and the skin was previously red
what does wrinkling tell you about a rash?
This tells you the swelling and inflammation has gone down and wrinkled
the skin, thus the rash is better today than it was yesterday
