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Derm > Miscellaneous Disorders - Exam 2 > Flashcards

Miscellaneous Disorders - Exam 2 Flashcards

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1
Q

______ are localized asymptomatic skin disorder manifesting with hyperpigmented, velvety plaques typically located in flexural and intertriginous regions. What are they commonly seen with? What race?

A

Acanthosis Nigricans

common seen with skin tags

African Americans 25x more likely than whites

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2
Q

What is the likely etiology of acanthosis nigricans?

A

Stimulation of insulin-like growth factor receptors and tyrosine kinase receptors on keratinocytes and fibroblasts

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3
Q

What are the 8 types of acanthosis nigricans?

A

obesity
malignancy
drug induced
syndromic
acral
unilateral
benign
or
mixed

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4
Q

What dz are closely related to AN?

A

diabetes
insulin resistance
high body mass index (BMI)
metabolic syndrome
polycystic ovarian syndrome (PCOS)

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5
Q

If AN is related to malignancy like going to be ______

A

gastric carcinoma

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6
Q

What drug is closely related to AN?

A

Niacin MC

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7
Q

What are the 2 causes of syndromic AN?

A

A = Hyperandrogenism, insulin resistant, acanthosis, acromegaly

B = Autoimmune and Diabetes

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8
Q

Where are acral AN commonly found?

A

Elbows, knees and knuckles

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9
Q

What are unilateral AN related to?

A

Nevoid (Epidermal Nevus)

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10
Q

What is benign AN related to? What is mixed AN?

A

Rare autosomal dominant type

mixed: any 2 or more of the AN types

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11
Q

Where is AN typically seen?

A

It is typically seen in the neck folds (“dirty neck” appearance) and axillae

The inguinal and inframammary folds, antecubital and popliteal fossae, and elbows and periumbilical region may also be involved

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12
Q

Where are rare sites of involvement for AN? If you see a rarely form of AN, what should you think?

A

Rarer sites of involvement include velvety plaques on the knuckles, palms (“tripe palms”), soles, eyelids, periorally, near mucosal surfaces, or generalized

These rarer forms of AN are more closely related to malignancy

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13
Q

What will AN look like on the oral mucosa/lips?

A

have thickening and papillation and usually lack hyperpigmentation

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14
Q

How do you dx AN? What tests could you order?

A

clinical dx

AIC or fasting plasma testosterone/dehydroepiandrosterone sulfate

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15
Q

What is the tx for AN? What topical treatments are helpful?

A

tx the underlying cause

usually insulin insensitivity

topical: topical retinoids and/or vitamin D analogs may help improve appearance of lesion

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16
Q

In a pressure injury, where does the breakdown of skin occur? What is the pathophys?

A

Breakdown of the skin and underlying tissue resulting from unrelieved soft tissue pressure between bony prominence and external surface

non-relieving pressure/shearing forces results in diminished blood supply leading to cell death

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17
Q

What are the risk factors for a pressure injury? Which one is MC?

A

impaired mobility (MC)
contractures/spasticity
impaired sensation
aging skin
incontinence/fistula (skin maceration)
malnutrition
hypoproteinemia
anemia

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18
Q

What are the common locations for a pressure injury? Who is the MC pt?

A

sacrum/hip (70%)- MC

LE: malleolar, heel, patellar, pretibial

MC in acute hospitalized patients: think ortho and ICU pts

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19
Q

Pressure injuries place patients with same risk factors at _____ greater risk of death

A

4.5 times

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20
Q

In a pressure injury, where is the wound wider?

A

wider at the base and the inspection can be deceiving to the untrained eye

may require pain medication administration for adequate exam

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21
Q

When is NPUAP staging used in pressure injuries? Does it change as it heals?

A

used for initial evaluation and diagnosis and for description and documentation purposes only. NOT used in the evaluation of wound progression

stage is NOT changed upon healing (aka reverse staging)

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22
Q

**Draw the different staging pressur ulcers chart

A
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23
Q

_______ intact skin and non-blanchable hyperemia. What stage? What does a blanchable lesion mean?

A

stage 1 pressure injury

blanchable erythema, skin firmness, change in sensation or temp may precede stage I injury

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24
Q

What stage?

A

stage 1 pressure injury

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25
intact blister or loss of epidermis with exposed dermis and subq tissue is NOT visible. wound bed is viable, pink/red, moist and NO granulation or eschar tissue. What stage?
stage II
26
stage II pressure injury
27
stage II pressure injury
28
full thickness skin loss, exposed subcutaneous tissue/adipose no fascia, muscle, tendon, ligament, cartilage or bone visible, may have scar tissue, may have eschar, may slough and have epibole What stage? What is an epibole?
stage III pressure injury epibole- rolled wound edge
29
stage III pressure injury
30
stage III pressure injury
31
stage III pressure injury
32
full-thickness skin/tissue loss exposed fascia, muscle, tendon, ligament, cartilage and/or bone eschar tissue epibole undermining/tunneling may be present What stage?
stage IV pressure ulcer
33
stage IV pressure ulcer
34
full thickness skin and tissue loss obscured by slough or eschar removal of obscuring tissue will reveal What stage? What should you NOT do?
unstageable usually stage III or IV if obscuring tissue was removed Do NOT remove a stable eschar for staging purposes
35
generally intact skin deep red, maroon, or purple discoloration blood filled blister unable to visualize What stage?
Suspected deep tissue injury necrotic/granulation tissue, subcutaneous tissue or deeper structures
36
Unstageable pressure injury
37
suspected deep tissue injury
38
suspected deep tissue injury
39
What labs should you order in a pressure injury?
ESR, WBC wound culture via punch bx bone bx if concerned for osteomyelitis
40
What is the broad tx of a pressure injury?
reduce/eliminate underlying risk factors redistribute pressure: reposition every 2 hrs or sooner and bed elevation to < 30 degrees, minimize friction/shear forces with proper transferring and turning techniques remobilization Clean skin with mild cleansing agents and keep dry control pain abx if indicated
41
What is the tx for stage I pressure injury? stage II? stage III/IV?
Stage I: cover with transparent film for protection Stage II: transparent or hydrocolloid dressing Stage III/IV: debridement
42
**What is the CI for hydrocolloid dressing?
CI in active infection
43
What are the 4 things you need to monitor for in pressure injury healing?
size in cm exudate amount tissue type (sloughing, eschar) Score (0-17) will decrease with healing
44
How long does it usually take for a stage I or II pressure injury to heal? stage III or IV? What is the MC complication?
Stage I & II heal in 1-2 wks Stage III & IV health in 6->12 wks MC complication: infection
45
What is Hidradenitis suppurativa? What areas are common?
Chronic suppurative disease of the apocrine gland bearing skin areas axillae, inguinocrural and anogenital regions; scalp(rarely)
46
What is the MC pt with HS? What are the risk factors? **What are the 2 RF specifically mentioned in class?
Females> Males Onset: beginning at puberty occlusive dress, trauma, obesity, smoking, host defence defects, hormones, genetics **obesity and smoking
47
What is the pathophys behind HS?
1. perifollicular inflammation 2. hyperkeratinization of follicular epithelium with occlusion and dilation of the follicle 3. follicular rupture and release of intrafollicular debris into the dermis with increased inflammation 4. formation of tunnels filled with debris and/or fluid that connect to the surface of the skin and to the base of other ruptured follicle
48
Open comedones are characteristic Nodules with sinus tracts (inflamed or noninflamed) Abscesses Scarring Sinus tracts lead to dermal contractures and ropelike elevation of the skin What am I? What is usually in the hx?
Hidradenitis suppurativa (HS) History of recurrent painful suppurative lesions which heal leaving scars
49
What are 3 complications of HS?
Secondary infection Fistulas to urethra, bladder, and/or rectum Chronic inflammatory reactions
50
What are the tx options for HS?
Intralesional glucocorticoids Oral antibiotics Isotretinoin Biologics Surgery
51
What is the immediate tx of acute HS lesions?
Intralesional steroid followed by I&D abscesses oral abx: B-lactamase PCN, Cephalosporins, Augmentin, Clindamycin oral steroids to decrease pain/inflammation
52
What is the tx for recurrent HS lesions?
abx PLUS retinoids (clinda PLUS isotretinoin) biologics: adalimumab (Humira) or infliximab (Remicade)
53
What is the tx for chronic recurrent HS lesions?
Surgical Treatment: small excision of chronic recurrent nodules or sinus tracts complete excision of lesions with wide margins address psychosocial complications
54
What are the lifestyle modifications to education your pt with HS?
55
______ is the abnormal response to light, usually sunlight, occurring in minutes, hours, or days of exposure and lasting weeks, months and even longer. What are the 3 types?
photosensitivity sunburn rash urticarial
56
______ Chronic repeated sun exposures over time result in polymorphic skin changes that have been termed dermatoheliosis or photoaging
chronic photosensitivity
57
A _____ type response with skin changes simulating a normal sunburn such as in phototoxic reactions to drugs or phytophotodermatitis A ____ response with macules, papules, or plaques, similar to eczematous dermatitis _____ responses are typical for solar _____
sunburn rash Urticarial, urticaria 3 different types of photosensitivity
58
______ A phototoxic reaction that presents as an acute, delayed, and transient inflammatory response of normal skin after exposure to UVR from sunlight or artificial sources
acute sunburn
59
Pruritus, pain and tenderness may develop headache, malaise even after short exposure What am I? What is a severe presenation?
acute sunburn If severe sunburn, patient can present “toxic” with flu like illness Fever, chills, fatigue, weakness, tachycardia
60
When does an acute sunburn s/s typically present? Describe it in words
Develops after 6 hours and peaks after 24 hours Confluent bright red erythema confined to sun-exposed areas and sharply marginated at the border between exposed and covered skin. May have vesicles and bullae. As edema and erythema fade, vehicles and blisters dry to crusts, which then shed
61
What is the tx for an acute sunburn?
Cool, wet dressings and topical glucocorticoids Aloe Vera NSAIDs
62
What is the tx for a severe acute sunburn?
Bedrest and oral fluids “Toxic” patients may require hospitalization for IV fluid replacement
63
What are the 3 prevention strategies for an acute sunburn?
SPT I/II should avoid sun exposure between 10AM and 2PM Adequate sunscreen use and proper reapplication Clothing - UV-screening cloth garment
64
_____ is an adverse reaction of the skin that results from an interaction between UVR with a chemical or drug. What are the 2 types?
Photosensitivity: Drug/Chemical Induced Phototoxic reactions Photoallergic reactions
65
_____ a photochemical reactions that presents like an irritant contact dermatitis or sunburn. What is the associated timing? What is the pathophys?
phototoxic reactions subtype of Photosensitivity: Drug/Chemical Induced minutes to hours onset of eruption after exposure direct tissue injury
66
__________ is formed that initiates an immunologic response, manifests in skin as a type IV immunologic reaction and presents like an allergic eczematous contact dermatitis. What is the associated timing? What is the pathophys?
Photoallergic reactions subtype of Photosensitivity: Drug/Chemical Induced 24-48 hours onset of eruption after exposure Type IV delayed hypersensitivity response
67
What is the tx for an phototoxic reaction?
remove offending agent and tx conservatively think sunburn
68
What is the tx for an photoallergic reaction?
remove offending agent antihistamines steroids treat like contact derm
69
_____ is also called dry skin or asteatosis, refers to a condition of rough, dry skin texture with fine scale and occasionally fine fissuring. What will the pt complain of?
xerosis Often pruritic
70
What is the pathogenesis of xerosis?
Pathogenesis involves a decrease in the amount of lipids in the stratum corneum and a deficiency in the water-binding capacity of this layer
71
The incidence of xerosis increases with _____. nearly all individuals over the _____ have some degree of xerosis
age age of 60
72
In more advanced xerosis, the _____ may begin to exhibit a _____ pattern of superficial cracks and fissures with erythema
stratum corneum polygonal
73
Where are the MC locations of xerosis?
lower extremities, trunk, and dorsal hands, usually sparing the head, neck, palms, and soles
74
What questions/pt educations points are important in xerosis?
Inquire about bathing habits (frequency, type of soap used, water temperature) Hot water, frequent or prolonged bathing, and the use of soaps worsen xerosis Take a complete medication history encourage bathing in luke-warm bathing and to apply moisturizers within 60 seconds of getting out of the shower too frequent bathing can also exacerbate factors humidifiers mild soap substitutes, nothing with fragrance
75
How do you dx xerosis?
clinical dx
76
What am I? How is it inherited? What is it?
ichthyosis autosomal dominantly inherited condition of abnormal cornification leading to scaling and desquamation and presents as fine, fish-skin-like scale.
77
When is Ichthyosis more commonly seen? What age range does it usually begin?
It is more prominent in winter and in climates with low relative humidity The condition usually begins in childhood between 3 and 12 months of age and follows a favorable course in which the scaling alleviates in intensity by adulthood.
78
What are the tx options for Ichthyosis? Where is it most prominent? You should look for _______ and _____
Hydration, lubrication, and keratolysis are the mainstays of therapy The condition is usually most apparent on the extensor extremities. Look for accentuated palmar creases and scaly palms.
79
How do you dx Ichthyosis? What does acquired ichthyosis make you think?
clinical dx but can skin bx Cases of acquired ichthyosis warrant a search for an underlying systemic disease or malignancy
80
What is the tx for Ichthyosis?
Emollients are the mainstay of therapy. Creams applied after bathing help the epidermis retain water non-drying soaps and cleansers soaking with mechanically exfoliating humidifiers may use keratolytic agent containing an alpha hydroxy acid, salicylic acid, or urea can be used but only if localized areas, topical retinoids, topical vit D, mid-potency steroid cream
81

Derm (13 decks)

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