Tutorial 2- Benign Lesions/Elderly Skin Flashcards
Features of elderly skin (7)
Rhytides (wrinkles)
Skin thinning
Solar/actinic purpura
Dyspigmentation
Subcutaneous lipoatrophy
Actinic damage
Solar lentigos
What are rhytides?
Wrinkles
What is actinic damage, or photoaging
Actinic damage, or photoaging, is distinct from the changes of chronological aging of the skin.
Manifestations include: Solar elastosis, Favre-Racouchot syndrome, Poikiloderma of Civatte
What is solar elastosis? What does it look like histologically?
Solar elastosis is thickened, yellowish discolored skin with significant wrinkling. Histologically, there are increased elastin fibres in the dermis.
What is poikloderma of vicatte?
Poikiloderma of civatte is reticulated pigment and telangiectasia on the sun-exposed areas of the neck, with sparing of the submental chin.
What is Favre-Racouchot syndrome
In Favre-Racouchot syndrome, there are multiple large comedones in the lateral and inferior periorbital skin associated with significant solar elastosis.
T or F? 80% of a person’s lifetime risk of skin cancer occurs before the age of 18
False.
The importance of sunscreen in elderly skin is often minimized or overlooked.
There are benefits of sunscreen use in the adult population, with significant decreases in the number of actinic keratoses in study subjects who used sunscreen for as little as a single summer.
What is acne rosacea?
Acne rosacea is a common skin disease in adults, affecting up to 12% of elderly patients. It has both vascular and inflammatory manifestations.
What are key features of acne rosacea? (6)
facial flushing (transient erythema) non-transient baseline erythema papules and pustules telangiectasias burning or stinging of the skin underlying soft tissue hypertrophy- can be rhinophyma
What is rhinophyma?
Soft tissue hypertrophy of the nose.
Associated with acne rosacea
What is the pathogenesis of acne rosacea?
Pathogenesis - unknown. The disease is on a clinical spectrum with acne vulgaris.
What are common triggers for the flushing seen in acne rosacea? (4)
UV light exposure, exercise, hot beverages, and spicy foods.
How do you treat inflammatory rosacea, including severe and most severe cases?
Inflammatory rosacea is treated with topical agents such as topical metronidazole, azelaic acid, precipitated sulfur, sodium sulfacetamide, or tretinoin (Retin-A). Most severe disease is treated with oral tetracycline class antibiotics. The most severe cases are treated with oral isotretinoin (Accutane).
How do you treat vascular rosacea?
What is the treatment of choice for telangiectasia?
Vascular rosacea responds minimally to topical and oral anti-inflammatory therapy. Treatments for vascular manifestations of the disease include oral beta-blockers such as nadolol or the alpha blocker clonidine. These medications help to improve flushing, though do not improve facial telangiectasia or baseline erythema.
The treatment of choice for telangiectasia is with a hemoglobin targeting laser such as a 585-595nm tunable pulsed-dye laser or the 532nm diolite laser.
How do you treat sebaceous and soft tissue changes in acne rosacea?
nasal planing
T of F? There is no relationship between alcohol use and acne rosacea?
True
Cutaneous growths commonly encountered during the skin exam of older patients
Seborrheic keratosis Acrochordon Solar lentigo Melanocytic nevi Cherry hemangioma Sebaceous hyperplasia Epidermoid cyst Milium Dermatofibroma Neurofibroma Lichen simplex chronicus and prurigo nodularis
What are seborrheic keratoses (SK)?
Seborrheic keratoses, or SKs, are very common benign skin lesion with a variety of morphologies, commonly affecting older persons, with an increasing number with increasing age.
Where do seborrheic keratoses occur and what do they look like?
The lesions occur on hair-bearing skin, with a sharply marginated “stuck-on”, waxy appearance. They are commonly light brown macules, papules, or plaques, though they can range from flesh-colored to black in color.
T of F: Seborrheic keratoses may be inherited in an autosomal dominant fashion
True
T or F: There is no association with HPV and seborrheic keratoses
True
What histological sign is seen in SK?
String of beads: SK lies on a flat horizontal plane surrounded by normal epidermis.
What histological signs can be seen in SK?
Proliferation of benign-appearing squamous and basaloid cells without cytologic atypia. There is hyperkeratosis, acanthosis, papillomatosis, and the presence of horn pseudocysts.
What is acanthosis?
Acanthosis is diffuse epidermal hyperplasia (thickening of the skin). It implies increased thickness of the stratum basale and stratum spinosum
What is hyperkeratosis?
thickening of the stratum corneum
What is Papillomatosis?
Papillomatosis is skin surface elevation caused by hyperplasia and enlargement of the dermal papillae
How do you treat SKs?
these lesions are benign so usually you don’t need treatment. But they can become traumatized, inflamed, erythematous, painful, or pruritic. In that case–> treat.
Destructive treatment methods include cryotherapy, electrodessication, and shave removal
What are acrochordons?
A skin tag or soft fibroma.
Acrochordons are soft, flesh-colored to tan-brown pedunculated papules. Lesions range in size from 1mm to 2cm. Acrochordons are asymptomatic, but may be painful secondary to torsion, irritation or infarction.
Where are acrochordons most commonly found?
in skin fold areas such as the lateral aspects of the next, breast creases, and groin folds.
What do acrochordons look like histologically?
Histologically, lesions are polypoid growths dense collagenous stroma containing blood vessels with a relatively normal-appearing overlying epidermis.
