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Flashcards in Dermatology 1 Deck (54):
1

Skin anatomy

epidermic- .5-1.5 mm, Dermis-.3-3 mm, contains, melanocytes, langerhans, merkel, collagen, elastic, reticular connective tissue, papillary and reticular dermis, subcutaneous layer

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Hair anatomy

5 mil hair follicles at birth, changes due to androgens, infundibulum, isthmus, inferior segment

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Nail anatomy

nail plate, nail fold, cuticle, matrix (synthesizes 90% of plate), lunula, hyponychium

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Macule

a circumscribed flat discoloration that may be brown, blue, hypo or apigmented

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Papule

elevated solid lesion up to .5 cm in diameter, may become confluent to form plaques

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Plaque

circumscribed, elevated, superficial, solid lesion more than .5 cm in diameter

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Nodule

circumscribed, elevated, solid lesion of more than .5 cm in diameter, large is called tumor, more depth to lesion than plaque

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Pustule

circumscribed collection of leukocytes or pus that varies in size

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Vesicle

circumscribed collection of free fluid up to .5 cm in diameter

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Bulla

circumscribed collection of free fluid more than .5 cm in diameter

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Wheal

firm edematous plaque resulting from infiltration of the dermis with fluid, wheals are transient and may only last for a few hours

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Scales

excess dead epidermal cells that are produced by abnormal keratinization and shedding

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Erosion

a focal loss of epidermis; erosions do not penetrate below the dermoepidermal junction and therefore heal w/out scarring

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Ulcer

focal loss of epidermis and dermis, heal w/ scarring

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Atrophy

depression in skin resulting from skinning of the epidermis or dermis

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Scar

abnormal formation of connective tissue implying dermal damage

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Eczema

most common inflammatory skin disease, 3 stages, can start at any stage and move to any stage

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Eczema and dermititis

all eczema is dermatitis but not all dermatitis is eczema

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Acute eczema

caused by contact w/ specific allergens, ie poison ivy, inflam. varies from mod to intense, vesicles, bullae, excoriations may be present, intense itching, temporarily relieved w/ hot showers due to pain, heat aggravates; hrs-d

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Acute eczema treatment

cool wet dressing, oral corticosteroids, antihistamines, and abx if there are signs of superficial 2nd infection

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Subacute eczema

erythema and scales are present in various patterns usually w/ indistinct borders, not itching- intense itching, initial or follows acute, can resolve spontaneously w or w.out scarring

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Subacute eczema treatment

topical steroids, topical macrolide, immune suppresants, lubricants

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Examples of subacute eczema

atopic dermatitis, nummular eczema, irritant hand eczema

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Chronic eczema

may be caused by prolonged irritation of subacute, or lichen simplex chronicus, thick plaques and deep parallel skin markings are said to be lichenified, sites common w/ habitual scratching, mod- intense itching, thickening of skin

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Chronic eczema treatment

High potency topical steroids, intralesional injection

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Hand eczema

inflammation of the hands, embarassment, 5.4% F:M 2:1, may be irritant contact dermatitis, atopic hand eczema, or allergic contact dermatitis, cleaners 21.3%, relapsingdifficult to dx

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Irritant contact dermatitis

housewives eczema, dishpan hands, detergents, most common hand eczema, environmental factors, inflammation varies

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Treatment of contact dermatitis

prevention, lubrication, topical steroids

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Atopic hand eczema

most common adult atopic dermatitis, backs of hands and fingers, chapping and erythema, edema, vesiculation, crusting, excoriation, scaling and lichenification

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Allergic contact dermatitis

inflammation reaction that follows absorption of antigen applied to the skin and recruitment of previously sensitized antigen-specific T-Lymph into the skin, affected area corresponds to allergen coverage, nickle, K dichromate, rubber, formaldehyde

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Rhus dermatitis

poison ivy, poison oak, poison sumac, cashew, mango, ginko, japanese laquer trees, presentation varies w/ quantity of oleoresin that contacts skin and susceptibility

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Rhus dermatitis treatment

prevention, immediate washing w/ soap and H2O, barrier vreams, wet compresses, topical steroids, prednisone dose pack, IM triamcinolone

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Pompholyx

unknown etiology, symmetric vesicular hand and foot dermatitis, mod-severe itching precedes the vesicles on the palm sides of the fingers, vesicles slowly resolve in 3-4 weeks, erythema, and dyshidrosis, stress induced

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Pompholyx treatment

topical steroids, cold wet dressing, abx, may use oral steroids or low dose methotrexate

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Statis dermatitis

eczematous eruption that occur in the lower legs in pts w/ venous insufficiency, unknown cause, allergic response to protein antigen, skin compromised more susceptible to irritation

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Atopic dermatitis

chronic, pruritis eczematous disease that nearly always begins in childhood, follows a remitting course that may continue throughout life, flared w. stress, infection, climate change, irritants, 7-17% prevalence,

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Pathogenesis of atopic dermatitis

elevated IgE, 20% have normal IgE, eosinophilia- major effector cells, correlates roughly w. disease severity, disordered cell-mediated immunity, pts may develop severe diffuse cutaneous infection, itching

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Diagnostic criteria of AD

must have- pruritis, age-specific patterns, relapse, facial, neck or extensor involvement in kids, current flexural lesions any age, sparing groin and axilla; may have- early age onset, fam hx, IgE reactivity, xerosis, ocular changes

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Differential of AD

rule out scabies, seborrheic dermatitis, contact dermatitis,, cutaneous t-cell lymphoma, psoriasis, immune def, erythroderma of other causes

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Treatment of AD

topical mild steroids, retinoids, and moisturizers

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Keratosis pilaris

xerosis, ichthyosis vulgaris, hyperlinear palmer creases, pityriasis alba, atopic pleats, cataracts and keratoconus

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ichthyosis vulgaris

disorder of keratinization characterized by development of dry rectangular scales, "fish scales"

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Triggering factors of keratosis pilaris

temp change, sweating, dec humidity, excessive washing, contact allergy, aeroallergens, staph infection, foods, emotional stress

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Treatment goals of keratosis pilaris

prevent triggers, eliminate inflammation and infection, preserve and restore the stratum corneum barrier, control pruritus, treat as per stage of inflammation

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Reasons for failure of treatment

poor pt compliance, allergic contact dermatitis to topical med, simultaneous occurrence of asthma or hay fever, inadequate sedation, continued stress

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Topical therapy for keratosis pilaris

topical steroids until clear, safe in children, group V topical steroids (fluticasone propionate .05%) up to 4 weeks in children and 3 months in adults, Group V creams or ointments for red scaly skin, Group 1 or 2 for lichenoid skin

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Other therapy options for keratosis pilaris

tar, main stay treatment before steroids, effective but slow; lubrication- petroleum, effect after bath, mild soaps, NSAID- pimecrolimus cream 1% (Elidel), tacrolimus .03%, .1% ointment (Protopic)

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Antihistamines keratosis pilaris

control pruritus and induces sedation and sleep, hydroxyzine, doxepin cream 5%, short term for 8 days

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Treating severe cases keratosis pilaris

oral or intramuscular steroids, cyclosporin, azathioprine, light therapy

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Urticaria

hives, wheal, 20% have one episode, majority are acute- hrs-w, chronic urticaria last more than 6 weeks more common in middle aged women

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Pathophysiology of urticaria

histamine is most important mediator, causes endothelial cell contraction, allows vascular fluid to lead between vessel wall, contributes to edema, H1- vasodilation/pruritis, H2- vasodilation

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Clinical features of urticaria

circumscribed, erythmatous, pruritic, nonpitting edematous plaque, changes size and shape by peripheral extension, lesion may vary in size from 2-4 mm papules to single lesion covering extremity, round, oval or polycyclic, varying colors, angioedema is more uniform and has much deeper edema

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Initial evaluation of urticaria

skin exam, detailed hx about food drugs, infections, chronic illness, acute or chronic, dermographism

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Treatment of urticaria

nonsedating H1 antihistamine (allegra, zyrtec, claritin); sedating H1 are more effective- use to treat severe cases, doxepin effective in anxious and depressed pts, H2 blockers (Zantec, pepsin)- not much efficacy, oral corticosteroids for refactory cases, immunotherapy