Week 3 - Skin, Hair, Nails

Question 1

What are the types of cyanosis? What are the causes and areas to detect each type of cyanosis?

Answer 1

Central cyanosis occurs because of low levels of oxygen in arterial blood. It will be seen in the lips,
tongue, and oral mucosa. Causes include advanced lung disease, congenital heart disease, and
hemoglobinopathies.

Peripheral cyanosis occurs when cutaneous blood flow decreases and slows, and tissues extract more
oxygen than usual from the blood. This can be a normal response to anxiety or a cold environment and is
often seen in the nails, hands, and feet. Causes include congestive heart failure or venous obstruction.

Question 2

What are the causes of generalized itching?

Answer 2

Causes of generalized itching include dry skin, aging, pregnancy, uremia, jaundice, lymphomas and
leukemias, drug reactions, and lice.

Question 3

How common is skin cancer in USA? What are the types of skin cancers? How do they look like?

Answer 3

Skin cancer is the most common of all cancers. About 3.5 million cases of basal and squamous cell skin
cancer are diagnosed in this country each year. Melanoma, a more dangerous type of skin cancer, will
account for more than 73,000 cases of skin cancer in 2015.

Basal Cell Carcinoma
Comprises 80% of skin cancers
Shiny and translucent with telangiectic vessels, they grow slowly and rarely metastasize

Squamous Cell Carcinoma
Comprises 16% of skin cancers
Crusted, scaly, and ulcerated, they can metastasize

Melanoma
Comprises 4% of skin cancers
Rapidly increasing in frequency, they spread rapidly

Question 4

What is the most lethal type of skin cancer? Which ethnic population in the USA·has the highest rate of skin cancer?

Answer 4

Melanomas are the most lethal type of skin cancer. White males have the highest incidence.

Question 5

What are the HARMM risk factors and additional risk factors for melanoma?

Answer 5

HARMM Risk Factors for Melanoma
▪ History of previous melanoma
▪ Age over 50
▪ Regular dermatologist absent
▪ Mole changing
▪ Male gender

Additional Risk Factors for Melanoma
▪ ≥50 common moles
▪ ≥1-4 atypical or unusual moles (especially if dysplastic)
▪ Red or light hair
▪ Actinic lentigines, macular brown or tan spots (usually on sun exposed areas)
▪ Heavy sun exposure (especially severe childhood sunburns)
▪ Light eye or skin color (especially freckles/burns easily)
▪ Family history of melanoma

Question 6

What is the most commonly recommended screening measure for skin cancer?

Answer 6

Total-body skin examination by a clinician is the most commonly recommended screening measure

Question 7

What are the ABCDEs of examining moles for detection of melanoma?

Answer 7

ABCDE: Screening Moles for Possible Melanoma
▪ A for asymmetry
▪ B for irregular borders, especially ragged, notched, or blurred
▪ C for variation or change in color, especially blue or black
▪ D for diameter ≥6 mm or different from other moles, especially changing, itching, or
bleeding
▪ E for elevation or enlargement

Question 8

How will you counsel patient about prevention of skin cancer?

Answer 8

Counsel them about preventative strategies such as reducing skin exposure, using sunscreen, routine self-examination.

Question 9

What are the different skin color or color change you may find? What are the causes of pallor?

Answer 9

Changes include increased pigmentation, loss of pigmentation, redness, pallor, cyanosis, and yellowing.
Pallor can be caused by anemia and decreased blood flow, such as in fainting or arterial insufficiency.

Question 10

What is jaundice? What are its causes? Where will you detect it?

Answer 10

Jaundice is yellowing of the skin and eyes. It suggests liver disease or excessive hemolysis of red blood
cells. It can be seen in the sclera, palpebral conjunctiva, lips, hard palate, underside of the tongue,
tympanic membrane, and skin.

Question 11

What is carotinemia? What are the areas you look for to detect it?

Answer 11

Yellow or orangish color of the palms, soles or feet, and face caused by very high levels of betacarotein
in the blood.

Question 12

What are the causes of skin dryness and of oiliness? What are the causes of skin roughness and of velvety texture?

Answer 12

Dryness can occur in hypothyroidism; oiliness can occur with acne.

Skin roughness also occur in hypothyroidism, but velvety texture could be hyperthyroidism.

Question 13

What are the usual areas of distribution of lesions in acne, psoriasis, candida albicans infection, and atopic eczema? Describe appearance of each lesion.

Answer 13

Acne affects the face, upper chest, and back.
Psoriasis affects the knees and elbows (extensor surfaces).
Candida albicans affects the intertriginous areas (areas where skin rubs together such as armpits).
Atopic eczema appears mostly on flexor surfaces.

Question 14

What are the pattern of lesion in Herpes and ring worm?

Answer 14

Herpes lesions are typically in a unilateral dermatomal pattern - sensory nerve distribution

Ring worm is typically in a serpiginous pattern (circular with a wavy margin).

Question 15

What are the risk factors for pressure ulcers? How can you diagnose it early?

Answer 15

Risk factors include patients confined to bed, especially if they are emaciated, elderly, or neurologically
impaired.
Local redness or ulcers of the skin may warn of impending necrosis.

Question 16

What are the causes of hair loss? How will you distinguish between them? What are the hair
characteristics in hypo-and-hyperthyroidism?

Answer 16

Alopecia areata will show clearly demarcated oval or round patches of hair loss with no inflammation.

Trichotillomania will show patches with broken hair shafts of varying lengths.

Tinea capitis (ringworm) will show patches with all of the hair broken off close to the scalp.

Dry, rough hair is typical of hypothyroidism.

Fine, silky hair is typical of hyperthyroidism

Question 17

Define paronychia, clubbing of finger nails, onycholysis, Mees’ lines, and pitting of nails.
What are the causes of each? How will you diagnose clubbing?

Answer 17

Paronychia is red, swollen, and tender nail beds due to a superficial infection of the proximal and lateral
nail folds.

Clubbing of finger nails is a bulbous swelling of the soft tissue at the nail base diagnosed by a nail angle
of greater than 180 degrees seen when placing the same nail of each hand against each other (showing no
space in between). This is caused by increased blood flow due to hypoxia.

Onycholysis is a painless separation of the whitened opaque nail plate from the pinker translucent nail
bed. Causes included trauma, psoriasis, fungal infection, and allergic reactions.

Mees’ Lines are transverse white bands in the nail parallel to the lunula. They are seen in arsenic
poisoning, heart failure, Hodgkin’s disease, chemotherapy, CO poisoning, and leprosy.

Nail pitting show defects in the nail plate often associated with psoriasis.

Question 18

What is koilonychias? What is its cause?

Answer 18

Koilonychias are spoon-like depressions in the nails associated with iron deficiency anemia

Question 19

How will you record physical exam findings of skin?

Answer 19

Initially you may use sentences to describe findings; later you will use phrases such as “Color good. Skin
warm and moist. Nails without clubbing or cyanosis. No suspicious nevi. No rash, petechiae, or
ecchymoses.”

Question 20

What happens to skin pigment in Addison’s disease? What are the causes of palmer Erythema
and spider angioma?

Answer 20

Skin pigment in Addison’s disease becomes hypersaturated and often appears bronze.
Palmar erythema with spider angiomas suggest possible liver disease and basal cell carcinoma.

Question 21

What is the cause of cafe-au-lait spots?

Answer 21

Café-au-lait spots are not pathologic unless you find several large ones together suggestive of
neurofibromatosis.

Question 22

What causes tinea versicolor? How does it look like? What are the usual sites?

Answer 22

Tinea versicolor is caused by a superficial fungal infection of the skin. It looks like hypopigmented,
slightly scaly macules on the trunk, neck, and upper arms.

Question 23

How does Vitiligo look like? What are the sites?

Answer 23

Vitiligo are depigmented macules on the face, hands, feel, and extensor surfaces

Question 24

Which infection causes “slapped cheek”?

Answer 24

Erythema infectiosum (“fifth disease” of childhood) causes “slapped cheek”. Viral infection

Question 25

What is heliotrope and what is its cause?

Answer 25

Heliotrope is violet skin over the eyelids caused by dermatomyositis (a collagen vascular disease).

Question 26

Define macule, patch, papule, nodule, vesicle, bulla, pustule, scales, and fissure

Answer 26

Macule: flat, slightly pigmented skin patch measuring smaller than 2 cm (e.g., freckle)
Patch: similar to macule but larger (e.g., childhood rash caused by measles)
Papule: slightly elevated, smaller than 1 cm (e.g., eczema caused by allergy)
Nodule: similar to papule but greater than 1 cm (e.g., nevus [mole])
Vesicle: fluid-filled elevation of epidermis, smaller than 1 cm (e.g., herpesvirus lesion on the lip)
Bulla: vesicle that measures more than 1 cm (e.g., burns)
Pustule: vesicle filled with pus (e.g., impetigo [bacterial infection])
Scales: keratin layers covering the skin as flakes or sheets that can be scraped away (e.g., seborrheic
keratosis, psoriasis)
Fissure: sharp-edged defect extending deeper into dermis (e.g., athlete’s foot)