skin Flashcards
Layers of the skin, their cells and their functions
Hypodermis (fatty supportive tissue)
epidermis:
- Contains melanocytes to protect from UV light,
- Skin cancers at this level
Dermis -Physical support and nutrients -Made elastin's, fibrillin and collagen -Contain nerve ending, sweat glands, sebaceous glands, hair follicles, Blood vessels -
What questions are asked to diagnose skin conditions
History, PC, HPC, O/E, PMH, FH, SH and DH
- Location of symptoms
- Odour
- In contact with irritant
- Discharge
List of skin infections
Tinea Infections
Warts and verrucae (viral)
Cold sores
What are the anatomical classification of dermatophytes location
athlete’s foot (tinea pedis), groin infection (tinea cruris) ringworm (tinea corporis) Psoriasis Dermatitis
What is the aetiology of tinea infections?
Invade the stratum corneum, hair and nail
Fungus grows then begins to grow and proliferate in the non-living cornified layer of keratinised tissue of epidermis
Signs and symptoms of tineas pedis
- Itching
- Flaking and fissuring of the skin
- Skin appears white and ‘soggy’ due to maceration of the skin
- Feet often smell
- Usual site is in the toe webs, especially the fourth web space
- Infection can spread to the sole and instep of the foot
- Nail involvement may be present
What specific questions should be asked in relation to tineas pedis
Age & Sex of patient- prevalent to in young adults especially men
>Nail involvement in older patient
Presence of itch, burning or irritation
Associated symptoms: flaky, smelly and nail involvement
Previous history- Usually have acute
What os the treatments for tinea pedis
First line: Imidazole for candidiasis for 10 days
> Canesten is licensed for 7 days BD
>Can be used with hydrocortisone
> Used in 10 y/o and older
Terbinafine for dermatophytes
>P Medicine
>More effective than imidazoles
> For 16 y/o and older
Self help advice for tineas pedis
Dry the skin thoroughly after showering or bathing
Keep personal towel and do not share it
Wear cotton socks and change them at least once a day
Avoid use of occlusive non-breathable shoes
Dusts shoes and socks with antifungal powder
Avoid scratching infected skin
Use flip-flops when using communal changing rooms
Describe the appearance of Tineas corporis (ring worm)
Itchy pink or red scaly slightly raised patches with WELL DEFINED INFLAMED BORDER
does not involve the face, hands, feet, groin or scalp
Differential diagnosis of tineas corporis and what question to ask to eliminate each
Psoriasis – take family history. Lesions tend not to itch, and exhibit more scaling and do not show central clearing
Eczema/dermatitis- take family history. Very itchy, particularly affects arms and legs- can be difficult to differentially diagnose.
Treatment for tineas corporis
Same ad Tineas Pedis
and refer when large areas become involved
What are warts and verrucae
Benign growths of the skin caused by the Human Papilloma Virus
Occurs in children up till 16 y/o
How do warts and verrucae occur
HPV enters the host by the epithelial defects in the epidermis
Transmitted by direct skin-to-skin contact (even shed skin)
Once in the epithelial cells, the virus stimulates basal cell division to produce the characteristic lesion
what conditions need to be eliminated
Corn/callus: lesion on toes caused by ill fitting shoes
signs and symptoms of verrucae
- Found on sole of the foot, usually in weight bearing areas
- Pressure on the nerves can cause considerable pain
- Lesions normally reveal tiny black dots on surface
- Rarely larger than 1cm in diameter
- Occur singly or in crops
Treatment options for Warts and Verrucae
Avoid treatment in diabetic people
Most self resove
- Salicylic aids products
> The feet should be soaked and hard skin should be removed
> Add few drops to lesion and surrounding skin daily - Glutaraldehyde (Glutarol)
TWICE daily
S/E: Colours skin brown - Formaldehyde (Veracur)
TWICE daily - Silver Nitrate (Avoca Pen)
Moistened tip applied for 1-2 minutes - Freezing products to kill viral particles
> Up to 3 applications for warts and 6 application for verrucae
Self-help advice for W and V
- Do not to pick, bite, suck or scratch
- Cover with waterproof plaster/sock when swimming
- Wear flip-flops in communal showers
- Avoid sharing shoes, socks & towels
what are requirements for referral with warts and verrucae
- Anogenital warts
- Multiple & widespread warts
- Diabetics/immunocompromised
- Lesions to the face
- Warts that have changed colour, grown, itch/bleed
What is psoriasis
Chronic relapsing inflammatory disorder with lesions that present in a number of forms.
More prevalent in 40-50 years old
Rare in infants and uncommon in children
What is the pathogenesis of psoriasis
Increased thickness of epidermis; increased turnover of cell and abnormal maturation
Dilated blood vessels; activated t-lymphocytes and neutrophils enter the skin
Signs and symptoms of plaque psoriasis
- Salmon pink lesions with silvery white scales and well defined boundaries.
- Can be single or multiple lesions & vary in size
- Pinpoint bleeding beneath the lesion (DIAGNOSTIC)
- Not characteristically itchy
- Often symmetrical in distribution & most commonly involves extensor aspects of elbows & knees.
Signs and symptoms of scalp psoriasis
Can be mild, exhibiting slight redness of the scalp
Severe cases have marked inflammation and thick scaling
Redness often extends beyond the hair margin and is commonly seen behind the ears.
What questions should be asked when diagnosing psoriasis
Onset: first occurs most commonly in adults
Distribution: often symmetrical involving scalp & extensor aspects
Other symptoms: itch not normally present
Look at rash: scaling is obvious feature
Previous history: psoriasis is chronic & remitting
What are the treatment options for psoriasis
Emollients (Doublebase, Diprobase, Cetraben)
Help soften scaling and soothe the skin to reduce irritation, cracking and drying.
Applied regularly and liberally.
- Tar-based products (Alphosyl, Cocois, Pinetharsol)
Anti-mitotic: slows down rate of cell production
S/E: local skin/scalp reaction & stain skin/clothes. and possible increase in cancer - Dithranol: for plaque
Combines with DNA to reduce mitosis & inhibits proliferation
Short contact-time is recommended because prolonged exposure can lead to irritation and burning skin.
Suitable for face, flexures, acutely inflamed psoriasis
E.g. Dithro-cream : apply for 20-60 minutes then wash off and apply emollient - Topical steroids
May be prescribed but NOT licensed for OTC psoriasis
Self help advice for psoriasis
Remind patients that emollients should be used liberally and regularly
Some emollients will make bath slippery- so take care
Stress, alcohol, smoking can exacerbate the condition
Practice relaxation techniques, avoid alcohol & quit smoking
When is referral in psoriasis required
Extensive lesions, follow recent infection or cause itching
No family history or past history
Pustular lesions
What should never be used to treat psoriasis and why
Oral steroids: risk forsteroid-induced conversion to pustularpsoriasis, the long-term side effects ofsteroids, and deterioration ofpsoriasisafter withdrawal ofsteroids
What are the characteristics of dermatitis
sore, red itching skin.
What are the 2 main causes of psoriasis in primary care
Irritant contact
Allergic contact
Difference between ICD and ACD
ICD: agent must penetrate the outer layer of skin to invoke physiological response.
ACD: first requires sensitisation to occur. Once skin sensitised to allergen, re-exposure triggers memory T-Cells to initiate inflammatory response 24-48hours after exposure
Signs and symptoms of contact dermis’s
Acute phase: Lesions appear rapidly, within 6-12 hours of contactSkin appears red, itchy, inflamed & might show papules
Chronic Exposure: Skin becomes dry, scaly, and can crack/fissure
Both develop a rash
ICD rash tends to be well demarcated.
ACD tends to be less well defined
Treatment options for contact dermatitis
- Emollients
Apply regularly & liberally.
a) Moisturisers e.g. Aveeno, Diprobase, Oilatum
b) Bath additives e.g. Balneum, Oilatum
c) Soap substitute e.g. Emulsifying Ointment, Aqueous cream, E45
d) Humectants e.g. Urea, lactic acid (Calmurid, Aquadrate, Humiderm) - Topical steroids
OTC: Hydrocortisone 1% crm & Clobetason crm 0.05%
BD for 7 days
Not to be used on the face
Anti-inflammatory. S/E: thinning of skin
Self advice for dermatitis
Self-help advice:
AVOID soap/bubble bath use soap substitute
Avoid contact with stimulus
Referral requirements for dermatits
Children under 10 in need of corticosteroid
Lesions on the face unresponsive to emollients
OTC treatment failure
Widespread/severe dermatitis (signs of secondary infection
What is Discoid eczema
Long-term condition that causes skin to become itchy, reddened, swollen and cracked in circular or oval patches
Mainly affects adults
The cause is unknown
Signs and symptoms of discoid eczema
Distinctive circular/oval patch of eczema anywhere on body
First sign is usually group of small red spots/bumps. These join up to form large pink/red/brown patches.
Initially, patches are swollen & blistered. Tend to be itchy particularly at night
Over time, patches become dry, crusty, cracked & flaky
Can appear anywhere on the body except for face and scalp
Skin cancers
Mole/Naevus/seborrheic, keratoses
Actinic keratoses
Basal cell carcinoma
Bowmen’s/ squamous cell carcinoma
Melanoma
