Integumentary Flashcards
Lichenification
Skin becomes hardened and leathery that’s caused by chronic inflammation and scratching
Excoriation
Scratch or abrasion of the skin, commonly seen in conditions with pruritis
Fissure
Linear cleavage, sharp walls, or crack through the epidermis, smaller than a laceration caused by irritants, dryness, or fungal infections
Purpura
flat, non-blanchable, confluent, purple-colored irregularly shaped lesions on skin ranging 2-20 mm in size
A 52-year-old woman states, “these purple splotches appeared on my arms and legs following a round of chemotherapy.”
Wheal
clustered, smooth, slightly raised circumscribed, pruritic skin-colored lesions of various sizes up to 2 cm surrounded by an area of erythema
An 18-year-old states, “this itchy rash appeared all over my body a few hours after starting my antibiotic”
Linear
streaks such as noted in photodermatitis, with vesicular lesions forming, typically a number of hours after exposure to plant oil (urushiol) contained in poison ivy, poison oak, poison sumac
Crusting
Formation of an outer layer or coating on the skin that occurs when bodily exudates (e.g., pus or blood) dry up, e.g., impetigo
Macule
Single, flat, non-palpable area of discoloration, irregularly shaped, and 0.5 cm at the widest diameter (< 1 cm wide), same texture as rest of skin
A 50-year-old man says I have had that spot on my cheek for years. Freckles, sunspots.
Papule
Single, uniformly colored, slightly raised, solid irregularly shaped with defined borders
A 45-year-old woman states, that thing on my shoulder hasn’t’ changed in years. Solid pimple, acrochordon (skin tag), molluscum contagiosum
Scattered
generalized over body without a specific pattern or distribution, as seen in viral exanthem such as rubella
Confluent / Coalescent
multiple lesions blending together, such as the plaques seen in severe psoriasis vulgaris
Annular
“bull’s eye” lesion often seen with central clearing
- Lyme’s disease
- Steven-Johnsons
- epidermal necrolysis / TEN
Potency
Low potency on face
Medium potency on Arms/Legs/Trunk
High potency on hands and feet
*lichen sclerosis is the only area that we can put high potency topical steroids is clobetazol
Psoriasis vulgaris
tx
Medium potency topical corticosteroid
Scabies (scabies mites)
tx
Permethrin Lotion
Verruca Vulgaris (warts)
Tx
Imiquimod Cream
Skin Cancer, Actinic Keratosis, Warts, HPV
Tinea Pedis
tx
Topical Ketoconazole
Rosacea
Tx
Topical Metronidazole
Phytodermatitis
- poison ivy, poison oak, poison sumac
Systemic Treatment
Systemic corticosteroid is preferred when greater or equal to 20% is affected prescribe:
- prednisone PO for 5-7 days
- reduce dose of prednisone 50% for another 5-7 days
Phytodermatitis
- poison ivy, poison oak, poison sumac
Topical Treatment
Mid or High potency topical corticosteroids on body
- triamcinolone (0.1% Kenalog, Aristocort) or
- clobestasol (0.5% Temovate)
Low-potency corticosteroids on face
- desinode (Desowen)
Phytodermatitis
- poison ivy, poison oak, poison sumac
Adjunctive Treatment
- cool compress
- calamine lotion
- colloidal oatmeal bath
- OTC analgesics
- Oral antihistamines (pruritus)
Impetigo (honey crusted exudate)
Nonbullous (no blisters)
Causes
Tx
Causes
- Staphylococcus aureus
- Streptococcus pyogenes
Tx: MUPIROCIN OINTMENT
Improvement: 3-5 days
Pregnancy B: do not use if breastfeeding
Cellulitis
What is it?
Causes?
Tx
Infection of dermis and subcutaneous fat with s/s/ of heat, redness, discomfort
Cause
- Streptococcus pyogenes (most common)
- Staphylococcus aureus
- MRSA
- MSSA
Tx: systemic antimicrobial therapy
Erysipelas (superficial form of cellulitis )
How does it present?
More red with sharply demarcated borders compared to cellulitis
Abscess
Moderate Tx
1) Incision and Drainage + Culture and Sensitivity
2) Empiric Tx - Orals
TMP/SMX or Doxycycline
3) Culture and Sensitivity Results - Orals
MRSA tx is TMP/SMX or Doxycycline
MSSA tx is dicloxacillin or cephalexin
Cellulitis / Erysipelas / Bullous Impetigo
Mild Treatments
Orals (5-7 days)
- penicillin VK
- cephalexin
- dicloxacillin
- clindamycin
Cellulitis / Erysipelas / Bullous Impetigo
Moderate Treatments
IVs
Penicillin
Ceftriaxone
Cefazolin
Clindamycin
Cyst
single, firm, smooth, raised, dome-shaped fluid filled, flesh colored encapsulated lesion of 1.5 cm in diameter
A 28-year-old woman states, “a smelly liquid leaks out of this when I push on the area.”
Abscess
Mild Tx
Incision and Drainage
Warm Compress
Shingles, Herpes Simplex Type 1 and Type 2`
Tx
Warning
Antivirals (topical and PO)
- drugs end in -cyclovir
- acyclovir (Zovirax) and valacyclovir (Valtrex)
Warning: AKI, thus we hydrate
**Must start of within 48 hours of onset to be effective (maybe 72 hours)
Seborrhoeic dermatitis, tinea corpus (ringworm), vaginal infections
Tx
Warning
Antifungals
- triazoles or - azole
- fluconazole (Diflucan)
Warning: teratogenic
*spontaneous abortion and heart defects in fetus (1st trimester)
*liver toxicity - do not prescribe with current liver issues
Selenium Sulfide (Selsun Blue)
What do I treat?
Anti-fungal and anti-infective (slows growth of yeast) shampoo that relieves itchy, flaking, redness
Tinea Versicolor, Tinea Capitus, common dandruff of scalp
Pinworms aka Enterobiasis
Tx
Other Interventions
MeBENDAZOLE / Vermax
AlBENDAZOLE / Albenza
*think I’m bending over for pinworms
- give one dose now, then another dose 2 weeks later
- highly contagious must treat everyone in the home
- daily showers, laundering
Terbinafine / Lamisil
What do I treat?
How long should I prescribe?
What do I assess before prescribing?
- treats tinea capitis & onychomycosis (nail fungus)
- 2 to 4 week tx for tinea capitus
- 6 to 12 week tx for onychomcosis
- assess liver before prescribing
Griseofulvin
What do I treat?
How long should I prescribe?
What do I assess before prescribing?
- treats tinea capitis
- 6 to 8 weeks
- take with a fatty meal
Premetherin (Nix)
What do I treat?
How do I treat it?
- treats lice with 1% lotion, reapply in one week if you see lice
- treats scabies (mites) with 5% cream, reapply in two weeks if you see mites
Acne Tx
1) Benzoyl Peroxide / Benzagel (see if the patient used OTC salicylic acid before this)
Other options:
2) tretinoin (Retin-A)…topical retinoids b/c it unclogs pores
3) oral antibiotics - tetracycline
4) refer to derm for accutane
do not prescribe accutane / isotretinoin, refer to derm = birth defects = birth control
Class III medium- to high-potency corticosteroids
amcinonide 0.1%
betamethasone dipropionate 0.05%
fluticasone propionate 0.005%
triamcinolone acetonide 0.5%
Class IV medium-potency corticosteroids
Class V medium-potency corticosteroids
betamethasone valerate 0.1%
desoximetasone 0.05%
Fluocinolone acetonide 0.025%
fluticasone propionate 0.05%
hydrocortisone butyrate 0.1%
hydrocortisone probutate 0.1%
hydrocortisone valerate 0.2%
mometasone furoate 0.1%
triamcinolone acetonide 0.025%
triamcinolone acetonide 0.1%
Class VI low-potency corticosteroids
alclometasone dipropionate 0.05%
desonide 0.05%
fluocinolone 0.01%
hydrocortisone butyrate 0.1%
Class VII least-potent corticosteroids
hydrocortisone 1% and 2.5%
Class II high-potency corticosteroids
amcinonide 0.1%
augmented betamethasone dipropionate 0.05% betamethasone dipropionate 0.05%
desoximetasone
diflorasone diacetate 0.05%
fluocinonide 0.05%
halcinonide 0.1%
Class I superpotent corticosteroids
clobetasol propionate 0.05%
augmented betamethasone dipropionate 0.05%
diflorasone diacetate 0.05%
fluocinonide 0.1%
halobetasol propionate 0.05%
Acanthosis Nicricans
patient population
s/s
- diabetes, metabolic syndrome, obesity, GI cancers
- diffuse thickening of the skin located behind the neck and on axilla
Xantheasma
raised yellow colored soft plaques located under eyebrow and upper/lower lids of eye
- sign of hyperlipidemia
Plane Xanthomas
raised yellow colored soft plaques
- sign of hypercholesterolemia
