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Flashcards in Skin Abnormalities Deck (51)
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1

What are the 3 layers of skin?

-Epidermis
-Dermis: blood vessels, hair follicles, sebaceous glands, sweat glands
-Subcutaneous

2

What are the appendages of the skin?

-Hair
-Nails
-Sebaceous glands
-Sweat glands

3

What do sebaceous glands do and where are they located?

-Produce fatty substance onto skin surface through hair follicles

-Present on all skin surfaces except palms and soles

4

What are the different types of sweat glands and what do they do?

-Eccrine: Widely distributed, open directly onto skin surface, help control body temp (via sweat production)

-Apocrine: Found chiefly in axillary and genital regions, usually open into hair follicles. Can be stimulated by emotional stress. Bacterial decomposition of apocrine sweat causes body odor

5

What are the key history questions for skin (HPI/ROS)

-Color changes?
-Rashes?
-Lumps?
-Itching?
-Dryness?
-Hair and nail changes?
-Weight changes, fever, chills or difficulty sleeping?

6

Describe the differences between Central and Peripheral cyanosis

-Central cyanosis: consistent with cardiac or pulmonary disease
-Peripheral cyanosis: may be seen with cold temperature or anxiety

7

What can be associated with jaundice?

Icterus-conjunctivae

8

What are the Skin- Color of lesions?

-Flesh-colored: same color as surrounding skin
-Erythematous: variable shades of red (pink, bright red, dull red)
-Violaceous: light violet
-Tan-brown
-Black or blue-black
-White

9

Describe the Morphology of Primary and Secondary Lesions

-Primary skin lesions: initial presentation, arise from previously normal skin --> Key to diagnosis

-Secondary skin lesions: results from changes to primary lesions --> Usually due to overtreatment, scratching or infection of the primary lesion

10

What are the Primary skin lesions?

-Flat: Macule or patch
-Palpable: Papule, plaque, nodule, tumor or wheal
-Palpable with contents: Vesicle, bulla, pustule or cyst

11

Describe a Macule

-<1 cm diameter
-Flat, non-palpable
-Variable color
-Examples: freckles, petechiae

12

Describe a Patch

-≥1 cm diameter
-Flat, non-palpable
-Irregular shape
-Examples- Café au lait spots, vitiligo

13

Describe a Papule

-<1 cm diameter
-Palpable, firm
-Circumscribes
-Flesh-colored, red, brown
-May be confluent and form plaques
-Examples- Molluscum contagiosum, warts, nevi (moles)

14

Describe Plaque

-≥ 1 cm diameter
-Elevated, firm, rough
-Circumscribed
-Example- psoriasis

15

Describe a Nodule

-≥ 1 cm but <2 cm diameter
-Deeper and firmer than a papule (must palpate to determine)
-Usually round
-Examples- lipoma, some skin cancers

16

Describe a Tumor

-≥ 2 cm
-A larger nodule
-Examples- hemangioma, tumors, lipoma

17

Describe a Wheal

-Irregular, transient, superficial edema
-Examples- mosquito bites, urticaria (hives)/allergic reaction

18

Describe a Vesicle

-<1 cm diameter
-Well-circumscribed
-Filled with serous fluid
-Examples- Herpes simplex “Dew drops on a rose petal”

19

Describe a Bulla (plural = bullae)

-≥ 1 cm diameter
-Well-circumscribed
-Filled with serous fluid
-Examples- blisters, 2nd degree burns

20

Describe a pustule

-Well-circumscribed
-Elevated, superficial, epidermal
-Filled with pus
-Example- acne

21

Describe a cyst

-Nodule filled with liquid or semisolid material

22

What are the Secondary skin lesions?

-Loss of skin surface- erosion, ulcer or fissure
-Material on skin surface- scale or crust
-Other- Excoriation, lichenification or atrophy

23

Describe Erosion

-Loss of superficial epidermis
-Surfaces is moist but doesn’t bleed
-Heals without scarring
-Examples- ruptured vesicle, atopic dermatitis

24

Describe an ulcer

-Deeper loss of epidermis and dermis
-Heals with scarring
-Examples- stasis ulcer

25

Describe a fissure

-Linear crack or break from the epidermis to the dermis
-Examples- atopic dermatitis, tinea pedis, angular cheilitis

26

Describe a scale

-A thick flake of exfoliated epidermis
-Examples- seborrhea, psoriasis

27

Describe crust

-Dried residue of serum, pus or blood
-Example- impetigo

28

Describe excoriation

-Abrasion or scratch mark
-May be linear or rounded
-Usually due to scratching
-Examples- scabies, atopic dermatitis, dry skin

29

Describe Lichenification

-Thickening and roughening of the skin
-Increased visibility of skin markings
-Examples- atopic dermatitis, chronic dermatitis

30

Describe atrophy

-Thinning of the skin with loss of normal markings
-Skin looks shinier and more translucent
-Example- striae (stretch marks)

31

Describe a keloid

-Hypertrophic scarring
-Extends beyond the borders of initial injury

32

What are the Skin Lesions? Describe if they blanch or not.

Do NOT blanch
-Petechiae
-Purpura
-Ecchymosis
-Cherry angioma

Blanch
-Spider angioma
-Spider veins
-Telangiectasia
-Hemangioma

33

Describe Petechia (pleural = petechiae)

-0.1-0.3 cm (1-3 mm) diameter
-Represent blood outside of a vessel
-Round or irregular
-Deep red or purple-red
-Seen with infections and bleeding disorders
-Do NOT blanch

34

Describe Purpura

0.3-1 cm
-Same as petechiae but larger
-Do NOT blanch

35

Describe Ecchymosis

-Generally >1 cm diameter
-“Bruise”
-Represent blood outside of vessels due to trauma, bleeding disorders
-Round, oval or irregular borders
-Purple lesions of variable size. Fade to green, yellow, brown
-Does NOT blanch

36

Describe Cherry angioma

1-3 mm diameter
-Flat or raised
-Red
-Non-pulsatile
-Seen on trunk
-Associated with aging
-Do NOT blanch

37

Describe Spider angioma

-Very small up to 2 cm diameter
-Central body with surrounding erythema, and radiating legs (spider)
-Seen on face, neck, arm and upper trunk
-Associated with- liver disease, pregnancy
-Do blanch
-A type of telangiectasia

38

Describe Spider veins

-Very small to several inches
-Variable shape, may resemble spider, be linear or irregular
-Most often seen on legs (varicose veins)
-Blanch with diffuse pressure only

39

Describe Telangiectasia

-Irregular lines secondary to dilations of capillaries
-Red
-Seen with basal cell skin cancers, sun-damage, rosacea
-Do blanch

40

Describe Hemangioma

-Irregular lesion secondary to dilation of dermal capillaries
-Red
-Starts as a macule, can progress to plaque or nodule
-Example- “strawberry hemangioma”

41

Describe Maculopapular lesions

-Macules with papules
-Examples:
♣ Viral exanthems: generalized, erythematous, maculopapular rash
♣ Drug eruptions

42

Describe Papulosquamous lesions

-Papules with plaques and scales
-Examples
♣ Lichen planus
♣ Pityriasis rosea

43

Describe Vesiculobullous lesions

-Vesicles and bullae
-Examples: Herpes simplex, Herpes zoster, Pemphigus vulgaris, Serious autoimmune disease affecting skin and mucous membranes

-Associated with a positive Nikolsky’s sign- slight rubbing of the skin results in exfoliation of the outermost layer

44

Describe Skin lesions- distribution

-Localized: lesions or abnormality appears in one small area
-Regional: lesions appear in a specific region of the body
-Examples- flexor surfaces, extensor surfaces

-Generalized/disseminated- Lesions or abnormality appears widely distributed or in multiple areas simultaneously

45

Describe the different characteristic distribution of skin lesions

Acne vulgaris: Face, chest, upper back
Atopic Dermatitis: Flexor surface (behind the knees/elbow crease)
Photosensitive eruptions: places exposed to the sun
Pitybiasis rosea: Tank top region and butt
Psoriasis: Knees and elbows
Seborrehic dermatitis: head

46

Describe Round/discoid lesions

-Coin shaped with no central clearing
-Example- nummular eczema (a form of atopic dermatitis)

-Umbilicated lesions
-Example- seen with molluscum contagiosum

47

Describe Oval/Ovoid lesions

-Example- Pityriasis rosea

48

Describe Annular lesions

-Round; active margins with central clearing
-Seen with tinea (fungal) infections

49

Describe shape/arrangement of lesions

-Dermatomal: Following a nerve segment (Herpes Zoster)
-Linear
-Serpiginous: Cutaneous larva migrans from hookworm larvae)
-Morbilliform: Measles-like (Erythematous maculopapular lesions that become confluent on the face and body)
-Target/targetoid: Pink macules with purple central papules (Erythema multiforme)

50

Describe Skin borders/margins

-Distinct: Well-demarcated or defined; able to draw a line around the area with confidence
-Indistinct: Poorly defined; borders merge with normal skin
-Active: Margin of lesion shows greater activity than center (Tinea infections)
-Irregular: Margins are notched, not smooth (malignant melanoma)
-Raised borders: Center of lesion is depressed compared to edge (Basal cell carcinoma)

51

What are the ABCDEs of Melanoma?

A- Asymmetrical shape
B- Borders (irregular)
C- Color (variation)
D- Diameter (> 6mm, pencil eraser)
E- Evolving