Secondary Skin Lesions Flashcards by Deleted Deleted

Excoriations

scratches, abrasions

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Atrophy

thinning or translucent (striae)

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Scale

flat/flaky (seborrheic dermatitis) crust – dried exudate

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Fissure

linear crack epidermis to dermis (cheilosis)

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Erosion

rupture of burn blister

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Ulcer

depressed lesion

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Scar

fibrous tissue with trauma

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Keloid

sharply elevated bulky scar

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Lipoma

benign subcutaneous tumor consisting of adipose tissue. (Usually older adults, asymptomatic)

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Eczema (Atopic dermatitis) Presentation

Primary symptom – pruritis.
Skin lesion range from mild erythema to severe lichenification. Presents as red patches with white scales on top.

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Eczema (Atopic dermatitis) Treatment

Moisturizers. Avoid triggers. Topical steroids or immune modulators. Oral antihistamine at night.

If wet: Burow’s solution, saline, or silver nitrate to dry out.

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Acne Presentation

Vulgaris: Located on face, chest, back, and upper outer arms.
* Mild = total lesions <30, noninflammatory. Comedones with small papules.
* Moderate = total lesions 30-125, inflammation. Papules & pustules with yellow/green tops.
* Severe = lesions > 125, nodulocystic acne.

Rosacea: Chronic, central face, persistent erythema telangiectasia, erythematous papules.

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Acne Treatment

Vulgaris: Tretinoin, topical vs. systemic antibiotics, Isotretinoin, BCP

Rosacea: Avoid triggers, topical flagyl (may take 6-8 wks), PO tetracycline, minocycline, or doxycycline

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Impetigo Presentation

Honey crusted plaques, usually on face
Bullous: begin as small vesicles that rupture easily with serous fluid turning into crust
Nonbullous, vesticulopustular: thick, adherent lesions, dirty yellow-colored crust with erythematous margins

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Impetigo Treatment

Clean lesions. Bactroban TID x 7 days. Antibiotic (Keflex, Augmentin, Cloxacillin). With no treatment, it is self-limiting 2-3 wks

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Herpes Zoster (shingles) Presentation

Unexplained pain along dermatome. Unilateral vesicular rash along dermatome lasting 3-5 days, up to 30.

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Herpes Zoster (shingles) Treatment

Famcyclovir, Acyclovir, Valacyclovir.
Prednisone taper.
Vaccine.

Herpes Simplex Presentation

Oral or genital, can be asymptomatic. Tenderness, pain, mild paresthesia’s, or burning before onset. Prodrome can include headache, fever, muscle ache, lymphadenopathy, local pain. Grouped vesicles on erythematous base.

Herpes Simplex Treatment

No cure.
Oral: lip ointment Blistex. OTC Abreva. Denavir for extensive lesions.
Genital: Valacyclovir and famciclovir better choices

Actinic Keratosis (precursor to SCC) Presentation

Most common precancerous growth. Fair-skinned pts aged > 40, sun exposure, men.
* Head, lips, ears, neck, hands, forearms.
* Primary lesions macules or papules poorly circumscribed. Small papules 0.5-2 mm flesh color or hyperpigmented.
* Secondary lesions erythematous, scaly with uneven surface. Pruritic, tender, or stinging, sandpaper feel.

Actinic Keratosis (precursor to SCC) Treatment

Topical therapy (5-FU) creams: Efudex, Carac
Surgical destruction (cryotherapy)

Melanoma (malignant) Presentation

Suddenly appears as new dark spot on skin. ABCDE:
* asymmetrical lesion
* irregular border, notching,
* varied color, can be mix of blue, red, tan, brown, black, and white
* diameter > 6 mm
* evolution of lesion

Melanoma (malignant) Treatment

Depends on stage. Biological therapy, Chemotherapy, Radiation, Surgery.

REFER!!!!

Basal cell cancer Presentation

Slow-growing, rarely metastasize. 50-60 year old. Usually head and neck but can be anywhere. Flesh color, pearly domed nodule with overlaying telangiectatic vessels, pinkish patch of skin. Later stage central ulcer and crusting. PUTON acronym.

Basal cell cancer Treatment

Simple excision: Electrodesiccation and curettage Cryosurgery Laser surgery Mohs microsurgery – highest cure

Squamous cell cancer (SCC) Presentation

* Rapid growing. NO SUN – nodular, opaque, sun exposed, ulcerating, non-distinct borders. * Firm, scaly, rough, later bleeds. * Does not heal * Hyperpigmented

Squamous cell cancer (SCC) Treatment

Electrodesiccation and curettage Mohs surgery – most effective

Tinea corporis (Ringworm of body) Treatment

Miconazole 2% cream BID x4 weeks, Clotrimazole 1%, Terbafine 1%

Tinea corporis (Ringworm of body) Dx

Hx of erythematous round and elevated pruritic lesion that grows in size & starts to clear in the center

Tinea capitus (ringworm of head) Presentation

Children common. Painless bald spot, may have kerion that looks like honeycomb, inflammation. Boggy mass containing broken hairs and oozing purulent material from follicular orifices

Tinea capitus (ringworm of head) Treatment

Systemic antifungals – Griseofulvin BID for 2-4 months or 2 weeks after negative cultures. Teratogenic – use 2nd method of contraception. OR terbinafine cream

Tinea versicolor (skin, AKA pityriasis versicolor) Presentation

Round or oval lesions of hypo or hyperpigmentation macule, located mainly on back chest, arms, sometimes neck/face. Sometimes very fine scales seen. Agent P oribiculare causes round, pityrosporum ovale causes oval

Tinea versicolor (skin, AKA pityriasis versicolor) Treatment

Clotrimazole 1% cream and solution BID up to 4 weeks

Lupus Presentation

More common women, AA. Fatigue, joint pain, myalgia, photosensitive, butterfly malar rash, thrombocytopenia, gastritis, systolic murmur

Lupus Treatment

Symptom control, NSAIDS, severe cases get immunosuppressants

Pityriasis rosea Presentation

Salmon-colored macule initially, may be mistaken for ringworm. Next several weeks = generalized exanthem with mild to moderate pruritis, Christmas tree

Pityriasis rosea Treatment

Self-limited, sunlight may help, symptomatic control for itching

Seborrheic dermatitis Presentation

One of most common in adult and elderly, Parkinsons, HIV – check for if severe. Scaly, greasy rash – skin is pink, edematous, and covered with yellow to brown scales and One of most common in adult and elderly, Parkinsons, HIV – check for if severe. Scaly, greasy rash – skin is pink, edematous, and covered with yellow to brown scales and crusts. Scalp, forehead, eyebrows, area around nose/ears. Common in infancy – cradle cap.

Seborrheic dermatitis Treatment

OTC dandruff shampoo leave on 5-7 mins. Resistant form may require shampoo 2.5 selenium sulfide, ketoconazole, or detoconazole. For superinfection Cephalexin 7-10 d. Not contagious

Folliculitis Presentation

Staphylococcus. Multiple small papules on erythematous base, can be large yellow white tender pustules in adults. Common in places hair is present, widespread is characteristic, bumpy rash, no itching.

Folliculitis

Only if becomes infected. Large lesions cleansed with weak soap solution, followed by soaking with saline or aluminum subacetate BID. TAO can be used BID for 5 days. Oral ABT 1st gen cephalo. if resistant