Geriatric skin Conditions Flashcards by tcarlso 3

What happens to lipid content of the skin with aging? What are the effects of this? (2)

Decreased:

Drier and rougher
Decreased barrier function

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With aging, the interdigitations of the dermis/epidermis flatten. What are the 4 major results of this?

Reduced contact between epidermis and dermis
Decreased nutrient transfer
Increased skin fragility
Easy bruising

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What accounts for the slower wound healing of old people?

Slower turnover of epidermal cells

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What is the effect of reduced numbers of langerhans cells with aging?

Decreased immune surveillance

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What causes the wrinkling with aging (2)?

Loss of elastin

- Decrease in ground substance (collagen, elastin etc)

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What causes the decreased hair density with aging?

Shortened duration of anagen, and increased duration of telogen (resting phase)

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What are the two UV rays that cause the most damage?

UVA and UVB

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What are the signs of photodamaged skin?

Mottling
Hyperpigmentation
Telangiectasias

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What are the drugs that are proved to reduce wrinkling?

Retinoids–topical tretinoin at high concentration for long periods

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What are the three main effects of topical retinoids on the skin?

Increases thickness of superficial skin
Reduces pigment changes
Increases collagen synthesis

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What is the concept behind derm surgeries?

damage epidermis to allow for dermis to heal again in a better fashion

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What is seborrheic dermatitis? Where on the body is it usually found? s/sx?

Erythematous, greasy, peely dandruffy type of condition that often occurs in the hairline or nasolabial folds. Sometimes pruritic.

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What disease is seborrheic dermatitis more common in?

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True or false: seborrheic dermatitis is only an acute condition

False–chronic, incurable condition, but can easily be controlled

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What is the treatment for seborrheic dermatitis?

Mild topical corticosteroids for acute phase, then medicated shampoos that act against yeast

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What is rosacea? What part of the body is it usually found on?

Diffuse erythema and erythematous papules on the face, forehead, and chin

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What happens to the nose with Rosacea?

Rhinophyma

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What ages are affected with rosacea?

all ages

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What is the common symptom of rosacea?

Recurrent facial flushing

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What is the cause of rosacea?

Idippathic

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What is the treatment for rosacea?

Avoid irritants
oral Abx for flares
topical abx for mild cases

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What is the treatment for refractory rosacea?

oral isotretinoin

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What is the treatment for the erythema and telangiectasias seen with rosacea?

Lasers!!

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What is xerosis?

Dryness of the skin

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What is eczema craquele?

Dry, erythematous fissured skin that is itchy

What condition do you get on your hands every year? What causes it?

Eczema craquele You're way too dry

What is the treatment for eczema craquele?

Wet it and avoid hot showers

What is an emollient?

Moisturizing agent

What is neurodermatitis (lichen simplex chronicus)?

Chronic itching of the skin causes it to thicken, and become more pruritic. Vicious cycle

What is the treatment for neurodermatitis (lichen simplex chronicus)? (3)

- Potent topical corticosteroids - Emollients - Behavioral modification

What is intertrigo? What usually causes it?

Irritative condition of the skin between intertriginous areas Usually caused by candida

What are the signs of intertrigo?

Moist erythema, maceration, and superficial erosion

Why is intertrigo more common in older adults?

More folds

What is the treatment for intertrigo?

Keep area dry | use typical antifungals PRN

What are the skin findings of bullous pemphigoid?

Large, tense blisters NOT on an erythematous base

What is the age range of BP?

60+

True or false: BP is usually self limiting

True, but lasts months to years

What are the antibodies that are formed in BP?

hemidesmosomes

What is the age range that is typically affected with pemphigus vulgaris?

Middle aged folk

What is the difference between the blisters of BP and PV?

``` BP = tense and firm PV = flaccid and easily ruptured ```

Which has oral lesions: BP or PV?

What is immunofluorescence pattern of BP and PV?

``` BP = BM PV = Intradermal ```

which is an epidermal problem, and which is along the dermis/epidermis: BP and PV?

``` BP = dermis/ epidermis PV = intradermal ```

Which has more uniform blisters: BP or PV?

What is the treatment for Bullous pemphigoid?

- Topical corticosteroids or calcineurin inhibitors | - Systemic steroids if more severe

What is the MOA of calcineurin inhibitors?

***

What causes scabies?

Sarcoptes scabiei

What are the bites like with scaries?

Linear ("breakfast, lunch, and dinner bites"), and pruritic

What is the treatment for pruritic jaundice?

Cholestyramine (bile acid sequestrants)

What is the treatment for pruritis, if you cannot find an underlying cause?

Topical corticosteroids or emollients

What are cutaneous horns? Are they malignant?

Proliferation of keratinocytes | usually benign, but may represent underlying pathology

What is the treatment for a cutaneous horn?

Excisional bx

What is stasis dermatitis?

an early sign of chronic venous insufficiency of the legs, triggered by chronic venous HTN and incompetent valves

Where is stasis dermatitis usually seen on the body?

Medial supramalleolar areas

What are the risks of untreated stasis dermatitis?

Ulceration and pruritis

What is the treatment of stasis dermatitis? (3)

- Compression - Leg elevation at rest - emollient and topical steroids

What are the skin findings of stasis dermatitis?

Erythematous and edematous legs, with dusky appearance, and possibly ulcers

Which tend to be serous, and which hemorrhagic: PV or BP

``` BP = hemorrhagic PV = serous ```

Why are there skin changes with stasis dermatitis?

Pressure from veins on small dermal capillaries decreases blood supply to the skin

What usually causes stasis dermatitis?

Vascular disease

What are the s/sx of venous leg disease, compared to arterial?

Venous = limb heaviness, aching, swelling that is made worse with standing for long periods Arterial = claudication, loss of hair, cool extremitis

What are the risk factors for venous leg disease?

Age Obesity h/o DVTs

What are the risk factors for arterial disease of the leg?

``` Age over 40 Cigarettes DM HTN Hyperlipidemia ```

Where are the location of venous leg ulcers, as compared to arterial?

Venous = Along the course of the long saphenous vein (medial) Arterial = over bony prominences

What are the complications from onychomycosis?

- Nail bed ulcerations | - Dm pts = route for bacterial infx

What is the treatment for onychomycosis? (3)

- Oral terbinafine - Fluconazole - Itraconazole

What are the issues with systemic treatment for onychomycosis in older adults?

- Long duration - High potential for drug interactions - Hepatotoxic

What are the skin findings of zoster?

Tiny serous pustules on an erythematous base

What is the treatment for shingles? (3) MOA?

- Acyclovir - Valacyclovir - Famciclovir Converted by thymidine kinase, to then inhibit HSV specific DNA polymerases

What is hutchinson's sign?

Herpes vesicles on the tip of the nose==represents involvement of the nasocilliary branch

What is the difference in the rash of intertrigo and candidiasis?

Candidiasis has peripheral satellite pustules

How do you diagnose candidiasis?

KOH prep

What is the treatment for candidiasis?

- Keep skin dry - Improve hygiene - Topical azoles

What is the treatment for scabies?

Ivermectin | burn everything

What is the treatment for body louse?

Pyrethrin

What are seborrheic keratoses?

Benign growths in older adults, that appear are tan, gray, or black plaques with a "stuck-on" appearance

What are the differences between seborrheic keratoses and melanoma?

- Melanomas are single vs multiple for seborrheic keratoses | - Chronic condition for seborrheic keratoses

What are cherry angiomas?

Acquired cutaneous vascular proliferations that appear as round to oval, bright red papules

What are cherry angiomas composed of? Are these malignant?

Dilated and congested capillaries and postcapillary venules benign

What is actinic keratosis? What causes it? Is it malignant?

- Rough, scaly, red-brown macules on sun exposed skin that are usually poorly circumscribed - Sun exposure caused - Premalignant lesion

What is the treatment for actinic keratosis?

- Cryotherapy - Topical acids - 5FU

What are the usual skin findings of SCC?

Chronic, erythematous papules, plaques, or nodules with scaling, crusting, or ulceration

Where does SCC tend to occur on the body?

In chronically sun-exposed areas

What is the issue with SSC on the lip?

Increased propensity to metastasize relative to location elsewhere

What is the treatment for SCC?

Cut it out

What are the typical skin findings for BCC?

Pearly papule that is ulcerated and has a characteristic rolled border

What is the issue with melanoma?

Mets early

What is the treatment for melanoma?

- cut it out - Lymph node dissection - Chemo/XRT PRN

What are the characteristics of melanomas?

Small, Irregular lesion with variations in pigment that grows quickly