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Week 5 - derm
derm
45
Nursing
Graduate
11/02/2014

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Term
Ichthyosis vulgaris
Definition
- a fish scale appearance ON SHIN, fine brown-gray scale most prominent on distal extremities; flexural areas are spared
- Autosomal dominant inheritance
- Flare up in winter because of the drying effect of the central heating
- Topical emolient
- altered epidermis
Term
Vitiligo
Definition
- Destruction of melanocytes
- completely depigmented patches
Term
Seborrheic Dermatitis
Definition
- GREASY, RED, SCALY eruption
- scalp, eyebrows, eyelashes, POST-AURICULAR areas
- sometimes in folds
- cradle cap: greasy salmon-colored scaly dermatitis
NOT ITCHY!!!!!!!!
adolescent: dandruff
Term
Lip-licking eczema (dermatitis)
Definition
- Well-defined erythematous patch surrounding mouth
- The perioral skin is inflamed, scaly, and thickened secondary to repetitive licking of the lips.
Term
Infantile atopic dermatitis
Definition
- Begins 1 – 6 months of age
- Lasts 2 to 3 years
- Red, ITCHY papules and plaques, many ooze and crust.
- On face, trunk, extensor surfaces of extremities
*Erythema, scaling, and crusting on leg
Term
Childhood atopic dermatitis
Definition
ANTECUBITAL, POPLITEAL, ALL FOLDS
- Erythematous excoriated plaques with indistinct borders seen in the antecubital areas
- Ages 4 – 10 years
- Dry, papular intensely pruritic circumscribed scaly patches on flexural surfaces of UE / LE
Term
Lichenification
Definition
- Marked thickening of skin secondary to chronic scratching
- Post-inflammatory hyperpigmentation
Term
5 highly allergic foods
Definition
- milk
- eggs
- soy
- wheat
- peanuts
Term
Keratosis pilaris
Definition
- Fine follicular papules
- Symmetrically distributed over the extensor surfaces of thighs and arms
Term
Pityriasis alba
Definition
- Discrete asymptomatic, ill-defined (poorly demarcated) hypopigmented patches on the face, neck, upper trunk, or proximal extremities of children
- patches covered by a fine superficial scale
- lesions of 1 cm or more
Term
Pityriasis alba: tx
Definition
- topical steroids and moisturizers
- low potency ON FACE ONLY 1-2 week (0.5% to 1%)
- midpotency - hydro 2.5%
- high 3 days only
- if secondary infection: treat infection
- neosporin
- reduce dry and itching: cleansing and lubrication (mild soap such as Dove and Neutraphil); hydrophilic lotion such as aveeno, brief 5 minute shower, pat skin dry
Term
Nummular eczema
Definition
- Coin-shaped, well circumscribed SUPER ITCHY
- Round to oval red scaly patches on the extensor thighs or abdomen
- Lack of central clearing differentiates from tinea corporis
Term
Staph diaper dermatitis
Definition
- Lots of intact thin walled pustules surrounded by ERYTHEMATOUS HALOS
- Pustules RUPTURED (peely circles)
- oral antibiotics
Term
Staph impetigo and tx (3)
Definition
- On face, honey colored, superficial shallow glistening erosion
- Bullous on trunk, thin, brown, varnish like, superficial SHALLOW glistening
- Beta lactam antibiotics: dicloxacillin, erythromycin, topical mupirocin
Term
Group A beta hemolytic Streptoccoccal Impetigo
Definition
- Vesicopustules with a yellow gold or honey-colored crust
- Triggered by minor skin trauma, insect bites underlying eczema
- Regional lymphadenopathy
- Brown crust
- Deep, ulcer
Term
Tinea capitis
Definition
- widespread breakage at the scalp, salt and pepper appearance
- Fungal infection seen in pre-school, children 2-6 years old
- Highly contagious
- AFRICAN AMERICAN children in urban areas
Term
Tinea capitis: complications
Definition
kerion (a tender, boggy mass), pustules, weeping and crusting lesions, suboccipital or posterior cervical lymphadenopathy
Term
Tinea capitis: tx (3)
Definition
- Griseofulvin 15-20mg/kg/day - max 1 gm with milk or fatty meal 6 weeks
- Prednisone for kerion – 1mg/kg/day for 5 days
- Selenium sulfide or ketoconazole 2% shampoo twice weekly
Term
Tinea corporis
Definition
- Annular lesion
- A raised erythematous scaling border with central clearing
Term
Fifth Disease
Definition
- erythema infectiosum
- Human Parvovirus B19
- More common in school children
- Adults who are around children are at risk
- Rare in AA children
- Late winter, early spring
- Spread by respiratory droplets in prodrome phase
- Mild constitutional symptoms
Term
Fifth disease: sx
Definition
- 3 stages of rash
- 1-4 days slapped cheek appearance (warm erythematous, nontender, circumscribed patches)
- 1-4 days erythematous papular eruption over upper and lower extremities spreading to trunk
- CENTRIPITAL
- Assumes lacelike or reticulated appearance
- Infection during pregnancy leads to intrauterine infection of fetus death or hydrops fettles
- Aplastic crisis –SCD or other hemolytic
Term
Roseola infantum
Definition
- Rash usually appears abruptly after 3 days of high fever and irritability. It is discrete, rose-pink macules.
- Rash is morbiliform in appearance (ALL OVER)
- May be generalized or start centrally and spread centrifugally
- CENTRIFUGAL
- Rash up to two days
- Infant looks well (6 mo. to 3 yrs)
Etiology: human herpes virus 6 (or 7)
Term
Hand foot and mouth
Definition
*Coxsackievirus A16
- summer and fall
- Characterized by fever, sore throat, and rash
- Oral involvement precedes the appearance of skin lesions
- Shallow ulcers, measuring 1 to 5 mm, surrounded by a red border, are observed on the buccal mucosa, soft palate, uvula, tonsillar pillars, and tongue
- herpangina: if no exanthem
- Cutaneous lesions: Thick-walled gray vesicles on an erythematous base, on palms, soles, and digits.
- Thighs and buttocks may also be involved.
- Self limited, resolving in about 1 week
FLUIDS
Term
Varicella
Definition
- lesions in VARIOUS stages, clustered, small geographic area
- Low grade fever, URI, mild malaise,
- Then a pruritic exanthem
- CENTRIFUGAL
- First tiny erythematous papules, rapidly enlarge to form thin-walled superficial central vesicles surrounded by red halos (“dew drops on a rose pedal” = vesicle on an erythematous base)
- Then drying begins causing an umbilicated appearance
- As surrounding erythema fades a central crust or scab is formed, which sloughs off after several days
Term
Irritant diaper dermatitis
Definition
- NOT IN THE FOLDS
- Acute, well demarcated erythema
- Erythematous patches sparing the folds
- Crusting and/or blister formation
Term
Irritant diaper dermatitis
Definition
Rx.: Frequent diaper changes, diaper cream with each change, topical low-potency corticosteroid bid prn 3 – 5 days
Term
Candidal diaper dermatitis
Definition
- bright red w/ lots of SATELLITE PAPULES and pustules
- intertrigenous areas involved!!!!
- KOH: budding yeasts and psudohyphae
- erythema w/ satellite lesions
Term
Thrush and tx
Definition
- White plaques, on an erythematous base
- Located on the tongue AND BUCCAL MUCOSA
- scrape off white thing, if it comes off, its just formula
- Treatment: Nystatin oral suspension
- Nystatin 1 ML PO oral TID (q tip)
Term
Verruca vulgaris and tx
Definition
- Warts: dry, rough, crusty
- Common in children who bite nails
- Viral induced epithelial tumors
- Spontaneous remission of warts within 2 years
- High recurrence rate
Rx: cryotherapy, podophyllum, surgical excision, laser treatments
Term
Plantar warts
Definition
- Painful
- Interrupt the normal skin lines
- Rough or smooth papules or plaques with tiny dark specks
Term
Scabies
Definition
- sarcoptesscabei, dies w/in 48 hr if not in human body
- 1 million cases annually. More common in crowded living conditions and nursing homes
Highly contagious, personal contact
Treat all contacts, hh members, babysitters, playmates
Infested person has about 12 mites on skin
Delayed and hypersensitivity cell
Term
Scabies: sx
Definition
- Easiest and most difficult dx begins with female who tunnels in to the stratum corneum, lives in burrows deposits two eggs daily for 4-5 weeks (lifespan of a mite)
- Burrow is pathognomonic sign = a small linear papule with pinpoint vesicle at the ends
Term
Pediculosis
Definition
- Head lice
- Check behind ears and nape of the neck for live lice, nits, excoriations
- Active infestation: presence of eggs on hairs within 1 cm of the scalp
- treat once, THEN ONE WEEK LATER
Term
Insect bites
Definition
- Flea bites or bed bug bites
- Multiple erythematous papules with central puncta
Flea bites usually in clusters of three “breakfast, lunch, and dinner”
- Hemorrhagic reaction to flea bites
Term
spider beat
Definition
- Can cause an inflammatory reaction
- A central wheal with a wide erythematous halo
- Painful and pruritic
Term
Morbiliform drug reaction
Definition
- Diffuse exanthem
- Maculopapular
- Rash begins to erupt 5 – 14 days after starting medication
- STOP THE DRUG
Term
Poison ivy
Definition
- rhus dermatitis
- Linear streaks of pruritic vesicles are typical of contact dermatitis caused by exposure to a plant.
Term
Nickel contact dermatitis
Definition
The location and distribution of the rash helpful in determining the cause of a contact dermatitis
- wherever they would have jewelry
Term
Pityriasis rosea
Definition
- Large herald patch on the back with central clearing, similar to tinea corporis (supposed to be like the christmas tree)
- Many oval lesions with appearance of fir tree distribution
- Lesions can be raised, macular, or scaly
- Can be erythematous, or hyper- or hypo pigmented
- No real tx: goes away in 4-6 weeks
Term
Lyme disease
Definition
- Borrelia burgdorferi
- Ertythema chronicum migrans appears 1 to 3 weeks after the bite of a tick
- IgM ab peaks 3 to 6 weeks
- IgG weeks to months
Term
Lyme disease: Sx
Definition
- Lesion begins as a red papule and slowly enlarges to form a large annular ring with a flat erythematous border (central clearing). Untreated it resolves spontaneously. 3 to 5 wks later multiple lesions will develop
-Cranial nerve palsies, meningitis, arthritis, conjunctivitis, headaches, fatigue, myalgias, and low grade fever
Term
Epidermis
Definition
- stratum corneum (corny layer)
- Langerhans cells: first line of immunologic defense
- Melanocytes: protection against UV light
Term
Dermis
Definition
- Sebaceous glands: oil produced by these glands help to lubricate the skin
- Receptors for pain, heat
- tough, leathery, mechanical barrier
Term
Subcutaneous tissue
Definition
- Adipose
- Arteries
- Thermoregulation: sweat glands and changes in cutaneous blood flow
Term
Functions of the skin (9)
Definition
- protection
- prevents penetration
- perception
- temperature regulation
- identification
- communication
- wound repair
- absorption and excretion
- production of vitamin D
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