Skin Intro Flashcards
What are the Fitzpatrick skin types?
Type 1 - pale white skin, blue/green eyes, blonde/red hair - doesn’t tan, always burns
Type 2 - fair skin, blue eyes - burns easily, tans poorly
Type 3 - darker white skin - tans after initial burn
Type 4 - light brown skin - burns minimally, tans easily
Type 5 - brown skin - rarely burns, tans dark easily
Type 6 - dark brown/black skin - never burns, always tans
What are the functions of the skin?
- Barrier to external injury
- Temperature control
- Fluid and electrolyte balance
- Produces vitamin D
- Cosmetic function
What is intrinsic aging?
Passage of time, skin becomes finely wrinkled, exaggeration of expression lines, laxity and pallor
What is photo aging?
Alterations in skin structure from chronic sun exposure in addition to passage of time
Causes xerosis, irregular pigmentation and more pronounced wrinkling
What is a nodule?
Solid raised lesion >3mm in diameter - contains no fluid
What is a papule?
A small solid raised lesion
What is a macule?
A flat coloured lesion - not raised
What is a patch?
A large flat coloured lesion
What is a vesicle?
A small fluid filled lesion <1cm
What is a bulla?
A larger fluid filled lesion >1cm
What is a cyst?
A soft raised encapsulated lesion filled with semi-solid or liquid contents
What is a pustule?
A vesicle filled with fluid and leukocytes
What is a plaque?
A large, flat-topped raised lesion
What is erythema?
Redness of the skin due to capillary dilation
What is a scale?
A collection of cells that have departed from the epidermis
What is excoriation?
Injury caused by scratching when the epidermis and dermis are removed
What is lichenification?
Thickening of the skin characterised by accentuated skin fold marking
What is a crust?
Dried exudate of body fluids that may be yellow or red
What is atrophy?
An acquired loss of substance
How would you diagnose skin conditions?
- Distribution
- Type of primary lesion
- Shape of individual lesions
- Arrangement
- linear - external
- generalised - systemic
What patient history would you need to diagnose a skin condition?
- Evolution of symptoms
- Associated symptoms
- Past/current medications
- Ongoing/previous illness
- History of allergies
- Presence of photosensitivity
What are the causes and triggers for eczema?
- Environmental irritants
- irritants
- extremes of temp and humidity
- abrasive fabrics - Infection
- Environmental allergens
- inhaled allergens
- dietary factors - Endogenous
- stress
- hormonal changes in women
What are the stages of eczema?
- Acute - skin is very oedamatous producing papules or bullae
- Subacute - glistening of skin with redness, scaling and crusting - secondary infection is common
- Chronic - skin is red, dry, scaly and slightly thickened with a tendency to crack and fissure
What are the clinical features of eczema?
Intense pruritis in all forms except seborrhoeic eczema
Itch - scratch - excoriation - lichenification
Epidermal barrier is disordered leading to secondary infection
What is discoid eczema?
A type of eczema that occurs in circular or oval patches on the skin
What is contact dermatitis?
A type of eczema that occurs when the body comes into contact with a particular substance
What is varicose eczema?
A type of eczema that occurs most often on the lower legs caused by problems with the flow of blood through the leg veins
What is seborrhoeic eczema?
A type of eczema where red scaly patches develop of the scalp, eyebrows, ears and sides of the nose
What is infantile seborrhoeic eczema?
Often but not always affects the scalp - cradle cap
What is pompholyx?
A type of eczema that causes tiny blisters to erupt across the palms if the hands
What is atopic eczema?
A chronic relapsing inflammatory skin condition characterised by a red itchy rash that favours the skin creases
What are the clinical features of atopic eczema?
- Pruritis
- Facial and flexural eczema in infants
- Flexural eczema in adults and children
- Chronic or relapsing dermatitis
- Personal or family history of atopy
What is the diagnostic criteria for atopic dermatitis?
An itchy condition plus three or more:
- Onset of signs and symptoms before the age of 2
- Personal history of allergy or allergic rhinitis
- Personal history of dry skin over the last 12 months
- Personal history of flexural eczema
- Visible flexural eczema involving the skin creases
What are the localised variants of atopic eczema?
- Eyelid
- exposed to environmental allergens and irritants
- ribbing or scratching can cause loss of eyelashes - Palmar/plantar
- glistening erythema with varying degrees of scaling and fissuring - Cheilitis
- dry scaly lips
What are the signs and symptoms of eczema?
- Pruritis
- Erythema
- Dry skin
- Scaly plaque in flexural surface
- Lichenification that feels thick/rough and is often hyper pigmented
- Hyper and hypopigmentation
How do you manages atopic eczema?
- Emollients and soap substitutes
- Topical corticosteroids or calcineurim inhibitors (second line) for ACUTE treatment
- Oral antibiotics for infections
What lifestyle treatment can you give for eczema?
- Avoid triggers
- Education
- Mittens and filed nails
- Soap substitutes
What is the fucntion of emollients?
- Improve hydration of skin
- Prevent scaling and cracking
- Restore barrier function
What emollients are used?
White soft paraffin and emulsifying ointment/liquid - occlusive effect
Urea - hydrating agent
Fire risk
How do topical corticosteroids work?
Used for acute control and maintenance
Control inflammation
- body site
- eczema severity
- age of patient
Use finger tip unit
What are the guidelines for topical corticosteroids?
- Use least potent that relieves symptoms
- Choose correct strength for correct body area
- Make sure emollients are used correctly
- Children under 12 with atopic eczema refer to nice
What are the potencies of topical corticosteroids?
Mild - hydrocortisone 0.1 - 2.5%
Moderate - clobetasone butyrate 0.05%
Potent - hydrocortisone butyrate 0.1%
Very potent - clobetasol proprionate 0.05%
What are the side effects of corticosteroids?
- Transient burning or stinging
- Worsening and spreading of untreated infection
- Permanent striae
- Thinning of skin
- Acne vulgaris/rosacea
- Excessive hair growth at site of application
- Allergic contact dermatitis
- Mild depigmentation
Systemic:
1. Growth suppression in children
2. Adrenal supression
3. Cushing syndrome
How do topical calcineurin inhibitors work?
Acute control or maintenance
Inhibit inflammatory cytokines transcription in active T cells and other inflammatory cells through inhibition if calcineurin
Steroid sparing effect
What are the adverse effects of TCI?
- Burning
- Stinging
- Soreness
- Pruritis
- Skin infections
How does pimecrolimus work.
1% cream that should be used early at the first sign of itching
Prevent flare progression and increase the time between flares
Can be used in children over 2 and adults
How does tacrolimus work?
0.1 or 0.03% ointment
Have a rapid and sustained effect in signs and symptoms of atopic eczema
Improvement after 1 week and sustained over 12 months
Children over 2
What is seborrhoeic eczema?
- A hyperproliferative skin disorder
- Sharply marginated covered with greasy looking scales
- Affects scalp, chest, back, face and groin
- Flaky, redness and dryness of skin
- Malassezia yeast species
