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)
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