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Geriatrics Exam 1 > Lecture 12- Geriatric Derm > Flashcards

Lecture 12- Geriatric Derm Flashcards

1
Q

The major dermatologic changes with aging are…

A
  • epidermal and dermal changes
  • Reduced lipids
  • Slower wound healing
  • Lower immune function
  • Reduced collagen and elastin
  • Hair changes
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2
Q

Epidermal Aging

A
  • When young, the epidermis interdigitates with dermis
  • With aging, the interdigitations flatten, resulting in
    • reduced contact between epidermis and dermis
    • Decreased nutrient transfer
    • Increased skin fragility
    • Easy bruising
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3
Q

Lipids and Aging

A

Aging is associated with decreased lipids in the top skin layer, which leads to…

  • dryness and roughness
  • decreased barrier function
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4
Q

Impaired healing and immune function with aging

A
  • slower turnover of epidermal cells - accounts for slower rate of healing
  • Lower number of immune antigen-presenting cells may cause reduced cutaneous immune surveillance
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5
Q

Aging Skin and Hair

A
  • Changes in follicular melanocytes cause graying hair

- Shortened growth phase of hair follicles, and increased duration of telogen results in decreased hair density

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6
Q

Preventing Photodamage

A
  • Use broad-spectrum sunscreens
  • avoid direct sunlight
  • Use protective clothing, including hats
  • use sunglasses
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7
Q

Seborrheic Dermatitis

A
  • Common chronic dermatitis
  • erythema and greasy looking scales
  • Usually along hairline, nasolabial fold, midline chest
  • Dandruff a typical precuror
  • more common in Parkinson patients
  • cause unclear
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8
Q

Seborrheic Dermatitis Treatment

A
  • suppressed by not cured

- mild topical corticosteroids

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9
Q

Rosacea

A

Diffuse erythema and erythematous papules and papulopustules on cheeks, forehead, and chin.

  • Thickening of the skin on the nose and changes like those of early rhinophyma
  • more common in fair-skinned people
  • affects all ages
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10
Q

Rosacea treatment

A
  • avoid skin irritants, strong soaps
  • Reduce sun exposure
  • use oral or topical antibiotics depending on severity
  • for SEVERE rosacea, use oral isotretinoin as well as some surgical procedures for cosmetic fixes
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11
Q

Xerosis

A
  • dry skin
  • Exacerbated by environemental factors
  • more often on legs, can result in pruritus
  • severe cases manifest as Eczema
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12
Q

Xerosis Treatment

A
  • avoid environmental triggers
  • don’t take hot showers
  • use moisturizers after bathing
  • mild topical corticosteroids if bad
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13
Q

Neurodermatitis

A
  • Chronic, pruritic conditions of unclear cause
  • AKA lichen simplex chonicus
  • show signs of chronic scratching
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14
Q

Intertrigo and Candidiasis

A

commonly found in the web space between the 4th and 5th toe

  • intertrigo more common in older adults because of increased skin folds
  • often associated with secondary candidal or mixed bacterial colonization
  • common under breasts, around scrotum
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15
Q

Intertrigo treatment

A

Keep area dry, open to air

  • use topical antifungal powder or cream
  • Mild topical corticosteroid occasionally to reduce inflammation
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16
Q

Bullous Pemphigoid

A
  • Tense, fluid-filled and hemorrhagic bullae on an erythematous base on trunk and extremeties
  • autoimmune blistering disorder
  • occurs mainly in adults in 60s and 70s.
  • Blisters usually large and tense- may be filled with clear or hemorrhagic fluid
  • Can last months to years, but often self-limited
  • antigens develop in the hemidesmosomes
  • antibodies bind them and activate complement cascade- lead to degraded mast cells causing separation of epidermis from basement membrane
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17
Q

Biggest difference between bullous pemphigoid and pemphigus vulgaris

A
  • Bulous pemphigoid does NOT occur on mucus membranes while Pemphigus vulgaris DOES.
  • also bullous pemphigoid seen in geriatrics while pemphigus vulgaris seen during middle age.
18
Q

Bullous Pemphigoid treatment

A
  • topical corticosteroids, calcineurin inhibitors, and nicotinamide with tetracycline
  • if more extensive, use systemic corticosteroids or other immunosuppressants
19
Q

Pruritis

A
  • can be very sever in older adults

- just means itching- can be from tons of different things

20
Q

Treatment of Pruritis

A
  • treat underlying cause when possible!

- topical corticosteroids, emollients, menthal all good for symptom relief

21
Q

Cutaneous Horns

A
  • proliferation of keratinocytes

- Almost always benign- but Excision of them is key!

22
Q

Stasis Dermatitis

A
  • Early sign of chronic venous insufficiency of legs- triggered by chronic venous hypertension and incompetent valves
  • usually seen around medial ankle area
23
Q

Stasis Dermatits Treatment

A
  • Compression bandages or stockings

- Leg elevation at rest

24
Q

Venous and Arterial Ulcers

A
  • of the lower extremity- often caused by vascular disease or neuropathy
  • majority are from venous disease
  • mixed arterial cause the next most common
25
Q

Onychomycosis

A
  • nails infected by fungi
  • about 1/3 of older adults have this
  • more common in adults with obesity, DM, PAD, immunodeficiency, chronic tinea pedis, or psoriasis
  • caused by dermatophytes mostly, but also yeasts and saprophytes
26
Q

Onychomycosis

A
  • no topical antifungals are effective
  • Oral terbinafine, fluconazole, and itraconazole
  • long treatment period typically, with high relapse rates
27
Q

Herpes Zoster

A
  • clusters of vesicles and pustules on an erythematous base involving a thoracic dermatome
  • most common in older than 50 population
  • the most important reason for varicella zoster virus (VZV)
  • Reactivation also associated with HIV, malignancy, and use of immunosuppressive drugs
28
Q

Herpes Zoster Complications

A
  • Involvement of the ophthalmic branch of trigeminal nerve- which can lead to Hutchinson’s sign- vesicles on the tip of the nose
  • Ramsay-Hunt Syndrome- presents as herpes zoster of external ear or tympanic membrane- leads to facial palsy with or without tinnitus, vertigo, and deafness
  • Pain can precede, co-exist, or persist after rash- can be very painful!
29
Q

Diagnosis of Herpes Zoster

A
  • characteristic physical exam
  • Tzanck smear from base of vesicle shows multinucleated giant cells
  • definitive diagnosis by viral culture
30
Q

Treatment of Herpes Zoster

A
  • start within 72 hours of rash with acyclovir, valacyclovir, or famciclovir
  • early treatment halts the progression of disease, and increases rates of clearance of the virus from vesicles
31
Q

Treatment of post-herpetic neuralgia

A
  • No definitive therapy!

- zoster vaccine recommended for adults over 50

32
Q

Candidiasis

A
  • rash resembles intertrigo but also have peripheral satellite pustules
  • oral thrush can develop
  • diagnose with KOH prep revealing spores and pseudohyphae
33
Q

Treatment of candidiasis

A
  • Keep skin dry
  • improve hygiene
  • topical or oral anticandidal agents like azoles
34
Q

Seborrheic Keratoses

A
  • benign growths- common in adults over 40
  • tan, gray, black, waxy, or warty papules and plaques
  • “stuck on appearance!”
  • can be confused with melanoma
  • WELL DEMARCATED border
35
Q

Cherry Angiomas

A
  • most common acquired cutaneous vascular proliferations
  • round to oval, bright red, dome-shaped papules
  • remove with excision, eletrodissecication, or laser
  • benign!
36
Q

Actinic Keratoses

A
  • Rough, scaly, red-brown macules on sun-exposed skin
  • Also known solar keratoses- from chronic UV exposure
  • Poorly circumscribed, occasionally scaly, erythematous macules and papules in sun-exposed areas
  • considered “pre-malignant”- but can resolve without treatment
  • 20% progress to squamous cell cancer
37
Q

Squamous Cell Carcinoma

A
  • occurs most in sun-exposed areas

- chronic, erythematous papules, plaques, or nodules with scaling, crusting, or ulceration

38
Q

Treatment of squamous cell carcinoma

A
  • surgical excision

- cryotherapy or local radiation another option

39
Q

Basal Cell carcinoma

A
  • A pearly papule that is ulcerated in the center and has a characteristic rolled border
  • most common cancer in the U.S.
  • treat with surgical excision
40
Q

Melanoma

A
  • incidence increasing
  • worst kind of skin cancer because it metastasizes early and quickly
  • see more geographic nodules without a well demarcated border
  • does not look “stuck on”
41
Q

Melanoma ABCDE

A 
A- asymmetrical shape
B- Border- smooth even
C- Color- more than one
D- Diameteres- more than 6 mm
E- Evolution

Geriatrics Exam 1 (15 decks)

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