Integumentary Flashcards
Anaphylaxis
S&S Angioedema and hives
flushing, hives, angioedema, dyspnea, wheezing, tachycardia or bradycardia, hypotension, hypoxia, or cardiac arrest
Cause: Food, insect sting, drugs
Immune globulin E
Onset: Acute onset
Minutes to several hours
Tx: Epinephrine IM 1 mg/mL 0.3mg to 0.5mg to mid-outer thigh
Repeat every 5 to 15 min
Rocky Mountain spotted fever (RMSF)
S&S: abrupt onset of high fever, chills, severe headache, nausea/vomiting, photophobia, myalgia, and arthralgia followed by a rash that erupts 2 to 5 days after onset of fever.
Rash: small red spots (petechiae) that start to erupt on the wrist, forearms, and ankles (sometimes the palms and soles). It rapidly progresses toward the trunk until it becomes generalized
10% have no rash
Tx: doxycycline
Prevention: DEET containing products
Brown recluse spider bites
Brown recluse spiders (Loxosceles reclusa) are found in midwestern and southeastern United States.
S&S fever, chills, nausea, and vomiting. Deaths are rare but more common in children (younger than 7). Any child with systemic signs should be hospitalized (the condition may cause hemolysis).
Most spider bites are located on the arms, upper legs, or trunk (underneath clothing). Bite may feel like a pinprick (or be painless). The bitten area becomes swollen, red, and tender, and blisters appear within 24 to 48 hours. Central area of bite becomes necrotic (purple-black eschar). When the eschar sloughs off, it leaves an ulcer, which takes several weeks to heal.
Erythema Migrans (Early Lyme Disease)
classic lesion: expanding red rash with central clearing that resembles a target. appears within 7 to 14 days and spontaneously resolves within a few weeks.
The rash feels hot to the touch and has a rough texture. Accompanied by flu-like symptoms.
Common locations: belt line, axillary area, behind the knees, and groin area.
northeastern regions.
Prevention: DEET-containing repellent on skin and permethrin on clothing and gear
Meningococcemia (Meningitis)
MEDICAL EMERGENCY
can progress very rapidly and cause death within several hours
C/b Neisseria meningitidis (gram neg)
S&S sudden onset of sore throat, cough, fever, headache, stiff neck, photophobia, and changes in level of consciousness. Rash in some cases
Risk factor: living in close quarters, asplenia, HIV
Vaccination for adolescents
Tx: Rifampin (twice a day for 2 days) and ceftriaxone 250 mg intramuscularly (one dose)
Shingles Infection of the Trigeminal Nerve (Herpes Zoster Ophthalmicus)
MEDICAL EMERGENCY
Cause: Reactivation of herpes zoster virus on trigeminal nerve
S&S: sudden eruption of multiple vesicular lesions on one side of scalp, forehead and sides and tip of the nose. If herpetic rash on nose, assume shingles. Eyelid can be swollen and red. C/o of photophobia, eye pain and blurred vision
Refer to ophthalmologist or ED
Melanoma
Dark-colored moles with uneven texture, variegated colors, and irregular borders with a diameter of 6 mm or larger
If in nail beds, may be very aggressive
Risk factors: fam hx, sunlight exposure, tanning beds, high nevus count, light skin/eyes.
Acral Lentiginous Melanoma
Sounds like “acra, ghana” and “Laos”
Most common melanoma in african americans and asains
Dark brown-to-black lesions on nail beds, palmar and plantar surfaces.
Basal cell carcinoma
Most common skin cancer
Pearly or waxy skin leasion w/ atrophic or ulcerated center that does not heal. Bleeds easily.
Risk factor: severe sun burn in childhood
Actinic keratosis
S&S: numerous dry, round, and red-colored lesions with a rough texture that do not heal. Slow growing.
Common locations: where sun hits, cheeks, nose, face arms, and back
High risk: light skin/hair/eyes
Subungual hematoma
Cause: Direct trauma to nail bed.
S&S: pain and bleeding trapped between nail bed and nail.
Complication: if 25% nail involved, risk of permanent ischemic damage.
Tx: draining
Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis
Multiple lesions start erupting abruptly and can include hives, blisters (bullae), petechiae, purpura, and necrosis and sloughing of the epidermis. Look like target.
Mucousal surface involvement (eyes, nose, mouth, esophagus, bronchial tree).
Can have prodomal of fever and flue like symptoms a few days prior
Triggers: medications (allopurinol, anticonvulsants, sulfonamides, NSAIDs)
Risk factors: HIV
Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis difference
SJS is less severe (involves <10% body skin) compared with TEN (involves >30% body skin)
Pseudofolliculitis barbae (barber’s itch)
Caused by inflammation from the curly hair growing back into the skin.
The “treatment” is to let the beard hair grow for 3 to 4 weeks. Avoid shaving beard hair too short and too close to the skin.
affects up to 60% of African American men.
Acral
Distal portions of the limbs (i.e., the hand or feet [acral melanoma])
Annular
Ring-shaped (ringworm, or tinea corporis)
Exanthem
Cutaneous rash
Extensor
The skin area that is outside of the joint (e.g., front of knee, back of elbow)
Flexor
The area of the skin on top of the joint with skin folds (e.g., back of knees, antecubital space)
Flexural
Skin flexures are body folds (eczema affects flexural folds)
Intertriginous
An area where two skin areas touch or rub each other (e.g., axilla, breast skin folds, anogenital area, between the fingers/digits)
Maculopapular rash
Rash with color (usually pink to red) with small bumps that are raised above the skin (viral rashes)
Morbilliform
Rash that resembles measles (pink rash with texture)
Nummular
Coin-shaped, round (nummular eczema)
Purpura
Bleeding into the skin; small bleeds are petechial (RMSF), and larger areas of bleeding are ecchymoses or purpura (meningococcemia)
Serpiginous
Shaped like a snake (larva migrans)
Verrucous
Wartlike
Xerosis
Dry skin
The “A, B, C, D, E” of melanoma
A: Asymmetry
B: Border irregular
C: Color varies in the same region
D: Diameter >6 mm
E: Enlargement or change in size
Macule
Flat nonpalpable lesion <1 cm in diameter
Example: Freckles (ephelis), lentigo or lentigines (plural)
Papule
Palpable solid lesion ≤0.5 cm in diameter
Example: Nevi (moles), acne, small cherry angiomas
Plaque
Flattened, elevated lesion with variable shape >1 cm in diameter
Example: Psoriatic lesions
Bulla
Elevated superficial blister filled with serous fluid and >1 cm in size
Example: Impetigo, second-degree burn with blisters, SJS lesions
Vesicle
Elevated superficial skin lesion <1 cm in diameter, filled with serous fluid
Example: Herpetic lesions
Pustule
Elevated superficial skin lesion <1 cm in diameter, filled with purulent fluid
Example: Acne pustules
Lichenification
Thickening of the epidermis with exaggeration of normal skin lines due to chronic itching (eczema)
Scale
Flaking skin (psoriasis)
Crust
Dried exudate, may be serous exudate (impetigo)
Ulceration
Full-thickness loss of skin (decubiti or pressure injury)
Scar
Permanent fi brotic changes following damage to the dermis (surgical scars)
Keloids/hypertrophic scar
Overgrowth of scar tissue; more common in Blacks, Asians
Urticaria (Hives)
Erythematous and raised skin lesions with discrete borders that are irregular, oval, or round
Can be the start of anaphylaxis
considered chronic if it lasts longer than 6 weeks. Most cases are self-limited
Multiple etiologies
Ts: Eliminate the cause