Geriatric skin Conditions Flashcards Preview

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Flashcards in Geriatric skin Conditions Deck (89):
1

What happens to lipid content of the skin with aging? What are the effects of this? (2)

Decreased:
-Drier and rougher
-Decreased barrier function

2

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
-Easy bruising

3

What accounts for the slower wound healing of old people?

Slower turnover of epidermal cells

4

What is the effect of reduced numbers of langerhans cells with aging?

Decreased immune surveillance

5

What causes the wrinkling with aging (2)?

-Loss of elastin
-Decrease in ground substance (collagen, elastin etc)

6

What causes the decreased hair density with aging?

Shortened duration of anagen, and increased duration of telogen (resting phase)

7

What are the two UV rays that cause the most damage?

UVA and UVB

8

What are the signs of photodamaged skin?

-Mottling
-Hyperpigmentation
-Telangiectasias

9

What are the drugs that are proved to reduce wrinkling?

Retinoids--topical tretinoin at high concentration for long periods

10

What are the three main effects of topical retinoids on the skin?

-Increases thickness of superficial skin
-Reduces pigment changes
-Increases collagen synthesis

11

What is the concept behind derm surgeries?

damage epidermis to allow for dermis to heal again in a better fashion

12

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.

13

What disease is seborrheic dermatitis more common in?

PD

14

True or false: seborrheic dermatitis is only an acute condition

False--chronic, incurable condition, but can easily be controlled

15

What is the treatment for seborrheic dermatitis?

Mild topical corticosteroids for acute phase, then medicated shampoos that act against yeast

16

What is rosacea? What part of the body is it usually found on?

Diffuse erythema and erythematous papules on the face, forehead, and chin

17

What happens to the nose with Rosacea?

Rhinophyma

18

What ages are affected with rosacea?

all ages

19

What is the common symptom of rosacea?

Recurrent facial flushing

20

What is the cause of rosacea?

Idippathic

21

What is the treatment for rosacea?

-Avoid irritants
-oral Abx for flares
-topical abx for mild cases

22

What is the treatment for refractory rosacea?

oral isotretinoin

23

What is the treatment for the erythema and telangiectasias seen with rosacea?

Lasers!!

24

What is xerosis?

Dryness of the skin

25

What is eczema craquele?

Dry, erythematous fissured skin that is itchy

26

What condition do you get on your hands every year? What causes it?

Eczema craquele

You're way too dry

27

What is the treatment for eczema craquele?

Wet it and avoid hot showers

28

What is an emollient?

Moisturizing agent

29

What is neurodermatitis (lichen simplex chronicus)?

Chronic itching of the skin causes it to thicken, and become more pruritic. Vicious cycle

30

What is the treatment for neurodermatitis (lichen simplex chronicus)? (3)

-Potent topical corticosteroids
-Emollients
-Behavioral modification

31

What is intertrigo? What usually causes it?

Irritative condition of the skin between intertriginous areas

Usually caused by candida

32

What are the signs of intertrigo?

Moist erythema, maceration, and superficial erosion

33

Why is intertrigo more common in older adults?

More folds

34

What is the treatment for intertrigo?

Keep area dry
use typical antifungals PRN

35

What are the skin findings of bullous pemphigoid?

Large, tense blisters NOT on an erythematous base

36

What is the age range of BP?

60+

37

True or false: BP is usually self limiting

True, but lasts months to years

38

What are the antibodies that are formed in BP?

hemidesmosomes

39

What is the age range that is typically affected with pemphigus vulgaris?

Middle aged folk

40

What is the difference between the blisters of BP and PV?

BP = tense and firm
PV = flaccid and easily ruptured

41

Which has oral lesions: BP or PV?

PV

42

What is immunofluorescence pattern of BP and PV?

BP = BM
PV = Intradermal

43

which is an epidermal problem, and which is along the dermis/epidermis: BP and PV?

BP = dermis/ epidermis
PV = intradermal

44

Which has more uniform blisters: BP or PV?

PV

45

What is the treatment for Bullous pemphigoid?

-Topical corticosteroids or calcineurin inhibitors
-Systemic steroids if more severe

46

What is the MOA of calcineurin inhibitors?

***

47

What causes scabies?

Sarcoptes scabiei

48

What are the bites like with scaries?

Linear ("breakfast, lunch, and dinner bites"), and pruritic

49

What is the treatment for pruritic jaundice?

Cholestyramine (bile acid sequestrants)

50

What is the treatment for pruritis, if you cannot find an underlying cause?

Topical corticosteroids or emollients

51

What are cutaneous horns? Are they malignant?

Proliferation of keratinocytes
usually benign, but may represent underlying pathology

52

What is the treatment for a cutaneous horn?

Excisional bx

53

What is stasis dermatitis?

an early sign of chronic venous insufficiency of the legs, triggered by chronic venous HTN and incompetent valves

54

Where is stasis dermatitis usually seen on the body?

Medial supramalleolar areas

55

What are the risks of untreated stasis dermatitis?

Ulceration and pruritis

56

What is the treatment of stasis dermatitis? (3)

-Compression
-Leg elevation at rest
-emollient and topical steroids

57

What are the skin findings of stasis dermatitis?

Erythematous and edematous legs, with dusky appearance, and possibly ulcers

58

Which tend to be serous, and which hemorrhagic: PV or BP

BP = hemorrhagic
PV = serous

59

Why are there skin changes with stasis dermatitis?

Pressure from veins on small dermal capillaries decreases blood supply to the skin

60

What usually causes stasis dermatitis?

Vascular disease

61

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

62

What are the risk factors for venous leg disease?

Age
Obesity
h/o DVTs

63

What are the risk factors for arterial disease of the leg?

Age over 40
Cigarettes
DM
HTN
Hyperlipidemia

64

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

65

What are the complications from onychomycosis?

-Nail bed ulcerations
-Dm pts = route for bacterial infx

66

What is the treatment for onychomycosis? (3)

-Oral terbinafine
-Fluconazole
-Itraconazole

67

What are the issues with systemic treatment for onychomycosis in older adults?

-Long duration
-High potential for drug interactions
-Hepatotoxic

68

What are the skin findings of zoster?

Tiny serous pustules on an erythematous base

69

What is the treatment for shingles? (3) MOA?

-Acyclovir
-Valacyclovir
-Famciclovir

Converted by thymidine kinase, to then inhibit HSV specific DNA polymerases

70

What is hutchinson's sign?

Herpes vesicles on the tip of the nose==represents involvement of the nasocilliary branch

71

What is the difference in the rash of intertrigo and candidiasis?

Candidiasis has peripheral satellite pustules

72

How do you diagnose candidiasis?

KOH prep

73

What is the treatment for candidiasis?

-Keep skin dry
-Improve hygiene
-Topical azoles

74

What is the treatment for scabies?

Ivermectin
burn everything

75

What is the treatment for body louse?

Pyrethrin

76

What are seborrheic keratoses?

Benign growths in older adults, that appear are tan, gray, or black plaques with a "stuck-on" appearance

77

What are the differences between seborrheic keratoses and melanoma?

-Melanomas are single vs multiple for seborrheic keratoses

-Chronic condition for seborrheic keratoses

78

What are cherry angiomas?

Acquired cutaneous vascular proliferations that appear as round to oval, bright red papules

79

What are cherry angiomas composed of? Are these malignant?

Dilated and congested capillaries and postcapillary venules

benign

80

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
-Premalignant lesion

81

What is the treatment for actinic keratosis?

-Cryotherapy
-Topical acids
-5FU

82

What are the usual skin findings of SCC?

Chronic, erythematous papules, plaques, or nodules with scaling, crusting, or ulceration

83

Where does SCC tend to occur on the body?

In chronically sun-exposed areas

84

What is the issue with SSC on the lip?

Increased propensity to metastasize relative to location elsewhere

85

What is the treatment for SCC?

Cut it out

86

What are the typical skin findings for BCC?

Pearly papule that is ulcerated and has a characteristic rolled border

87

What is the issue with melanoma?

Mets early

88

What is the treatment for melanoma?

-cut it out
-Lymph node dissection
-Chemo/XRT PRN

89

What are the characteristics of melanomas?

Small, Irregular lesion with variations in pigment that grows quickly