Module 14 Flashcards
1
Q
Skin Lesions
A
- Primary
Physical changes in the skin considered to be caused directly by the disease process. - Secondary
May evolve from primary lesions, or may be caused by external forces such as scratching, trauma, infection, or the healing process.
*Not always clear if lesion
- There is a primary and secondary skin lesion
- Secondary: you are doing something to your body
2
Q
Primary Skin Lesions Macule: Vesicle: Pustule: Papule: Nodule: Wheal: Telengieactasia:
A
- Macule > small, circular, flat, different color > freckle
- Vesicle > small raised, filled with clear fluid > if large > bullae or blister
- Pustule > raised lesion filled with pus > acne
- Papule > solid raised lesion > group > plaque
- Nodule > solid lesion that is moveable to area around it > lipoma
- Wheal > skin elevation with itching > allergic reaction
- Telengieactasia > dilated blood vessels on surface of skin
3
Q
Secondary Skin Lesions (Check you book for pictures!)
- Ulcer
- Scale
- Crust
- Erosion
- Scar
- Lichenification
- Atrophy
A
- Ulcer > loss of dermis and poss. Epidermis > w/ deep - crack > fissure
- Scale > dry, scaly dead skin with flaking > psoriasis
- Crust > dried substance > blood, pus, scab
- Erosion > loss of epidermis > scrape
- Scar > discolored fibrous tissue that replaces normal skin
- Lichenification > rough epidermis > dermatitis
- Atrophy > thin wrinkled skin > topical corticosteroid use
- We are expected to know what these are and what they look like
- Make sure you can apply the proper name to different diseases/symptoms
4
Q
Acne
Comedone:
A
Comedone: A pore clogged with sebum and dead skin cells
- Clogged up comedone (pore)
- Can be open or closed
- When it is clogged there is a collection of bacteria where they multiply
- Closed comedone is a white head
- Open comedone all of that puss gets oxidized so it is a blackhead
5
Q
Acne
A
- Acne Vulgaris
- Main cause of skin disease (85% of population 12-25)
- Whiteheads (closed comedones), blackheads (open comedones), papules, pustules
- Nodules, cysts
- Face, neck, chest, back – most sebaceous glands located
- Severe forms:
- Acne Conglobata – Large interconnected lesions
- Most common in males 18-20
- Acne Fulminans (Acute Febrile Ulcerative Acne – abrupt onset of acne congoblata, or after unsuccessful treatment of conglobata
- Begins as pain and inflammation in the joint > progresses into a swelling of the lymph nodes located at the base of the neck, causing inflexibility in the neck within weeks after the nodes swell > After some time, extreme loss of weight and atrophy of the muscles
- Acne Conglobata – Large interconnected lesions
- (Acne) Rosacea – red facial rash (adult acne)
- Transient, recurrent, persistent (middle aged adults)
- Possibly due to overactive facial > Triggers that cause episodes of flushing and blushing play a part in the development of rosacea (Exposure to temperature extremes, strenuous exercise, heat from sunlight, severe sunburn, stress, anxiety, cold wind, and moving to a warm or hot environment from a cold one such as heated shops and offices during the winter can each cause the face to become flushed. Certain foods and drinks can also trigger flushing (alcohol, caffeine (especially, hot tea and coffee), foods high in histamines, and spicy food)
- Corticosteroids make it worse!
- Rhinophyma – following slide pictures
- Everyone gets it at some point
- Most people just get nodules
- Anything fulmonating is never good (acne fulminans)
- Acne rosacea is more of a blood vessel thing
6
Q
Acne Vulgaris
A
Acne vulgaris is thought to be caused by multiple factors. Overproduction of a normal oil on the skin, called sebum, increases under the influence of hormones. This, coupled with insufficient shedding of exfoliating dead skin cells, plugs hair follicles. The plugged follicle can become inflamed and have increased growth of normal skin bacteria, Propionibacterium acnes.
- Cystic acne occurs across the upper chest as well as on the back.
- Anywhere where a person has increase sebum production is where they are more likely to get this
7
Q
Acne Vulgaris blackheads
A
Blackheads (open comedones) are collections of oil and debris that clog pores. The material is normally whitish, but as it oxidizes, the surface turns black, producing this characteristic appearance.
8
Q
Rhinophyma
A
Rhinophyma (subtype of rosacea) is a large, bulbous, ruddy nose caused by granulomatous infiltration, commonly due to untreated rosacea. Alcoholism is mistakenly attributed as the cause of this disease, but heavy alcohol consumption does aggravate the condition. It is a slowly progressive condition due to hypertrophy of the sebaceous glands of the tip of the nose often seen in cases of long-standing acne rosacea
- Alcoholishm is not the cause but it can aggrivate it
9
Q
Acne Conglobata Tx
A
Healthy diet, foods high in antioxidants, fruits
- sugar is proinflammatory so cut out sugar or refined foods
10
Q
Polycythemia Vera (1 in 200,000 in US)
A
- Abnormal, slow, idiopathic proliferation of RBC at bone marrow (WBC and platelet counts may also be elevated) increased risk for AML later in life
- Primary polycythemia - neoplastic proliferation and maturation of erythroid, megakaryocytic and granulocytic elements to produce what is referred to as a panmyelosis
- Secondary polycythemias - low serum level erythropoietin (EPO). PCV cells have a mutation in the EPO receptor, which makes them hypersensitive to EPO
- S/S: due to increased blood volume & hyperviscosity
- Splenomegaly, thrombi, HA, tinnitus, chorea, delirium,
- Visual disturbances, angina, thrombosis, ischemia, infarct
- Pruitis after warm bath/shower
- Plethora (ruddy complexion) in the face, palms, nail beds, mucosa, and conjunctiva.
- Testing: CBC
- Tx:
- Meds for bone marrow suppression
- Phlebotomy
- Low dose aspirin
- Poly means multiple cyt means cell emia means blood so a lot of red blood cells
- Two main types: primary vs. secondary
- Neoplastic is new growth
- Primary is a pan (everything) increase in all of the blood cell types
11
Q
Polycythemia Vera
A
Polycythemia is a condition of increased production of red blood cells (RBCs). The percentage of RBCs in the blood may become so high that the blood ceases to flow in some smaller vessels and capillaries. In this photomicrograph, the RBCs are densely packed together.
12
Q
Insect bites
A
- Causes
- Bees, wasps, fire ants, fleas (Bubonic plaque), lice, ticks (Lyme disease), mosquitoes (malaria, West Nile Virus), fly (typhoid fever, dysentery), bedbugs
- Spiders
- Signs and Symptoms
- Redness, swelling, pruritis, hives, pain
- Cellulitis
- Anaphylaxis
- Secondary bacterial infection
- Testing
- Clinical
13
Q
Eczema
A
- A term for a group of medical conditions that cause the skin to become inflamed or irritated.
- Types:
1) Atopic dermatitis: has a genetic basis and is probably most commonly called eczema. Begins early in life in those with a predisposition to inhalant allergies, but it probably does not have an allergic basis. Characteristically, rashes occur on the cheeks, neck, elbow and knee creases, and ankles.
2) Contact Dermatitis- Irritant contact dermatitis: This occurs when the skin is repeatedly exposed to toxic substances (i.e. sodium lauryl sulfate)
- Allergic contact dermatitis: After repeated exposures to the same substance, the body’s immune recognition system becomes activated at the site of the next exposure and produces eczema (i.e . poison ivy, nickel)
3) Stasis dermatitis: It commonly occurs on the swollen lower legs of people who have poor circulation in the veins of the legs.
4) Fungal infections: the fungus can be visualized with a scraping under the microscope or grown in culture.
5) Scabies: infestation by the human itch mite
6) Pompholyx (dyshidrotic eczema): common but poorly understood condition which classically affects the hands and occasionally the feet by producing an itchy rash composed of tiny blisters (vesicles) on the sides of the fingers or toes and palms or soles.
7) Lichen simplex chronicus: It produces thickened plaques of skin commonly found on the shins and neck.
8) Nummular eczema: This is a nonspecific term for coin–shaped plaques of scaling skin most often on the lower legs of older individuals.
9) Xerotic (dry skin) eczema: When the skin becomes pathologically dry, it will crack and ooze.
10) Seborrheic eczema: It produces a rash on the scalp, face, ears, and occasionally the mid-chest in adults. In infants, in can produce a weepy, oozy rash behind the ears and can be quite extensive, involving the entire body.
- Many different types
- Contact Dermatitis: grass, poison ivy, etch
- Stasis: paralyzed or in bed,
- Scabies: look for in webbing , overcrowding dirty places
- Dyshidrotic (dry skin) eczema: nurses because they are constantly washing their hands
- Best Tx for eczema is to identify the cause
14
Q
Eczema
causes
s/s
testing
A
- Causes
- Unknown - dysfunctional interplay between the immune system and skin
- Allergy?
- Anything physical, mental or emotional
- Signs and Symptoms
- Intense itching, burning, dry flaky erythematous skin > often found in the bends of the arms or legs, face, and neck
- Secondary bacterial infections > danger if person is immunocompromised
- Testing
- Clinical
- Wound culture and sensitivity
15
Q
Psoriasis
A
- Causes
- Autoimmune T-cell reaction to skin
- Risk factors:
- FHx, genetic predisposition, HIV, stress, obesity, smoking
- Triggers: Alcohol, stress, infections, injury to skin, cold weather, certain meds (Lithium – for bipolar disorder)
- Main areas: Elbows, knees and scalp
- Signs and Symptoms
- Red skin with silvery scales and inflammation
- Nail involvement: pitting, onycholysis
- Separation of nail plate
- Psoriatic arthritis-skin disease precedes in 80%
- Testing
- Clinical
- R/O RA
- Silvery scales it hallmark SILVERY SCALES
- Usually happens in the same place
- If it is autoimmune a person will take humera, steroids, any immunosupressants
