Module 6 - Derm I & II Flashcards
Danger signs of moles *
ABCDE
asymmetry
borders
color
diameter
evolving
itching bleeding crusting is bad
melanoma
goes down to dermis
add more
primary prevention
secondary
tertiary
sunscreen, long sleeves
skin exams
biopsy
BCC vs SCC
BCC
- most common skin ca
- shiny, pearly, papular, nodule
- umbilicated center + telangiectasia
- NOSE
SCC
- more common in immunosuppressed
- hyperkeratotic lesion with crusting and ulceration
- more aggressive growing
- ear
Contact Dermatitis Treatment *
DO
- take lukewarm showers (not hot)
- lotion after showers (syran)
- drinks lots of water
Rx: med-high potency topical steroids
- If > 20% BSA PO steroids
- antihistamines not helpful
- biopsy if not responsive to treatment
Poison Ivy *
- wash area ASAP
astringents (domeboro), aclamine lotion, oatmeal baths - helps soon itching or dry weeping rash
- dont bother with pre lotions
- cool compress or OTC topicals (IVY DRY)
- DO NOT USE topical diphenhydramine, antibiotics, caine topicals
- oral antihistamines are NOT helpful
- OTC mild hydrocortisone
- med-high potency top steroids for mod-sev
oral steroids if >20% BSA
- prednisone taper 2-3 weeks
- dont use methyl prednisone
Eczema Treatment *
AVOID:
- triggers (wools, soaps, detergents)
- temperature changes
- sweating
- low humidity in winter
- foods: eggs, peanuts, soy, milk
- stressful stimulants
- allergens and dust
- excessive handwashing
TREATMENT:
emollients can be used for dryness
- 1st line: low potency topical steroid
(1-2.5% hydrocortisone)
- intermediate cases
(triamcinolone)
- severe cases
(betamethasone)
Oral antihistamines ARE effective in controlling and preventing pruritic
Long term use of steroids *
- skin atrophy such as striae
- telangiectasias
- systemic effects
( growth restriction in children, risk of glaucoma)
Topical Drugs for Atopic Dermatitis *
Atopic Dermatitis = Eczema
Corticosteroids
- inhibit release of inflammatory cytokines
- use smallest amount to limit exposure and s/e
TREAT: thin layer once or twice a day in affected areas
PREVENT: thin layer once or twice weekly
Topical corticosteroids comparison and potency from readings *
occlusive dressings can significantly increase absorption - but means increased s/e. (also including skin irritation and folliculitis). Dont use occlusive dressings with betamethasone and fluticasone because of high potency.
Total dose for high potency should not exceed 50g a week bc of possible adrenal suppression. Clobetasol may cause adrenal suppression - dont discontinue abruptly but instead switch to lower potency agent. Sx of decreased adrenal suppression: weakness, lb loss, hypotension, GI distress.
Applying to wet skin may IMPROVE effectiveness. Can use different products on different parts of the body.
Very high potency *
High potency
Moderate
Low
Very high potency: scalp, palms, soles, resistant thick lesions
High potency: palms, soles, scalp
Moderate: extensive area of skin
Low: elderly children face folds genitals extensive area of skin
Pityriasis Rosea *
Begins as rash (harolds patch) and spreads like christmas tree
- spring and fall, favors adolescents and young adults
Harold patch: salmon, oval, scaly (trunk, UE)
- heals after 2-4 weeks, gone by 6-14 weeks
- idiopathic cause
- NOT CONTAGIOUS or STD
systemic symptoms sometimes
No treatment necessary
Tinea vs. Nummular Eczema *
tinea = ring worm
tinea: central flaring
NE: dry, flaky lesion throughout
tinea capitis: needs systemic therapy
tinea ungium (nail): needs systemic therapy
Antifungals *
- apply to lesion + 2 inches surrounding area
- continue for 1-2 weeks after lesion resolves
- itching resolves with antifungal treatment but if extra therapy for itching needed: sarna sensitive
- avoid topical steroids !
