Derm 1 Flashcards Preview

Pharm 558 > Derm 1 > Flashcards

Flashcards in Derm 1 Deck (27):
1


•Type of lesion
•Arrangement
•Distribution
 

Q image thumb

  • Vesicular, red, hot and inflamed, on trunk (not cross midline), follow dermatome
  • Shingles, terrible pain for a while and then get rash, lots of nerve pain
  • Vesicular, erythramateous, dermatome
  • Keep cool, moist packs, water, antiviral, pain pill (NO CREAMS/OINTMENT), creams too much for the first day, not rub on it
  • Capsaicin after lesion gone 

2

  • Flat
    • Macule
    • Petechiae
    • Ecchymosis
    • Infarct
    • Sclerosis
  • Depressed
    • Atrophy
    • Ulcer
    • Fissure
    • Erosion
  • Elevated
    • Papule
    • Plaque
    • Nodule
    • Wheal
    • Vesicle, bulla
    • Pustule
    • Abcess
    • Lichenification
    • Crust (exudate)
       

  • Flat
    • Macule: change in the color of the skin
    • Petechiae: small (1 - 2 mm) red or purple spot 
    • Ecchymosis: larger red or purple spot
    • Infarct: small localized area of dead tissue resulting from failure of blood supply
    • Sclerosis: hardening of skin 
  • Depressed
    • Atrophy: thinning or depression of skin
    • Ulcer: sore with disintigeration of skin
    • Fissure: crack
    • Erosion: loss of superficial layers
  • Elevated
    • Papule: dome shaped lesion
    • Plaque: solid, flat topped
    • Nodule: solid, more than 1 cm
    • Wheal: circular, red border, pale centers
    • Vesicle, bulla: circular, fluid filled, small
    • Pustule: pus filled
    • Abcess: larger, fluid/pus filled
    • Lichenification: thickening, perhaps from scratching
    • Crust (exudate): layer of dried serum

3

Which does not describe:
A.Linear
B.Vesicles
C.Ulcer
D.Erythema


How treat?

Water and itch correlation

Q image thumb

  • Not an ulcer
  • Rhu sensitivity
  • Not put anything on it when it is weepy like this
  • Water the first days, creams in the secondary days
  • Water and itch
    • Cooling effect
    • Evaporates and vasocontricts, less itching mediators to surface 
       

4

Atopic Dermatitis

Q image thumb

  • AKA: Eczema
  • Erythema
  • Chapping
  • Pruritus
  • Papules
  • Vesicles
  • Excoriation
  • Lichenification
  • Infection (S. aureus)
  • Chronic
  • Redness in acute phase, dryness I
    • Excoriating, digging, thickening like elephant, from scratching, cause infection
  • If not responding, might be infection
  • Common spot is flexor surfaces 

5

Eczema: Definition

  • Pruritic skin condition PLUS  (3 or more)
    • Onset < 2 years of age
    • Skin crease involvement
      • Flexural dermatitis
  • Generally dry skin
  • Other atopic disease (personal or family member)
     

A image thumb
6

When to Refer for Derm

  • Severe
  • Intense pruritus
  • Extensive involvement
  • <2 years of age
  • Infected
     

A image thumb
7

Atopic Dermatitis: Treatment

  • Stop “itch-scratch cycle
  • Hydration
    • during chronic phase
  • Avoid triggers
    • Allergies
  • Prevent infection
  • Emollients
    • grease, petroluem jelly, Vaseline, mineral oil, Always
  • Antihistamines
  • Hydrocortisone
  • Bath oils
    • get in water, prune up, then put on bath oil 
    • Not waterproof yourself and then get in bath
  • No soap
    • Cetaphil, baby soap, not wash away oils
       

8

Xerosis:

Q image thumb

  • Pruritic
  • Rough
  • Scaling
  • loss of flexibility
  • “Cracked”
  • ichthyosis
     

9

Xerosis: Marker for Systemic Diseases

  • Treat underlying cause, but in meantime, need to treat the xerosis
  • Hypothyroidism
  • Lymphoma
  • Kidney disease
  • Sarcoidosis
  • Ichthyosis
  • Atopic eczema
  • Drug side effects
    • Lithium, Vit A, niacin
       

10

Xerosis: Treatment

  • AKA: Winter Itch
  • Emollients (petrolatum, mineral oil, glycerine, propylene glycol)
  • Keratinolytics (urea, lactic acid)
    • When really bad, breaks down skin to let emollients in
  • Soap-free cleansers (Cetaphil)
  • Steroids
  • Antipruritics (systemic, topical (not))
    • Benadyrl, Sarna lotion
    • NOT topical because is a sensatizer, can get sensativities
  • Less showers

11

Scaly Dermatoses

  • Dandruff
  • Seborrheic Dermatitis
  • Psoriasis 
    • Normal skin turns over in 21 days
    • Psoriasis turns over in 3 days

12

Dandruff: Treatment

  • Better in summer, aggrevated by stress, difusse, pruitis, bald spots will have no dandruff, uncommon in children
  • Wash
  • Cytostatics
    • Pyrithione zinc
    • Selenium
    • Coal tar
  • Kertatolytics
    • Least potent, use if super scaly
      • Salicylic acid
      • Sulfur
  • Ketoconazole
    • Could encourage resistance, don't use randomly 

13

Seborrheic Dermatitis: What it is and Treatment
 

Q image thumb

  • Yellow/oily lesions on red skin – hair line, nasolabial folds, scalp, axillae, sternam or goin
    • occurs where sebacous glands (scalp, face, trunk)
    • Red, scaly, itchy, well demarcated
    • Worse in winter
    • Parkinson’s, zinc deficiency, endocrine states associated with obesity, and HIV

 

  • Wash/shampoo
    • will run down face
  • Cytostatics
  • Keratolytics
  • Ketoconazole*
    • When immunocompromised or obvious overgrowth
  • Steroids
    • because more inflammed
    • Kenlog aresol, looks less greasy
       

A image thumb
14

  Psoriasis

Q image thumb

  • Non-contagious, chronic inflammatory disease
  • Causes: environment, infection, steroid withdrawl, stress, endocrine changes
  • Start as papules and coelece to plaques, well demarcated, silvery scales (mineral mica)
  • Extensor, back, trunk, scalp
  • Nails: Onychomycosis
  • Psoriasis arthritis: assymetric
  • Treatments: 
    • Emollients
    • Cytostatics
    • Steroids
    • Calcipotriol
    • Retinoids
    • PUVA, UVB
    • Methotrexate
    • Immunomodulatory Agents (alefacept, etanercept, etc.)

A image thumb
15

Contact Dermatitis

Q image thumb

  • Inflammatory skin condition characterized by inflammation, redness, itching, burning, stinging and vesicle and pustule formation on dermal areas exposed to irritant or allergenic agents.
  • ICD (irritant), ACD (allergic)
  • Poison ivy, posion oak
  • Inflamed, red, itchy, blisters
  • Treatment:
    • General
      • Cool with water first, then use below
    • Topical anesthetics
      • NOOO!
    • Steroids
      • back of loggers hands, not work, too thick
    • Topical antipruritics
      • Calamine lotion
    • Astringents
    • Antihistamines
    • Bentoquam (Ivy Block)
      • you put on BEFORE

16

Diaper Dermatitis

Q image thumb

  • Erythramateous, fussy, hot
  • Reasons for diaper rash
    • Friction and Moisture
    • Overgrowth (killed good bacteria and bad overtook)
  • Change diapers frequently, cool and dry it, get air time (lock him in the kitchen on lineoleum)
    • Vasocontrists during air time
  • Wants protection
    • Not ointment, lock in moisture and not want fungi
  • Use cream: Destin,
  • Baby powders are okay, cornstarch can cause overgrowth (fungus and yeast love cornstarch)
  • If in the creases, then yeast
    • Clotrimazole cream because ointment be bad because yeast like moisture
  • Need to do both
    • Need antifungal cream, mix in steroid
    • 15g clotrimazole, 15 g, 1/2?% or 1%
    • Yeast love steroid by itself
    • Use ointment as a protectant (bag balm, desatin, etc.)
    • For refill, steroid not needed, just use antifungal cream 
       

17

UV Radiation

  • UVC (200-290 nm band)
  • UVB (290-320 nm band)
    • Sunburn radiation, skin cancer, aging
    • Vit D
  • UVA (320-400 nm band)
    • Photosensitizing, skin cancer, aging
       

18

Sunscreens

  • MED – minimal erythema dose
    • 2 MED is red, 4 MED pain, 8 MED blister
  • SPF – sun protection factor
    • MED protected/MED unprotected
    • SPF 10 means that it takes 10 times longer to get burned
  • SPF 15 – 93% of UVB; SPF 30 – 96.7% of UVB; SPF 40 – 97.5% of UVB; SPF 70 – 98.6% of UVB
  • UVA?   (Broad Spectrum)
  • Waterproof 

19

Sunscreens: Types

  • Chemical
    • Aminobenzoic acid (PABA) – UVB; major sensitizer
    • Anthranilates – UVA (weak), combos
    • Benzophenones – UVB, UVA
    • Cinnamates – UVA, UVB
    • Dibenzoylmethane – UVA
  • Physical – UVR
    • Zinc oxide, titanium dioxide
       

20

Sunscreen Changes

  • SPF only
    • Helps prevent sunburn
  • Broad Spectrum SPF <15
    • Helps prevent sunburn
  • Broad Spectrum SPF >15
    • Helps prevent sunburn, decreases skin cancer and early aging
  • Water Resistant
     

21

How Would You Evaluate?

Q image thumb

A.  Shape

B.  Irreg. Borders

C.  Color(s)/changing

D.  > pencil eraser size (6 mm)

 

ABCD for melanoma

22

What is the diagnosis?

A.  Benign photoaging skin lesion

B.  Possible malignant melanoma

C.  Actinic keratosis

D.  Seborrheic keratosis

Q image thumb

  • Yes, benign photoaging skin lesion
  • Not melanoma, same color and regular border
  • Not AK
  • Yes, seborrheic keratosis

23

Seborrheic Keratosis

Q image thumb

A image thumb
24

AK vs. SCC

Q image thumb

  • AK: actinic keratosis, was the front picture
    • bald areas, wrists and forearms
    • rough spot on ear/forehead
    • sting/rough when rub
    • Cryotherapy and freeze off, can go to SCC
  • SCC: Squamous cell carcinoma, this picture
    • if freeze and comeback, need to biopsy
  • Bottom Line: Refer

A image thumb
25

What is this?

Q image thumb

Basal cell carcinoma, pearly dome like leison on side of nose 

A image thumb
26

What is this?

Q image thumb

  • Melanoma
  • A: Asymmetric shape
  • B: Border irregular or poorly defined border
  • C: Color variation or change in color
  • D: Diameter larger than pencil eraser

27

Burns

  • 1st, 2nd, 3rd degree
  • Superficial
  • Superficial, partial thickness
  • Deep partial thickness
  • Full thickness
  • Minor, Moderate, Major
  • Treat OTC: 2% superficial, superficial partial thickness, not involving eyes, ears, face, genitalia, not chemical/electrical, healthy
    • Cool water
    • NO OINTMENT until later in treatment
    • Aleve for pain
  • Tetanus status?