module 2 week 2 skin our colors Flashcards
(62 cards)
1
Q
Normal and abnormal
variations in non-Caucasian skin
A
- Pigment differences often mask cutaneous reactions
- Cyanosis, erythema, and pallor are more difficult to detect in non-
Caucasian skin - Look and feel for skin changes
- Hypo- and hyperpigmentation
- Localized tissue discoloration
- Temperature discrepancies
2
Q
Non-Caucasian skin
* The pores, sweat glands and sebaceous glands in dark skin are _________. Dark
skinned people produce more sebum around hair follicles, have more microbial
flora and a lower pH (more acidic) skin
A
larger
- The pores, sweat glands and sebaceous glands in dark skin are larger. Dark
skinned people produce more sebum around hair follicles, have more microbial
flora and a lower pH (more acidic) skin - Because of this, darker skin is more prone to scarring from acne and to spontaneous
peeling - However, it is also less sensitive to certain chemicals that irritate the skin of white
and Asian people
3
Q
Dark
skinned people produce more sebum around hair follicles, have more microbial
flora and a lower pH (more acidic) skin
* Because of this, darker skin is more prone to…
A
more prone to scarring from acne and to spontaneous
peeling
4
Q
Post-inflammatory hyper/hypopigmentation
black skin
A
- Black skin may respond to
trauma or inflammation by
either an increase or decrease in
pigmentation (dyschromia) - Melanocytes respond in
exaggerated way - Marked change in pigment
5
Q
Hypopigmentation in black skin represents as either ….
A
as localized or widespread
loss of melanin in the skin
* This is not Vitiligo
* Note the feathered edges
6
Q
is hypopigmentation in black skin the same as Vitiligo?
A
no, hypopigmentation has feathered edges
7
Q
vitiligo
A
loss of pigment in skin - has more fine edges and not feathered change of color at edges like hypopigmentation
8
Q
Normal variations in black skin
- Futcher’s (Voigt’s) line
A
- Benign condition
- Sharp, bilateral, pigmentary
demarcation lines usually
on lateral side of biceps
9
Q
Normal variations in black skin
Midline hypopigmentation
A
Linear band overlying the sternum
* Unknown etiology
* Incidence approximately 30-40%
10
Q
Normal variations in black skin
Nail pigmentation
A
Longitudinal melanonychia (Longitudinal linear lesions):
* Linear hyperpigmented nail streaks
* Represents normal variant in over 77% of
black people
* Melanin is deposited in nail plate/matrix
possibly due to trauma or UV light
* Positive correlation with advancing age
* Thumb & index nails most commonly
involved
* Often bilaterally
* An irregular nail pigment or history of
changing lesion warrants biopsy as > 50%
of melanomas in black people are found
in the nails
11
Q
Normal variations in black skin
Palmar changes
A
- Palmer/plantar
hyperpigmentation: - Due to localized hypermelanosis
- Polymorphous brown macules
with sharp or indistinct borders - Creases on the palms often
present with hyperpigmentation
12
Q
Normal variations in black skin
Plantar changes
A
- Palmer/plantar
hyperpigmentation: - Due to localized hypermelanosis
- Polymorphous brown macules
with sharp or indistinct borders - Creases on the palms often
present with hyperpigmentation
13
Q
normal variations in black skin
Dermatosis papulosa nigra
A
- Benign, brown to black papules
most common at the neck, face, trunk - 50% have family history; more common in females and peaks in the 6th decade of life
- ‘Flesh moles’ do not require treatment although some seek cosmetic excision
14
Q
- Atopic dermatitis
- Contact dermatitis
- Stasis dermatitis
- Environmental dermatoses
- Intertrigo
A
Common skin disorders
15
Q
Atopic dermatitis
A
- Chronic inflammatory disease
- Eczema
- Causes unknown
- Complex relationship of genetics, environment, pharmacologic, psychologic, immunologic factors
- Red, oozing, crusty rash
- Found on the flexor surfaces
- Major symptoms: Xerosis and pruritis
- Can lead to bacterial or viral infections
- Treatment:
- hygiene, moisturizing, topical agents (antibiotics, antihistamine, corticosteroids), avoidance of irritants
16
Q
Contact dermatitis
A
- In pattern of contact with allergen
- Can be chemical, mechanical, physical or biological
Common causes:
* Nickel (jewelry)
* Chromates (tanning leathers)
* Rubber additives (latex)
* Topical antibiotics or anesthetics (neomycin, lidocaine)
17
Q
Stasis dermatitis
A
- Very dry, thin skin of lower
extremities with shallow ulcers - History of varicose veins and deep
vein thrombosis (DVT) - Significant lower extremity edema
due to venous insufficiency - Tissue necrosis from hypoxic blood
supply - (ulcers, open sores, weepy skin)
18
Q
Stasis dermatitis
* Treatment
A
- Ambulation with pressure support garments
- LE elevation with support garments
- Wound Care
- UNNA boot (gauze impregnated w/ zinc oxide, gelatin, calamine, glycerin)
- Applied distal to proximal in upward spiral and allowed to dry
- Left on for average of 3-4 days (up to 7)
19
Q
Stasis dermatitis
wound care
are then in a boot?
if so, how long are they in it?
A
- Wound Care
- UNNA boot (gauze impregnated w/ zinc oxide, gelatin, calamine, glycerin)
- Applied distal to proximal in upward spiral and allowed to dry
- Left on for average of 3-4 days (up to 7)
20
Q
Intertrigo
A
- Dermatitis of the skin folds
- Increased friction
- Increased moisture
- Bacterial, viral, fungal infection
- Common areas
- Axilla
- Breasts
- Neck
- Groin
21
Q
more than 50% of melanomas, in black people, are found in the ….
A
nails
22
Q
Infections of the skin
* Be aware of contagious problems
* Careful recognition and handling is key
* Do not transmit the infection to yourself; use exam gloves
* Four main types: What are they ?
A
bacterial - impetigo, cellulitis
viral - herpes zoster, warts
fungal - tinea corporis, tinea pedis
parasitic - scabies, pediculosis
23
Q
Bacterial - Impetigo
A
- Highly contagious superficial
infection from staphylococci or
streptococci - Incidence <5 y/o or older adults
- Presentation: small macules
develop into small blisters (pus-
filled) - Vesicle breaks and forms thick
yellow crust. Causes pain,
erythema, itching, cellulitis - Scratching spreads infection
- Management: oral antibiotics
24
Q
bacterial - cellulitis
A
- Inflammation of dermis and subcutaneous
tissue spread widely through tissues – often
bacterial infection of staphylococci or
streptococci - Incidence: aging adult and those with a
decreased immune reaction: Diabetes
mellitus, malnutrition, steroids,
wounds/ulcers, edema and lymph obstruction - Presentation: erythema, edema, tender,
nodular tissue - Management: intravenous antibiotics, may
require debridement
25
what bacteria goes with cellulitis usually?
bacterial infection of
staphylococci or streptococci
26
what bacteria usually goes with impetigo ?
Highly contagious superficial
infection from
staphylococci or streptococci
27
what bacteria usually goes with impetigo and cellulitis ?
staphylococci or streptococci
28
staphylococci or streptococci
bacteria that infects people and prob gives them
impetigo or cellulitis
29
Viral infections - Herpes zoster
* Shingles-reactivation of the virus that
causes chicken pox (Varicella zoster)
* Peak incidence ages 50-70
* Brought on by immunocompromised
state:
* Virus lies dormant in ganglia of nerves
(posterior spinal nerve root or cranial
nerve root)
* Spreads down sensory nerve root to skin
30
Herpes zoster
* Clinical Presentation: unilateral
distribution of red ......
Herpes zoster
* Clinical Presentation: unilateral
distribution of red papules along
dermatome usually trunk or cranial
nerves
* Pain, neuralgia, itching
* Papules develop into vesicles - within 5 days - dry, resolve in 2-4 weeks
31
Herpes zoster
* Papules develop into vesicles -
within
__ days - dry, resolve in ____
weeks
5 days - dry, resolve in 2-4 weeks
32
Herpes zoster
* Management: Supportive treatment
to relieve itching and neuralgic pain involving...
* Corticosteroids early may abort
the attack
* Acyclovir to slow progression of
rash
* Isolation room (when in hospital) –
if you have not had chicken pox or
not been vaccinated you should
not come in contact with
individuals exhibiting shingles
33
varicella zoster
the virus that causes chicken pox
the virus that is reactivated with shingles > herpes zoster
34
varicella zoster lies dormant in ganglia of nerves, but where?!!
posterior spinal nerve root or cranial nerve root and spreads down sensory nerve root to skin
35
virus - WARTS - verrucae
* Common benign infection of skin and
adjacent mucous membranes
* Caused by human papilloma viruses
(HPV’s)
* Transmission: direct contact or
autoinoculation
* Presentation: Single or multiple lesions
with thick white surfaces
* Most common type (verruca vulgaris) has
rough elevated round surface: mostly
seen on extremities
36
Plantar warts - remember warts are a virus
* Painful
* Obliterate skin lines
* Red or black capillary dots
37
warts treatment - remember you are treating the virus of warts
Treatment: depends on size, number,
type
* Salicylic acid
* Cryotherapy
* Electrodessication w/ curettage
38
what virus causes warts ?
HPV , human papillomavirus
39
HPV , human papillomavirus
warts
40
Fungal infections –Tinea corporis
* Ringworm
* Ring-shaped pigmented patches covered
with vesicles or scales, often itchy
* Treatment:
* Antifungal powder or ointment, keeping
skin clean and dry
* Oral medication available
41
Tinea Corporis is
Ringworm
42
ringworm big word is...
tinea corporis
I sweat too much playing tinneas (tennis) and I got got ring work also know as tinea corporis
43
Tinea pedis
* Athletes foot
* Presentation: erythema, skin peeling,
pruritus
* Location: between toes and on sole
of foo t
* Treatment:
* Clean, dry socks and well-ventilated,
properly fitting footwear
* Washing feet and drying thoroughly
between toes
* Antifungal powder or cream
44
Tinea pedis or Tinea corporis .... which is athletes foot?
Tinea Pedis
think pedal pulse
45
Parasites - scabies
* Highly contagious eruption caused by
mites
* Common worldwide problem
* Female mite burrows into skin, lays
eggs that hatch in a few days
* Transmitted skin to skin or contact
with contaminated objects (linens,
brushes)
46
parasite
Scabies
presentation:
location:
treatment:
* Presentation: intense pruritis,
excoriated skin, linear ridges with
vesicles at one end (eggs)
* Locations: web spaces, flexor
aspect of wrist, axillae, waistline,
umbilicus, breasts and genital areas
* Treatment: lotion or oral
medication
47
parasite
Pediculosis - lice
* Infestation by Pediculus humanus of
the head, body and/or genital areas
* Transmission: personal items, skin to skin
* Incidence: school children, overcrowded situations, poor hygiene
situations
* Treatment:
* Soap or shampoo with permethrin
48
big word for the parasite lice....
Pediculosis
49
* Lupus erythematosus
* Sclerosis (Scleroderma)
* Psoriasis
are examples of what?
autoimmune disease manifestations
50
Systemic Lupus Erythematosus (SLE)
* Chronic, systemic, inflammatory
disease impacting skin, joints, kidneys,
heart, blood forming organs, nervous
system, and mucous membranes
* Discoid lupus is limited to the skin
* Systemic lupus is typically more severe
51
autoimmune disease SLE prognosis
* Survival rate has improved but death can occur from renal failure, cerebral
infarct, and cardiovascular failure – secondary to immune complex deposition
* Drug treatment of SLE includes a combination of anti-inflammatory,
immunosuppressive, and chemotherapeutic agents
52
Scleroderma
* Occurs in any individuals but more prevalent in women 25-55 years old
* Characterized by inflammation and fibrosis of many parts of the body
53
* Occurs in any individuals but more prevalent in women 25-55 years old
* Characterized by inflammation and fibrosis of many parts of the body
scleroderma
54
Scleroderma
* Two subsets
* Limited scleroderma (cutaneous;
CREST) – generally a more mild
form but can be life-threatening
with intestine and pulmonary
involvement
* Diffuse scleroderma – wide spread
skin thickening and visceral organ
involvement
55
limited and diffuse are two subsets of what autoimmune disease ?
scleroderma
* Limited scleroderma (cutaneous; CREST) – generally a more mild form but can be life-threatening with intestine and pulmonary
involvement
* Diffuse scleroderma – wide spread
skin thickening and visceral organ
involvement
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* No cure
* Treatment focuses on the organ systems involved
* Medications: immunosuppression, antibiotics, anti-inflammatories
* Exercise, joint protection, skin protection, stress management
* The average 10-year survival rate is now 70% to 80%
* Still carries a relatively poor prognosis
* Progressive pulmonary fibrosis, pulmonary hypertension, severe gastrointestinal
involvement, and scleroderma heart disease
scleroderma
57
Psoriasis (autoimmune disease)
* Autoimmune disease
* Increase in cell proliferation in the
stratum basal and stratum spinosum
* Decrease in the cycle time
* Results in an increase in epidermal
thickness
* Abnormal keratinization
58
* Management
* Topical agents (corticosteroids, retinol,
oatmeal baths)
* Phototherapy (UV exposure)
* Immunosuppressant therapy
Psoriasis
59
Rosacea
* Chronic facial disorder of middle aged and of the aging adult
* Related to acne
* Differentiated by age
* Large vascular component
* Linked to GI disturbances (bacterium H. pylori)
* Presentation: cheeks, nose, chin or entire face presents with a rosy appearance
* Can be very inflammatory with papules and pustules
* Worse in summer – sun, heat, humidity
* Complaint of burning or stinging with flushing
* Medical treatment: topical or systemic
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Presentation: cheeks, nose, chin or entire face presents with a rosy appearance
Rosacea
Can be very inflammatory with papules and pustules
* Worse in summer – sun, heat, humidity
* Complaint of burning or stinging with flushing
* Medical treatment: topical or systemic
61
Benign neoplasms and hyperplasias
* Broad classification of a variety of skin conditions
* Clinicians should be aware of:
* Benign presentations
* Malignancies
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