Flashcards in Geriatric skin Conditions Deck (89):
What happens to lipid content of the skin with aging? What are the effects of this? (2)
-Drier and rougher
-Decreased barrier function
With aging, the interdigitations of the dermis/epidermis flatten. What are the 4 major results of this?
-Reduced contact between epidermis and dermis
-Decreased nutrient transfer
-Increased skin fragility
What accounts for the slower wound healing of old people?
Slower turnover of epidermal cells
What is the effect of reduced numbers of langerhans cells with aging?
Decreased immune surveillance
What causes the wrinkling with aging (2)?
-Loss of elastin
-Decrease in ground substance (collagen, elastin etc)
What causes the decreased hair density with aging?
Shortened duration of anagen, and increased duration of telogen (resting phase)
What are the two UV rays that cause the most damage?
UVA and UVB
What are the signs of photodamaged skin?
What are the drugs that are proved to reduce wrinkling?
Retinoids--topical tretinoin at high concentration for long periods
What are the three main effects of topical retinoids on the skin?
-Increases thickness of superficial skin
-Reduces pigment changes
-Increases collagen synthesis
What is the concept behind derm surgeries?
damage epidermis to allow for dermis to heal again in a better fashion
What is seborrheic dermatitis? Where on the body is it usually found? s/sx?
Erythematous, greasy, peely dandruffy type of condition that often occurs in the hairline or nasolabial folds. Sometimes pruritic.
What disease is seborrheic dermatitis more common in?
True or false: seborrheic dermatitis is only an acute condition
False--chronic, incurable condition, but can easily be controlled
What is the treatment for seborrheic dermatitis?
Mild topical corticosteroids for acute phase, then medicated shampoos that act against yeast
What is rosacea? What part of the body is it usually found on?
Diffuse erythema and erythematous papules on the face, forehead, and chin
What happens to the nose with Rosacea?
What ages are affected with rosacea?
What is the common symptom of rosacea?
Recurrent facial flushing
What is the cause of rosacea?
What is the treatment for rosacea?
-oral Abx for flares
-topical abx for mild cases
What is the treatment for refractory rosacea?
What is the treatment for the erythema and telangiectasias seen with rosacea?
What is xerosis?
Dryness of the skin
What is eczema craquele?
Dry, erythematous fissured skin that is itchy
What condition do you get on your hands every year? What causes it?
You're way too dry
What is the treatment for eczema craquele?
Wet it and avoid hot showers
What is an emollient?
What is neurodermatitis (lichen simplex chronicus)?
Chronic itching of the skin causes it to thicken, and become more pruritic. Vicious cycle
What is the treatment for neurodermatitis (lichen simplex chronicus)? (3)
-Potent topical corticosteroids
What is intertrigo? What usually causes it?
Irritative condition of the skin between intertriginous areas
Usually caused by candida
What are the signs of intertrigo?
Moist erythema, maceration, and superficial erosion
Why is intertrigo more common in older adults?
What is the treatment for intertrigo?
Keep area dry
use typical antifungals PRN
What are the skin findings of bullous pemphigoid?
Large, tense blisters NOT on an erythematous base
What is the age range of BP?
True or false: BP is usually self limiting
True, but lasts months to years
What are the antibodies that are formed in BP?
What is the age range that is typically affected with pemphigus vulgaris?
Middle aged folk
What is the difference between the blisters of BP and PV?
BP = tense and firm
PV = flaccid and easily ruptured
Which has oral lesions: BP or PV?
What is immunofluorescence pattern of BP and PV?
BP = BM
PV = Intradermal
which is an epidermal problem, and which is along the dermis/epidermis: BP and PV?
BP = dermis/ epidermis
PV = intradermal
Which has more uniform blisters: BP or PV?
What is the treatment for Bullous pemphigoid?
-Topical corticosteroids or calcineurin inhibitors
-Systemic steroids if more severe
What is the MOA of calcineurin inhibitors?
What causes scabies?
What are the bites like with scaries?
Linear ("breakfast, lunch, and dinner bites"), and pruritic
What is the treatment for pruritic jaundice?
Cholestyramine (bile acid sequestrants)
What is the treatment for pruritis, if you cannot find an underlying cause?
Topical corticosteroids or emollients
What are cutaneous horns? Are they malignant?
Proliferation of keratinocytes
usually benign, but may represent underlying pathology
What is the treatment for a cutaneous horn?
What is stasis dermatitis?
an early sign of chronic venous insufficiency of the legs, triggered by chronic venous HTN and incompetent valves
Where is stasis dermatitis usually seen on the body?
Medial supramalleolar areas
What are the risks of untreated stasis dermatitis?
Ulceration and pruritis
What is the treatment of stasis dermatitis? (3)
-Leg elevation at rest
-emollient and topical steroids
What are the skin findings of stasis dermatitis?
Erythematous and edematous legs, with dusky appearance, and possibly ulcers
Which tend to be serous, and which hemorrhagic: PV or BP
BP = hemorrhagic
PV = serous
Why are there skin changes with stasis dermatitis?
Pressure from veins on small dermal capillaries decreases blood supply to the skin
What usually causes stasis dermatitis?
What are the s/sx of venous leg disease, compared to arterial?
Venous = limb heaviness, aching, swelling that is made worse with standing for long periods
Arterial = claudication, loss of hair, cool extremitis
What are the risk factors for venous leg disease?
What are the risk factors for arterial disease of the leg?
Age over 40
Where are the location of venous leg ulcers, as compared to arterial?
Venous = Along the course of the long saphenous vein (medial)
Arterial = over bony prominences
What are the complications from onychomycosis?
-Nail bed ulcerations
-Dm pts = route for bacterial infx
What is the treatment for onychomycosis? (3)
What are the issues with systemic treatment for onychomycosis in older adults?
-High potential for drug interactions
What are the skin findings of zoster?
Tiny serous pustules on an erythematous base
What is the treatment for shingles? (3) MOA?
Converted by thymidine kinase, to then inhibit HSV specific DNA polymerases
What is hutchinson's sign?
Herpes vesicles on the tip of the nose==represents involvement of the nasocilliary branch
What is the difference in the rash of intertrigo and candidiasis?
Candidiasis has peripheral satellite pustules
How do you diagnose candidiasis?
What is the treatment for candidiasis?
-Keep skin dry
What is the treatment for scabies?
What is the treatment for body louse?
What are seborrheic keratoses?
Benign growths in older adults, that appear are tan, gray, or black plaques with a "stuck-on" appearance
What are the differences between seborrheic keratoses and melanoma?
-Melanomas are single vs multiple for seborrheic keratoses
-Chronic condition for seborrheic keratoses
What are cherry angiomas?
Acquired cutaneous vascular proliferations that appear as round to oval, bright red papules
What are cherry angiomas composed of? Are these malignant?
Dilated and congested capillaries and postcapillary venules
What is actinic keratosis? What causes it? Is it malignant?
-Rough, scaly, red-brown macules on sun exposed skin that are usually poorly circumscribed
-Sun exposure caused
What is the treatment for actinic keratosis?
What are the usual skin findings of SCC?
Chronic, erythematous papules, plaques, or nodules with scaling, crusting, or ulceration
Where does SCC tend to occur on the body?
In chronically sun-exposed areas
What is the issue with SSC on the lip?
Increased propensity to metastasize relative to location elsewhere
What is the treatment for SCC?
Cut it out
What are the typical skin findings for BCC?
Pearly papule that is ulcerated and has a characteristic rolled border
What is the issue with melanoma?
What is the treatment for melanoma?
-cut it out
-Lymph node dissection