wk 3- derm presentations Flashcards
(88 cards)
1
Q
when looking at skin conditions on the feet where else should you check to help diagnoses
A
upper limbs
2
Q
what can you find out by palpating skin lesions
A
flat or elevated
firmness/ texture/ swelling
3
Q
macule
A
less than 0.5cm, flat, colour different to surrounding tissue
4
Q
patch
A
greater than 0.5cm, flat, colour different to surrounding tissue
5
Q
cyst
A
closed sac containing fluid or semisolid material
6
Q
nodule
A
greater than 0.5cm, dermal or subcutaneous firm, well defined lesion.
7
Q
papule
A
less than 0.5cm, solid elevated mass
8
Q
plaque
A
greater than 0.5cm, solid, elevated mass
9
Q
bullae
A
greater than 0.5cm, fluid-filled blister
10
Q
pustule
A
less than 0.5cm, elevated circular lesion containing pus
11
Q
vesicle
A
less than 0.5cm, fluid filled, elevated
12
Q
erythema
A
localised redness (increased blood flow to area)
13
Q
erythroderma
A
generalised redness that may arise from desquamation
14
Q
telengectasia
A
dilation of small and superficial cutaneous blood vessels
15
Q
ecchymosis
A
extravasation of blood under the skin
leakage of blood outside the vessels
16
Q
petechiae
A
1-2mm (small), itchy macules caused by tiny haemorrhages
17
Q
palpable purpura
A
raised, palpable discolouration due to vascular inflammation and extravasation of blood
18
Q
atrophy
A
thinning of tissue
19
Q
erosion
A
loss of epidermal or epithelium
20
Q
ulcer
A
loss of epidermis
21
Q
eschar
A
scab or dry crust due to trauma, infection or skin condition
22
Q
gangrene
A
necrotic, black tissue due to loss of blood supply (wet or dry)
wet- odour, spreads rapidly
dry- cold, dry, turns black
23
Q
impetigo
A
superficial bacterial infection under statum corneum
small vesicles that rupture and develop yellow crust
contagious
24
Q
treatment for impetigo
A
topical:
1. fusidic acid 2% 3 times a day for 5 days
- mupirocin
if extensive
oral:
antibiotics for a week.
25
ecthyma
bacterial infection of epidermis
round, painful punched out ulcer with crust on top
26
erysipelas
bacterial infection of upper dermis
oedema, pain, erythema, demarcated border
27
cellulitis
bacterial infection of lower dermis
oedema, diffuse erythema
unilateral typically
28
necrotising fascia
bacteria infection of the subcutaneous fat and deep fascia
29
what bacteria causes impetigo
staph aureus
30
what bacteria causes ecthyma
staph aureus and strep
31
cellulitis is caused by what bacteria
strep
sometimes staph aureus
32
if someone with cellulitis has what symptoms does it indicate sepsis?
- fever
-hypothermia
-tachycardia
-hypotension
33
what bacteria causes erysipelas
strep
34
pitted keratolysis presents as
malodour
clusters of crater like pits
35
treatment for pitted keratolysis
control sweating
cotton socks, changing socks, changing footwear
topical:
fusidic acid for several days
36
erythrasma
bacterial infection of skin folds
37
erythrasma treatment
1. topical imidazoles (not ketaconazole)
or
2. fusidic acid
38
what is dermoscopy
magnifying lense with lighting system to exam the skin
39
why use dermascopy
1. early diagnosis of melanoma
2. tracking lesions
3 discriminate between differentials
40
dermoscopy modes
polarized non contact-
used when the surface isnt flat (between toes or under nail plate) or when pressure causes pain-need an interface fluid to allow for better visualisation (doppler gel)
polarized contact- allows for examination of deeper layers
non-polarized contact- examination in superficial layers
41
ABCDE- standard used for body lesions
A-ASYMMTERY (divided into 4s)
B-BORDER- less well defined
C-COLOUR- varied within the lesion
D-DIAMETER- >6mm
E-EVOLVING- changing over time
42
3 point check list for lesions
1. asymmetry in colour or structure
2. atypical network
3. blue/white structures
2 of these is a high likelihood of melanoma
43
chaos, clues, exceptions
1. chaos present?
- asymmetry (divided into quarters)
2. clues present?
-eccentric structureless area
-thick lines reticular or branched
-grey or blue structures
-black dots
-parallel lines or ridges
-white lines
-polymorphous vessels
biopsy if there is chaos and 1 clue present
OR if there is an exception present such as
3. exceptions
-changing lesion on adult (bigger, smaller, colour change)
-nodular or small lesion with any clue
-volar skin- on the soles of feet: parallel ridge pattern
44
causes of pigmented nail bands and what they present like
1. trauma (blood)- not arising from proximal nail, sharp border
2. ethnic pigmentation
-multiple nails, regular bands
3. reactive pigmentation
-colour not brown, regular bands, multiple nails
4. lentigo
-parallel regular bands, no nail fold involvement
5. melanoma
-brown, irregular bands (wide at base than proximal, width greater than 3mm), hutchinsons signs
45
what is hutchinsons sign
pigmentation extends to the proximal nail fold
46
CUBED when to use it
for suspicious lesions of the foot, different presentations than other areas in the body
47
CUBED
C-coloured
U- uncertain diagnosis
B-bleeding
E- enlargement/ deterioration despite treatment
D- delay in healing beyond 2 months
48
ABCDEF- for nail lesions
A; age (50-70), african, japanese, chinese and native american heritage
B- brown- black pigmented band >3mm with blurred borders
C- change/ lack of change despite treatment
D- digit most commonly involved (thumb, big toe, index finger)
E- extension of pigment to skin surrounding nail (hutchinson sign)
F- family or personal history of melanoma or dysplastic nevus
49
solar lentigo
early phase of solar keratosis- due to exposure to sun
50
dermatoscopic features of solar lentigo
1. sharply demarcated moth eaten borders
2. homogenous pigmentation
3. parallel brown lines (finger like structures)
4. invaginations
51
seborrheic keratosis what is it and its features
benign skin growth
waxy or scaly surface
well demarcated borders
white spots
light- brown colouration
52
verruca pedis features
1. black pinpoint bleeding/linear capillaries
2. interuption or absence of skin lines
53
prevelance/ incedence of verruca pedis
40% of population have HPV
7-12% a wart develops
most commonly seen in children
54
life cylce of HPV
2 years with most resolving spontaneously without treatment
55
risk factors for verruca pedis
1. exposure
2. decrease immunity
3. previous plantar wart
4. increased epidermal penetration (moisture)
56
HPV 1 presentation
singular deep plantar wart
57
HPV2 presentation
mosaic warts
58
patho of verruca pedis
spread by direct or indirect contact
impairment of the skin barrier lets virus in
incubation period can be weeks to over a year
virus causes abnormal and excessive keratin growth
59
appearence and assessment of verruca pedis
1. cauliflower appearance
2. interruptions in skin lines over the wart
3. black pinpoints (thrombosed capillaries)
4. painful on lateral pressure more than dorsal- not very specific/sensitive
60
can verrucas become cancerous?
yes, SCC (subtype veruccous carincoma)
61
history taking for verrucas
1. onset
2. immune status now and during onset
3. pain/ impact on function
4. activities (barefoot, moist environments, trauma)
5. any partners, family members with warts. Previous history of warts
6. allergies
62
when to treat a verruca pedis
1. patient wants therapy
2. symptomatic - pain, bleeding, itching/burning
3. diabling/function loss
4.large numbers/lesions
5. patient wanting to prevent spread to other areas or people
6. immunocompromised condition (refer)
63
aims of the treatment for verruca
creating cellular damage to initiate an immune response (cytokinese to destroy the virus)
64
treatment options for verruca (topical, physical)
1. caustics (salicyclic acid)
2. escharotic (silver nitrate)
3. vesicants (cryotherapy)
1. faulkers needling
2. laser - derm
3. microwave therapy
injection therapy is also possible
1. HPV vaccination
others by dermatologists
65
evidence for verruca pedis, which treatment is best
first line:
topical sal acid
-most evidence
cryotherapy
-most evidence
second line:
silver nitrate stick
66
cryotherapy how often/ success rates
every 2-3 weeks for 3 months
70% chance of resolution
67
considerations for cryotherapy
1. not to be used on/near nails
2. darker skin tones may cause pigmentation
3. not to be used on impaired healing
4. not to be used on previous ADR
5. can be painful- not recommendation for children
6. don't have to keep it dry
68
salicyclic acid
40-80% for verruca pedis treatment
69
salicyclic acid considerations
1. high risk feet (impaired healing OR neuropathy to feel changes)
2. ADR - aspirin? linked to sal acid or zinc oxide?
3. pregnancy (cat C)
4. slight burning- not as much as cryotherapy
5. needs to be kept dry
70
sal acid neutralised with
bicarb with water to form a paste
71
how often is sal acid used
keep on for 3-7days (start with 3/4 days to see tissue destruction)
repeat weekly for 10-12 weeks
72
how to perform sal acid treatment
debride tissue until bleeding or until tolerable
apply friars balsam, zinc oxide and semi compressed felt as barrier to protect surrounding skin
apply sal acid in paraffin base (40-80%)
occlude sal acid
leave in place for 3-7days
73
silver nitrate is made up of
75% silver nitrate, 25% potassium nitrate
74
when would you use silver nitrate stick
someone that cant keep their foot dry and is fearful of pain
- child
75
what else can you use silver nitrate stick for
1. corns
2. hypergranulation
3. excessive bleeding
4. onychophosis- nail fold callous
76
silver nitrate considerations
1. at risk feet (impaired healing, neuropathy)
2. pregnancy (cat C)
3. allergy
4. burning/stinging of application
77
neutralisation of silver nitrate with
NaCl- sodium chloride
78
how to perform silver nitrate application
1. debride lesion
2. moisten stick with sterile water
3. apply to lesion for 60 seconds
4. weekly applications for 10-12 weeks
79
light does what to silver
inactivates it
80
OTC option
wart off
81
success of treatments
salicyclic- 70%
cryotherapy- 30%
silver- 43%, 15% recurrence
82
side effects of silver
tissue staining, stinging, burning
83
side effects of cryotherapy
hypopigmentation
bleeding/blistering
84
side effects of salicyclic
burning, stinging, maceration, contact dermatitis
85
faulkners needling
pushing viral tissue into subcutaneous tissue where it can be picked up from immune response
plantar infiltration using LA
limited evidence but shows 70% success rate
86
if theres multiple verrucas then how can you treat
treat the larger areas as it will cause a response for all areas
87
patient education for verruca pedis
1. what the treatment involves
2. how many treatmeants required
3.success rates
4. alternative options
5. costs
6. risks
88
how to perform cryotherapy
2mm or 5mm applicator
-debride to pinpoint bleeding
-insert applicator into canestan
-remove protective cap
-press down for 3-5 seconds to moisten the tip
-point applicator down and wait 15 seconds to reach effective temp
-apply tip downward to wart for 40 seconds
-discard 2mm applicator after 1.5 mins and 5mm after 2 mins
