Skin Lesions/Skin Conditions Flashcards
Treatment of mild comedonal acne vulgaris
Topical retinoid or benzoyl peroxide
Treatment of mild to moderate inflammatory acne
Topical retinoid, benzoyl peroxide, or antibiotic
Treatment of moderate to severe inflammatory acne
Topical retinoid or benzoyl peroxide or oral antibiotics
Treatment of severe nodulocystic acne
Oral retinoid (derm referral), topical benzoyl peroxide, or oral antibiotic
If limited response after 3 months antibiotic therapy….
Increase does, change medication, or refer to derm
Follicular plug
Excessive keratin in an inactive hair follicle»resulting in rough, cone-shaped elevated papules
Teratogenic
Can disturb the development of the fetus; increased risk of spontaneous abortion, birth defects
Adverse effects of oral isotetinoin
dry skin, lips, nose, mouth, pruritus, epitaxis, conjunctivitis; increased intracranial pressure, pancreatitis, IBS, premature epiphyseal closure, hyperlipidemia
Telangiectasia
Condition in which widened venules cause threadlike red lines or patterns on the skin (spider veins)
Differential diagnoses of acne
Peri-oral dermatitis, keratosis pilaris, rosacea, steroid folliculitis
Rosacea clinical presentation
Skin: papules and pustules, erythema, telangiectasia
Nonskin: mild conjunctivitis, redness of sclrea, blepharitis, telangiectasia of lid
Differential diagnoses of rosacea
Staphylococcal folliculitis, pustular tinea, systemic lupus erythematous, perioral dermatitis
Classification of rosacea
Erythematotelangiectatic (erythema and telangiectasia on nose and cheeks)
Papulopustular (erythema with papules and pustules on nose and chin, erythematous patches on cheeks)
Phymatous (facial erythema, scattered pustules and papules on forehead, nose, cheeks, chin; thick, oily skin; rhinophyma)
Stage 1 pressure ulcer
Nonblanchable erythema
Stage 2 pressure ulcer
Loss of epidermis w/ or w/o true ulceration; ulcer shallow with a pink to red wound be without slough
Stage 3 pressure ulcer
Full-thickness (into subcutaneous or beyond) loss w/o underlying muscle, tendon, or bone exposure
Stage 4 pressure ulcer
Full thickness with underlying bone, tendon, or muscle exposure
Unstageable pressure ulcer
Covered with debris or eschar which does not allow depth assessment
Diffuse hair loss (telogen effluvium)
Reversible; caused by chemo or other meds (lithium, warfarin, beta-blockers, retinoids, interferon, amphetamine); initial labs - TSH, hemoglobin/hematocrit, iron
Patterened hair loss
Miniaturization of individual hair follicles/shaft due to effects of dihydrotestosterone, hyperandrogenism; topical minoxidil, oral finasteride, hair transplant
Circumscribed (non-scarring) alopecia
Autoimmune process in which T-lymphocytes surround hair bulb deep in dermis; no inflammation
Scarring alopecia
Irreversible; active lesions with scalp inflammation and eventually scalp scarring; lichen planus and discoid lupus cause
Characteristics of psoriasis
- Occurs at any age
- chronic relapsing skin disease
- sharply demarcated plaques
- silvery scales
- Auspitz sign
- extensor surfaces (may be on palms and soles)
Symptoms and associated disease with psoriasis
- Guttate psoriasis can be triggered by streptococcal infection
- onycholysis and pitting of nails
- Koebner
- psoriatic arthritis
Pathogenesis of psoriasis
Increased proliferation and shedding of keratinocytes
Treatment of psoriasis
Topical retinoids and steroids
UV light
Characteristics of lichen planus
- skin, hair, nails and mucous membranes (especially oral mucosa) may be affected
- insatiable itching
- can occur abruptly or secondary to drug
- flexor surfaces
Symptoms and associated disease of lichen planus
- violaceous and hyperpigmented polygonal papules and plaques
- Wickham striae (thick hyperkeratotic plaque with white lacelike pattern)
- Koebner
- oral squamous carcinoma rare
5 Ps of lichen planus
Pruritic Planar Polygonal Purple Papules/plaques
Treatment for lichen planus
- Self-limited resolves in 8-12 months
- first line is topical steroids
Seborrheic dermatitis characteristics
- Common, chronic inflammatory papulosquamous disease
- any age; peaks in adolescence
- linked to Pityrosporun(Malassezia) yeast
- favors areas with sebaceous glands (scalp margins, central face, presternal areas)
Seborrheic dermatits symptoms and associated diseases
- moist, transparent to yellow, greasy and scaling with coalescing red patches and plaques
- locations: eyebrows, base of eyelashes, nasolabial folds and paranasal skin, external ear canals
- flexural skin (skin on skin)
- seborrheic blepharitis
- cradle cap
Seborrheic dermatitis treatment
- topical antifungals
- antidandruff shampoo or soaps containing zinc pyrithione (ZNP)
Acute atopic dermatitis
Poorly defined erythematous patches, papules, and plaques with or without scale. Skin may be extremely dry, cracked, and scaly.
Chronic atopic dermatitis
Lichenification results from repeated rubbing or scratching; Fissures
Atopic dermatitis characteristics
- Usually begins in infancy
- Characterized by dry skin and pruritus; consequent rubbing leads to increased inflammation and lichenification and to further itching and scratching: itch-scratch cycle
- skin barrier dysfunction
- Often associated with a family history of AD, allergic rhinitis, and asthma
- Most experts believe there is a genetic basis for AD (80% concordance in monozygotic twins), influenced by environmental factors
- Staph aureus exotoxins may trigger
Location of atopic dermatitis
Predilection for the flexures, front and sides of the neck, eyelids, forehead, face, wrists, and dorsa of the feet and hands. Generalized in severe disease.
Exacerbations of atopic dermatitis
- Skin Barrier Disruption: decrease of barrier function and increased transepidermal water loss.
- Infections: S. aureus secondary infection is often present in severe case
Special populations of atopic dermatitis
- Children: affects the cubital and popliteal fossae, neck, and face
- Adults: lichenification and exoriations
Atopic dermatitis management
- optimal skin care (hydration, topical, unscented moisturizers)
- NO ANTIHISTAMINES
- Antibiotics if secondary infection suspected
- wet-wrap therapy