SKIN EXAM & DERM THERAPY PDF Flashcards by Namitha Kache

when describing skin lesions = what to include

carefully describe ALL skin lesions
indicate the distribution of the lesions (where are they on the body?)
indicate the configuration of the lesions (shape & grouping)
indicate the color of lesions

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lesions that represent the early stage of the lesion, how they look when they start, prior to evolving

PRIMARY LESIONS

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lesions that represent a later stage; after the lesion has evolved or been altered

SECONDARY LESIONS

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Identifying the lesion as primary or secondary may help you determine

where in the skin the process is occurring (epidermis, dermis, fat)

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types of primary lesions

Macule
Patch
Papule
Nodule
Plaque
Wheal
Cyst
Vesicle
Bullae
Pustule
Telangiectasia

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types of secondary lesions

Crust
Scale
Induration
Erosion
Ulcer / ulceration
Atrophy

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flat, non-palpable lesion < 1cm

MACULE

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flat, non-palpable circumscribed lesion > 1cm

PATCH

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Vitiligo is what type of primary lesion

PATCH

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Macules & Patches = only represent a change in

Red means
White means
Brown means

color

the color helps to locate the pathology
⦁ Red = from blood vessels in the dermis
⦁ White = from loss of melanin in the epidermis
⦁ Brown = from melanin in the epidermis or dermis

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Palpable, elevated solid mass
Up to 1cm (< 0.5 cm)
Example: elevated nevus

PAPULE

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palpable elevated solid mass > 0.5 cm

NODULE

Palpable
Elevated solid mass
0.5 cm to 1-2cm
Often deeper and firmer than a papule

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Large nodules, >2cm are often referred to as

tumors

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plateau like lesion > 0.5 cm

plaque

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Palpable
Flat, elevated surface
Larger than 1 cm
Often formed by the coalescence of papules

plaque

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Special plaque composed only of fluid (a hive)

wheal

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primary lesion that is somewhat irregular
Relatively transient
Superficial area of localized skin edema

Example: mosquito bite, hives

wheal

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Papule or nodule filled fluid or semisolid material

cyst

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fluid filled blister (< 0.5cm)

vesicle

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fluid filled blister (> 0.5cm)

bullae

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Cloudy fluid filled lesion containing Cloudy fluid filled lesion containing many inflammatory cells (pus)

pustule

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Dilated superficial vessels (not Dilated superficial vessels (not “broken blood vessels”)

telangiectasia

dried fluid & keratinocytes arising from broken vesicles & bullae

crust

thickened stratum corneum (scale occurs in the epidermis)

scale

scale occurs in the

epidermis

increased firmness & thickening of the dermis

induration

loss of epidermis

erosion

loss of epidermis & some or all of dermis and sometimes subcutaneous tissue

ulcer

loss of dermis or fat (sunken in) or thinning of the epidermis (skin becomes finely wrinkled and translucent)

atrophy

shapes & configurations of lesions

- annular - grouped - linear - dermatomal

making a circle, round or oval, clear in the center

annular

lesions Going along the nerves

dermatomal

efficacy of dermatologic topical therapy is related to

1. the concentration of the medication 2. the vehicle (mode in which med is in = ointment / cream / lotion / etc) 3. the active ingredient (correlates with strength) 4. anatomic location

most effective vehicle for penetrating the skin

ointment = greasy & moisturizing, but messy ex: vaseline

vanish when rubbed in; are less greasy, can sting, and are more likely to cause an allergy (due to preservatives / fragrances)

CREAMS

liquid & has a cooling effect | good for use in hairy areas

lotion

liquids that are greasy or alcoholic; can sting, good for hairy areas

SOLUTIONS

semi solid alcohol-based; can sting; good for hairy areas or wet lesions

GELS

cosmetically elegant; good for hairy areas

FOAM

how many grams of topical medication covers the whole body

30g

each whole leg is ____% of body surface area (BSA)

18%

formula for calculating how many grams needed per application

grams for whole body x % of BSA needing medication ex: for 1 whole leg = 30g x 18% = 30 x 0.18 = 5.4g per application ex: ex: rash on left calf; must apply topical BID. How much does she need for 1 month? 30g x about 4% = 30 x 0.04 = 1.2 x 2 (BID) = 2.4 x 30 = 72g = give 80g...

the sole of the foot = _____% of BSA

BSA OF THE BODY

- head = 9% (anterior = 4.5, posterior = 4.5) - front torso = 18% - back = 18% - each arm = 9% (anterior arm = 4.5%, posterior arm = 4.5%) - each leg = 18% (anterior = 9%, posterior = 9%) - genitalia = 1%

ex: How much would you prescribe for 1 month if someone needed to medicate both soles of their feet qd?

- if each sole = 1%, then both soles = 2% | - 30g x 0.02 x 30 days = 18g (0.5 oz)

steroid potency is inherent to the _________, not the concentration

class / molecule

STEROIDS ``` super high potency high potency medium potency mid-low potency low potency ```

⦁ Super High Potency = Clobetasol (Temovate) ⦁ High Potency = Fluocinonide (Lidex) ⦁ Medium Potency = TAC ⦁ Mid - Low Potency = Aclometasone (Aclovate), Desonide ⦁ Lowest potency = Hydrocortisone

applying corticosteroids

- can be applied in general areas or as spot treatment - SOAK & SMEAR = patient soaks in tub x 15 minutes to open pores, then smear topical steroid on the skin ⦁ sometimes occlusion with saran wrap or vinyl suit over the area is done to increase penetration of steroid into skin - Typically mid-low / lowest potency steroids (aclometasone / desonide / hydrocortisone) are used on the face, and stronger steroids are used on the body. Using stronger steroids on the face may cause atrophy (thins the skin)

SE of topical steroids

⦁ Acne (perioral dermatitis / rosacea) can result when a higher potency steroid is used on the face ⦁ Atrophy & Striae (stretch marks) can result when steroid used in groin or armpits ⦁ Petechiae & Telangiectasias are possible from skin atrophy ⦁ Increased fungal infections (ex: steroids suppress the immune response from killing the fungus on its own)

fungistatic vs fungicidal

``` fungistatic = stop fungus from growing fungicidal = kill the fungus ```

topical antifungals

- Fungistatic = stop fungi from growing - Fungicidal = kill the fungi - not all conditions are treatable with topical antifungals (ex: hair & nail infections do NOT respond to topical treatment and require systemic treatment)

imidazoles are ____________ examples of imidazole drugs

o IMIDAZOLES = fungistatic ``` ⦁ Ketoconazole ⦁ Clotrimazole (OTC) = Lotrimin ⦁ Econazole ⦁ Oxiconazole ⦁ Sulconazole ⦁ Miconazole (OTC) ```

allylamines are ____________ examples of allylamine drugs

o ALLYLAMINES (fungicidal) ⦁ Terbinafine (Lamisil) ⦁ Naftifine (Naftin) ⦁ Butenifine ⦁ Ciclopirox = may have both fungistatic & fungicidal properties)