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Flashcards in Skin Deck (65):
1

Layers of the skin

Epidermis: outer layer- horny; dead keratin

inner layer-cellular, melatonin and keratin formed

inner layer migrates to outer layer in a month

superficial thin layer, no blood vessles

 Dermis: nourish epidermis, connective tissue, sweat glands, sebaceous glands, hair follicles

Subcutaneous: adipose tissue/fat

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Skin pigmentation

Melanin- brownish

Carotene- golden yellow

Oxyhemoglobin- bright red

Deoxyhemoglobin- dark blue pigment

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Cyanosis

depends on oxygen concentration

Central; low O2 level in blood

Advanced lung disease, congenital HD, hemoglobinopathys

Peripheral; occurs when cutaneous blood flow decreased and slow- may be normal

CHF, reflects low blood flow, venous obstruction

PEdema can e both

Tissues extract more oxygen than usual from the blood

Can be normal response to anxiety or cold

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Hair

Vellus: short, fine, inconspicuous, relatively unpigmented

Terminal: coarser, thicker, more conspicuous, usually pigmented, scalp hair and eyebrows

Changes with hair distribution d/t systemic effects from Thyroid gland

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Nails

protect distal ends of fingers and toes

fingernails grow 0.1mm daily

toenails grow slower

angle between nail fold and plate <180degrees

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Glands

Sebaceous: produce fatty substance screened onto the skin surface through the hair follicles. Absent from palms and soles

Sweat :

Eccrine: widely distributed, open directly onto skin, sweat production helps control body temp.

Apocrine: Axillary & genital regions, usually opens into hair follicle, stimulated by emotional stress, bacterial decomposition of apocrine sweat is responsible for adult body odor

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Health History

Changes with hair, nails, skin??

Noticed: rash, sores, lumps, itching

Family Hx of skin CA

Personal Hx of skin Bx

Seen Dermatologist

Any special skin products

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Pruritis

causes: dry skin, aging, pregnancy, uremia, jaundice, lymphoma, leukemia, lice, drugs

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Moles

Concerning moles?

Changes with size, shape, color, sensation, new moles?

A- asymmetry

B-borders

C-color change

D-diameter >/= 6mm

E-elevation/evolving

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Skin Cancer

Basal Cell: 80%- basal level of epidermis, pearly white, head and neck, slow growth, no mets

Squamos Cell: 16%- upper layer, crusted, red, ulcerated, mets

Melanoma: 4% Lethal, mets to lymph, int organs. Half detected by patient

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Skin 4 letter words

skin

itch

burn

peel

rash

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ROS

onset pruritis, repsonse to Tx

Associated constitution or systemic Sx

home/OTC Tx/response

skin lesions: change in size/color

Bleeding

Unusual dryness/ Increased sweating

painful lesions

hair changes

nail changes

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Dyshydrotic

related to water or sweat

14

Hyperhydrosis

excessive/profuse sweating

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Xerosis

excessive dryness

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Induration

process of becoming firm or hard

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Usual Suspects

Contact Dermatitis

Pyodermas- Bacterial Infection

Viral infection

fungal infection

candida/monolial overgrowth

BCC/SCC potential for overlap

Medication effects

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Derm Principles

Be alert and integrate exams

keep a good derm text near

Find out what pt has beend oing, treating with, what they think, their Dx

Maintain low threshold for Bx for any lesions that don't respond to Tx- esp ulcers and nodules

Speak and write language fluently

ID by location, distribution, morphology, pregression, symptomatology- can always reference treatment

ABCDE of moles

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Physical Exam

General Survey:

Closely inspect hair, nail, skin. Palms, soles, web spaces, mucous membranes

Bedridden patient: sacrum, coccyx, buttock, greater trocanter, knees, heels

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Skin

Color- cyanosis, pallor

Moisture

Temperature- warm=Hyperthroid, fever: cool= hypothyroid: local warmth=inflammation/cellulitis

Texture: rough=hypothyroid: velvety=hyperthyroid

 Mobilty/Turgor: decr mobility with edema & scleroderma, decr turgor=dehyration

Lesions

 

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Alopecia

Hair loss

Causes: genetic, local inflammatory process, systemic disease

diffuse patchy or total

Hypothyroid=sparse

Hyperthyroid=fine/silky

 

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Distribution

Acne: face chest, back

psoriasis: knees, elbows

Candida: intertriginous

Herpes Zoster: unilateral dermatomal pattern

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Skin Lesions

location: general/local

distribution

blanchable?

pattern/shape: linear, clustered, annular, arciform, geographical, serpiginous

size

 shape

type- macule,papule, vesicle, nevi

color

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Scabies

Mites can be loosened with scapel blade

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Derm Colors

Flesh

Erythematous- red

Violaceous- blue

brawny- brown

jaundice- yellow- seen in sclera

hyperpigmented- dark

hypopigmented- light

vitiligo- absense of melanin

heliotropic- changing

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Cafe Au Lait Spots

uniformly pigmented spots, macule/papule (0.5-1.5 cm diameter). Benign. 6 or more with diameter > 1.5cm c/w neurofibrmatosis

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Heliotrope

viloceous eruptions over eyelids in collagen vascular disease, dermatoyositis

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Tinnea Versicolor

sup fungal infection->decr pigmentation, scaly macules on neck and upper arms

easy to see dark skin, light skin may be red/tan instead of pale

29

Fifth's Disease

Slapped cheeks, erythema infection

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Vitiligo

depigmented macules on face, hands, feet, ext surfaces. May coalecse into large areas without melatonin: hereditary

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Herpes Zoster

Shingles, reactivation of chicken pox virus (Varicella).

follow dermatomal pattern

often preceded by prodromal symptoms of pain, burning, tingling

vesicles erupt on erythematous base

 can be painful

may need long term pain management

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Pityrisis Rosea

scaly fine paules/plaques

dull pink or tawny

christmas tree distribution- on trunk and prox ext.

Herald pattern- 2-5cm bright red slightly raised plaque with fine scale at periphery

more common fall/spring

sontaneous recovery in ~ 6 wks

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Intertriginous

dark in skin folds

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Macule

<1cm spot, different color, not raised or depressed

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Patch

> or = 1 cm spot different in color, nat raised or depressed

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Papule

circumscribed solid elevation < 1 cm

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Plaque

circumscribed solid elevation > or = 1 cm
confluence of papule

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Nodule

palpable solid round elevated mass/lesion > 0.5cm

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Tumor

palpable solid round elevated mass/lesion > 2cm
 

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Erosion

breakdown of epidermis to dermis

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Lichenification

thickening of skin

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Atrophy

thinning of skin layers

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Ecchymosis

bruising

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Scale

small thin plate of horny epithelium heaved up keratin

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Crust

accumulation of debris: thick/thin

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Ulcer

open area caused by superficial loss of tissue, usually with inflammation

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Keloid

hypertrophic scarring extending beyond borders of the initiating injury

48

Fissure

deep furrow, cleft or slit

49

Warts

Caused by HPV, > 65 types

subclinical infection/ benign lesion

skin/mucus membranes affected

infect keratinized skin

firm papular lesions

plaque may have hyper keratotic surface, studded with black/brown dots

Tx: cyrotherapy, slaicylic acid, duct tape

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Skin tags

Acrochordon/cutaneous papilloma/soft fibroma

common

soft, skin colored/tan/brown, round/oval pedunculated fleshy skin lesion (polyp)

tender after trauma/torsion, may crust/bleed

common in skin folds

 often increase with pregnancy, insulin resistance

51

Trichotillomania

compulsion to pul out hair

52

Nail DO

Paronychia: sup inf of prox/lat nail fold(staph/strep)

Pitting: punctuate depression of nails

Clubbing: nail angle >180 degrees

Transverse/Linear depression: Beau's line: transverse depress of nail plate, usually following illness: severe febrile, malnutrition, trauma, coronary occlusion

Longitudinal bands of pigment may be normal in people with darker skin

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Nail inspection

inspect, palpate nails/toenails

color, shape, lesion

54

Seborrheic Keratosis

starts as macule

skin colored lesion or light tan with more pigment over time

flat to raised

 stuck on warty looking lesions

plaque-like

yellow brown velvety/warty

white pearly nodules within

not associated with risk for malignancy

Tx: cryotherapy

 

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Actinic Keratosis

superficial flattened papules covered by dry scale

often multiple

can be round/irregular

pink/tan/grey

appear on sun-exposed skin of older, fair skinned of people

1/1000 per year develop into squamos cell carcinoma

56

Basal Cell

80% skin cancer

pearly white

round border, depressed center/firm elevated borders

flesh color

central divot

translucent

telegectacias

ulcerates/bleeds

rarely metatasized

slow growing

fairskinned > 40 years

 

57

Squamos Cell

Suddenly shows up, grows quick

upper layer of epidermis

crusted/scaly/ firm red

inflammed/ulcerated

can metastasize on skin exposed to sun

can be evolving AK, usually > 60yo

 

58

Melanoma

from pigmented layer of epidermis

 lethal, most rapidly increasing US malignancy

Inc risk with severe blistering sunburn

 80% of deaths from skin cancer

rare cases of amelneous melanoma

59

HARRM Risk Model

Hx previous melanoma

Age > 50yo

Reg derm absent

mole changing

male gender

 

60

Spider Bite Epidemic

Community acquired MRSA

MRSA

often difficult to Tx d/t resistance

 PCP

Can be sup pyoderma

absess, impetigo, folliculitis, cellulitis

visual Dx inadequate

secondary infection

61

Derm Emergencies

Urticaria w/Angiodedema

Anaphylactic Reaction

Toxic Epidermoid Necrolysis (TEN)

Necrotizing Fascititis

TSS

62

Health Promotion

Risk factors

Skin self exams

Avoid tanning beds

Avoid excessive sun exposure: daily SPF UVA/UVB 15 or greater, reapply every 2 hours or if skin wet

63

Bedbound patient

shaering, sustained compression, friction

localized redness,warmth sign of impending necrosis

64

Age related Skin changes

Flattening of dermoepidermal junction: less resistance to shearing forces/thinning of skin

Reduced collagen/elastin: wrinkling

Decr epidermal cell turnover rate: reduce healing

Decr vasc responsiveness: red vasodil(cooling) and dec transdermal absorption

Decr subq fat: dim bony protection of prominences & thermoreg

Decr epidermal :angerhan cells: decr hypersensitivity response

Atrophy of eccrine/sebaceous gland: reduce oil/sweat, decr thermoreg. and pliabilibty of skin

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