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1

What are the layers of the skin?

Epidermis, dermis, and subcutaneous layer

2

What type of epithelial cells is the epidermis?

Stratified squamous epithelium

3

How thick is the epithelium?

0.05mm to 1.5mm

4

What are the functions of the skin and nails?

-Physical barrier: prevents fluid loss and entry to toxic chemicals, organisms and trauma -temperature regulation -protection against UV radiation -Synthesis of Vit. D -Sensation

5

"Peach fuzz" body hair on children and adults, not effected by hormones

Vellus

6

Characteristics of both vellus and terminal hair

Intermediate hair

7

Growth phase; duration average of 3 years

Anagen

8

Degenerative stage; duration few weeks

Catagen

9

Resting phase; length varies by body site

Telogen

10

Fine hair that covers fetus that is discarded after birth

Lanugo

11

Hair shaft shedding 25-100 per day

Effluvium

12

How thick is the dermis?

0.3mm to 3.0mm

13

What are the functions of hair?

-Protection -Regulation of temperature -Evaporation of perspiration -Sensation

14

What is it important to do what evaluating the patient's skin?

MAKE SURE TO UNDRESS THE PATIENT

15

Scalp, beard, axilla, pubic-area: growth influenced by hormones

Terminal hair

16

inflammation of the skin

dermatitis/eczema

17

Sx of acute phase of dermatitis

  • Pruritis
  • redness
  • vesicle formatio
  • oozing crusting

18

Sx of subacute phase of dermatitis

  • pruritis
  • reddness
  • scaling
  • parches or scalded appearance 

19

Sx of chronic phase of dermatitis

  • lichenification due to scratching/itching
  • hyperpigmentation
  • excoriation
  • fissuring 

20

Results from contact by irritating substance. direct toxic effect on skin

contact dermatits

21

What are common agents for contact dermatitis?

  • Abrasives
  • cleaning agents
  • caustic agents

22

What are the acute and chronic rashes seen in contact dermatitis?

  • Acute
    • erythema
    • vesicles
    • erosion
    • crusting
  • Chronic
    • papules
    • plaques
    • crusts 

23

T-cell mediated response that occurs in individuals that have become sensitized

Allergic contact dermatitis

24

Causes of allergic contact dermatitis?

  • Topical medications
  • jewlery
  • rubber
  • disinfectants
  • cosmetics
  • plants (most commonly poison ivy)

25

What acute and chronic rash is seen with allergic contact dermatitis?

  • Acute
    • Erythema
    • Vesicles
    • Erosions
    • Crusting
  • Chronic
    • Papules
    • Plaques
    • Crusts

26

What type of testing is done for allergic contact dermatitis?

Patch testing after the dermatitis resolves

27

What is the most common fo all mucocutaneous infections?

Superficial fungal infections

28

What causes most superficial fungal infections?

overgrowth of mucocutaneous microbiome, invading skin & mucosal sites 

  • Candida species
  • Malassezia species
  • Dermatophytes

29

Superficial infection that may involve any cutaenous or mucous surface of the body 

Candidiasis 

30

What is the most common cause of Candidiasis?

Candida albicans 

31

Risk factors for mucocutaneous candidias?

  • Diabetes
  • Pregnancy
  • Obesity
  • HIV/AIDS
  • Systemic antibiotics
  • Oral corticosteroids
  • OCP & IUD
  • Warm/humid climate
  • Moist/occluded sites

32

What lab exams should be carried out for dx of mucocutaneous candidiasis?

  • Direct microscopy with KOH prep
    • Pseudohypae & budding yeast
  • Culture  to identify Candida albicans/rule out secondary infection 

33

Patches & pustules on erythematous base "beefy red" become eroded & confluent, sharply demarcated, "satellite lesions"

pruritis, tenderness, pain

 

Candidal intertrigo

34

What is the distribution of Candidal intertrigo?

Axillae, groin (perineal, intergluteal cleft)

35

What will be on the diff dx with candidal intertrigo?

  • Psoriasis
  • Erythramsa
  • Pityriasis versicolor
  • Tinea  cruris

36

Management of candidal intertrigo?

  • Topical antifungal (eg Nystatin cream), oral antifungals

37

Prevention of candidal intertrigo?

keep area dry, use imidazole powder 

38

Irritability, discomfort with urination/defecation, changing diapers; erythema ("beefy red"), edema with papular & pustular lesions

Diaper dermatitis

39

Distribution of diaper dermatitis?

Genital & perianal skin, inner aspects of thighs/buttocks 

40

Diff dx with diaper dermatitis?

  • eczema
  • psoriasis
  • irritant dermatitis

41

Prevention of diaper rash?

Keep dry

42

Management of diaper rash?

Topical antifungals (eg Nystatin cream)

43

White-curd like plaques on mucosal surface that when removed with dry gauze leaves erythematous mucosal surface

Oropharyngeal candidiasis (“thrush”)

44

Distribution of Oropharyngeal candidiasis (“thrush”)?

Dorsum of tongue, buccal mucosa, hard/soft palate 

45

Diff dx with Oropharyngeal candidiasis (“thrush”)?

  • Leukoplakia
  • condyloma acuminatum
  • geographic tongue
  • lichen planus
  • hairy tongue
  • SCC

46

Management of Oropharyngeal candidiasis (“thrush”)?

  • Correct precipitating cause (eg d/c inhaled corticosteroids)
  • topical antifungals (eg Nystatin suspension)

47

What % of women experience at least 1 episode of Vulvovaginitis candidiasis?

75%

48

>20% of women have vaginal colonization by...

C. albicans 

49

Abrupt onset, vaginal discharge/soreness, pruritis, burning, dyspareunia, that may occur before menses 

Vulvar/vaginal erythema and edema, curd-like white plaques 

Vilvovaginitis candidiasis 

50

Diff dx with Vilvovaginitis candidiasis?

  • Trichomoniasis 
  • bacterial vaginosis
  • lichen planus
  • lichen sclerosis 

51

Management of Vilvovaginitis candidiasis?

Oral antifungal (eg fluconazole)  or intravaginal prep (many OTC)

52

Etiology of Balanitis?

Uncircumsized men

53

Pruritis, itching/burning 

Papules, pustules, erosions; white plaques under foreskin

Balanitis 

54

Diff dx with Balanitis?

  • Psoriasis
  • Eczema 
  • Lichen planus

55

Which infection should you consider treating sexual partner if reinfection ooccurs?

Balanitis 

56

Management of Balanitis?

Topical nystatin ointment and warm soaks BID to relieve pruritis/burning 

57

Superficial overgrowth of Malassezia furfur (lipophiic yeast that normall resides in the keratin of skin & hair follicles) under favorable 

Pityriasis versicolor

58

Risk factors of Pityriasis versicolor?

  • sweating
  • tropical climate
  • poly skin
  • aerobic exercise
  • application of cocoa butter 

59