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Derm exam 1 bethel university
derm exam 1
153
Science
Graduate
01/24/2010

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Cards

Term
Papulosquamous Disorders of the Skin
Definition
1. Dermatophyte infection
2. Tinea Versicolor
3. Tinea corporis/pedis
4. Drug Eruptions
5. Lichen Planus
6. Pityriasis Rosea
7. Psoriasis
Term
Eczematous Eruptions
Definition
Dermititis, Dehydrosis, Lichen Simplex Chronicus
Term
Types of Dermititis
Definition
Atopic, Contact, Diaper, Nummular, Perioral, Seborrheic Statis
Term
Fitzpatrick Classification Scale describes...
Definition
skin types from very fair to dark skinned. Type 1 through Type 6
Term
Keobner Phenomenon
Definition
Minor trauma leads to more lesions. Seen in psoriasis.
Term
Patch Test
Definition
Demonstrates a hypersensitive reaction
Term
Darier Sign
Definition
rubbing a lesion causes urticarial flare
Term
Auspitz Sign
Definition
pinpoint bleeding after scale is removed
Term
Nikolsky Sign
Definition
pushing a blister or skin causes further separation of the dermis
Term
Photopatch test
Definition
documents a photo allergy
Term
UVA
Definition
1. penetrates deeper into the dermis
2. visible effect with in an hr and fades quickly
3. penetrates epidermis where connective tissue and blood vessels exist.
Term
UVB
Definition
1. primarily remains at the epidermis level
2. large dose=acute sunburn, redness burning sensation and blistering
3. cause significant pigmentation of the skin
4. seen after 24 hrs and is long lasting
Term
Eczema/Dermititis Definition
Definition
A family of superficial, intensely pruritic erythematous, eczematous, inflammatory skin lesions, including atopic contact dermititis, etc..
Term
Atopic Dermititis
Definition
-itch that rashes
-effects any race, any age
-seen predominantly in children less than 5 years old
-exacerbation and remission are typical
-PRURITIC!!!
Term
Atopic Dermititis presents as...
Definition
erythematous and papulovesicular
-vesicles rapture and weep
-located on the face, neck, wrists, elbows, trunk, knees
Term
Atopic Dermititis Pathophysiology
Definition
-immune response-will have increased levels of circulating IgE
-Inflammatory Process
Term
Atopic Dermititis Treatment
Definition
1. Education regarding soaps and detergents
2. antihistamines for itching
3. low potency steroids for inflammation
4. non-steroid immunodulator
Term
Contact Dermititis Presents as
Definition
sharply demarcated erythema, edema and vesicular lesions.
-lesions of Poison Ivy are generally linear
-may have serious fluid discharge
Term
irritant dermitits
Definition
non immunologically mediated inflammation of the skin. The intensity of the rxn depends on concentration of irritant and exposure
-80 percent of all cases
Term
Allergic Dermititis
Definition
delayed cell mediated hypersensitivity reaction stimulated by repeat exposure to an allergen that binds to a carrier protein forming a sensitizing agent Langerhands cell process the antigen and carry it to the T cells that then become sensitized to the antigen
-20 percent of all cases
Term
Contact Dermititis Treatment
Definition

-steroids and moisturizers 

-avoid the allergen/irritant 

Term
Diaper Dermititis 
Definition

-common disorder among the 6-13 month olds

-also seen in incontinent patients or any patient with incontinence issues

Term
Diaper Dermititis Pathophysiology
Definition

-related to the moist skin that is permeable to irritants

-friction leads to breakdown of skin

Term
Primary Diaper Dermititis
Definition

-Erythematous and papularvascular over the diaper covered area

-Treatment with frequent diaper changes and a skin barrier

Term
Secondary Candidiasis Diaper Dermititis
Definition

-confluent erosions, marginal scaling, and "satellite pustules" in the area covered by the diaper

-treatment must include anti-fungal agents like nvstatin or ketonazole

Term
Nummular Eczema
Definition

-chronic, pruritic 

-coin shaped lesion/plaques composed of groups of small papules and vesicles on an arythematous base

-common on the lower legs of older adult males, during winter months 

Term
Nummular Eczema Pathophysiology 
Definition

-unknown

unrelated to atopic diathesis with normal IgE levels 

Term
Nummular Eczema Treatment
Definition

-application of potent to super potent steroid ointment

-hydroxyzine TID

-intra-lesional triamcinenolone injections

-IM steroids

-Moisturize and gentile skin care because the entire skin is hypersensitive

Term
Perioral Dermitis
Definition

-Erythematous micropapules/micropapulovescles that often become confluent on the perioral and perorbital skin

- 5 mm of clear zone between the vermillion border and affected skin

Term
Perioral Dermititis Pathophysiology 
Definition

-unknow

-markedly aggravated by topical steroids  

Term
Perioral Dermititis Treatment
Definition

-avoid steroids

-metronidazole and erythromycin gel

-sulfactamide lotion

-minocyclin/doxyclylcine or tetracyclin P/O

 

Term

Seborrheic Dermititis

 

Definition

-common chronic dermititis characterized by redness and scaling 

-occurs where sebaceous glands are most active-face, scalp, chest and body folds 

Term
Seborrheic Dermititis predisposing factors 
Definition

-Parkinson's Disease

-Neuroleptic Drugs

-HIV

-Epilepsy

-Diabetes Mellitus 

Term
Seborrheic Dermititis Pathophysiology
Definition

-increase in Malassezia furfur in people with SD

-increase in IgG antibody levels to these organisms

-skin lipids are high

-the two mentioned above propagate lipophylic organism, produce inflammation and precipitate the condition

Term
Seborrhiec Dermititis Treatment
Definition

-2% ketoconazole shampoo

-selenum shampoo

-steroid lotion

-ears-combine steroid with antibacterial ointment

Term
Statsis Dermititis
Definition
-a blotchy red motting and a yellowish or light brown pigmentation of the lower third of the lower legs due to venous insufficiency 
Term
Statis Dermititis Pathophysiology 
Definition

-Edema-->Inflammation and shunting of blood into the superficial veins, thus the pressure increase and flow rate lead to hemorrhage in the microvasculature

Predisposing factors

-Obsity

-CHF

Term
Statis Dermitits Treatment
Definition

-leg elevation

-compression dressings

-avoid trauma

this is also known for being an ID reaction

Term
ID reaction
Definition

-AKA autoeczamatization

-refers to the development of widespread or distant dermititis from a local inflammation focus

-The agent causing local focus is not the direct cause of the dermititis at distant site

Term
Stasis Dermititis Complications
Definition

-often results of a minor trauma, an ulcer may form

-the dermititis may be weepy or dry, scaling of lichefied, it is generally hyperpigmented by melanin and hemosiderin

Term
Types of Leg Lesions
Definition

1. venous

2. arterial 

3. neuropathic 

Term
Venous Leg Ulcers 
Definition

-Irregular, sloped, borders, necrotic base

-Malleolar and supermalleolar 

-lipodermatosclerosis and statis dermititis 

-Atrophe blanch Pigmentation

Lymphedema

-vercose veins, pain, worse in independent state

Term
Arterial Leg Ulcers 
Definition

-punched out necrotic base  

-pressure sites; distal toes, pretibial supramalleolar (lateral)

-atrophic, hair loss pallor or reactive hyperemia 

-weak abscent pulse, pallor or elevation of leg, pain worse on elevation of leg

Term
Neuropathic Leg Ulcers
Definition

-punched out

-pressure sites, plantar

-callus before ulceration and callus surrounds the ulcer

-peripheral neuropathy and decreased sensation and don't fell pain

Term
Dyshidrosis AKA Pompholyx
Definition

-relapses, etiology not know

-highly pruritic, burning symmetric vescilles on the palms, lateral fingers or plantar feet

-deep seated vesicles, 1-5 cm, fluid think

-resolve slowly in 1-3 weeks, leaving a red cracked base with brown spots 

Term
Dyshidrosis Pathophysiology
Definition

-unknown

-probably multifactorial

a. irritants

b. genetics

c. dematophyte infeciton

d. hyperhydrosis

e. smoking 

Term
Dyshidrosis treatment 
Definition

-Potent Topical steroids, may require systemic steroids as well

-occasionally anti-biotics such as Keflex or Tetracycline are very helpful

Term
Lichen Simplex Chronicus (LSC)
Definition

-results from repeated rubbing and scracthing

-localized form of lichenfication, circumscribed plaques

-involves the wrist, neck, ankles and anogenital area

-common in adults and lasts for decades 

Term

Lichen Simplex Chronicus 

P.E.

Definition
-skin reveals sharply demarcated deeply violet-colored or red scaly plaques with thick skin lines
Term
Lichen simplex Chronicus Treatment
Definition

-rubbing and scratching must stop

-occlusive dressings

-potent steroids-not on the face though

-antihistamine for anti anxiety

-intralesional triamcinolone injection

Term
Papulosquamous Disease
Definition

Dematophyte Infection

Drug Eruptions

Lichen Planus

Pityriasis rosea

Psoriasis

Term
Lichen Planus
Definition

-Uncommon in children

-uncommon inflammatory papulosquamous disorder

-usually occurs on wrist, lumbar area, shins, penis and mouth

Term
Lichen Planus 5 P's
Definition

1. pruritic

2. planar

3. polygonal

4. papules

5. purple

Term
Pityriasis Rosea
Definition

-A common papulosquamous disorder of uknown etiology-HSV type 7 is suspected causative 

-Starts of a single patch, then few weeks or days later, more

-Christmas tree Patters.

-First patch known as Herald Patch

Term
Pityriasis Rosea Treatment
Definition

-symptomatic- may use steroid cream for itching

-inverse PR can occur in young children in the groin, axilla, elbows and knees- treat the same 

Term
Psoriasis
Definition

-A hereditary inflammatory condition with multiple clinical expressions

-equal in both males and females

Hereditary

Term
Psoriasis Trigger Factors 
Definition

-Physical Trauma (Koebner's phenomena)

-infection

-stress

-drugs

-alcohol

Term
Psoriasis Pathophysiology
Definition

-abnormal differentiation

-keratinocyte hyperproliferation

-inflammation

Term
Types of Psoriasis
Definition

-Eruptive/ Inflammatory

- Chronic Stable 

Term
Eruptive/Inflammatory Psoriasis
Definition

-AKA Guttate psoriasis 

-Multiple small lesions with a greater tendency to spontaneously resolve

-often but not always follows a streptococcal pharyngitis 

Term
Chronic Stable Plaque Psoriasis 
Definition
-majority of patients with chronic indolent lesions present for months to years 
Term
Distribution and Predilection sites for Psoriasis 
Definition

-acute guttate

-chronic stable

-pattern 

Term
-Acute Guttate Psoriasis 
Definition
-disseminated, generalized mainly to the trunk
Term
Chronic Stable Psoriasis 
Definition
-single lesion or multiple lesions localized to the knees, elbows, sacral-gluteal, scalp, palm/soles 
Term
Pattern Psoriasis 
Definition
-often symmetrical, bilateral, often spares exposed areas, facial region is uncommonly involved 
Term
Special Sites for Psoriasis 
Definition
palms, soles, scalp and nails 
Term
Invasive Psoriasis 
Definition

-Peranal, Genital and Body folds

-warm, moist environement

-no scales, just bright red and fissured

-sharp demarcation distinct from candidiasis, contact dermititis, and tenia curis 

Term

Psoriasis Treatment 

Trunk/Extremities 

Definition

-Topical steroids+ointment base

-intralesional steroid injection

-VitD analog+steroids

-Topical Retinoids

-if greater than 10 percent of BSA combine these treatments with PUVA

Term
Psoriasis Treatment Palms/Soles
Definition

-occlusive dressings and ointment based super-potent steroids 

-PUVA 

Term
Psoriasis Treatment Scalp
Definition

-Mild-Tar or Ketoconazole shampoo followed by steroid lotion/foam

-Severe-Remove scale with mineral oil or salicylic acid, then steroid cream

Term
Psoriasis Treatment Nail
Definition
-intralesional steroid injection at the nail base maybe helpful but very painful
Term
Psoriasis Treatment Inverse 
Definition
-steroids-use caution on strength because this is a highly sensitive area with the greatest absorption rates 
Term
Systemic Psoriasis Treatment
Definition

-NO SYSTEMIC STEROID USE!! causes a severe reaction in twenty percent of the cases

-at psoriasis center or by a dermatologist 

a. oral retinoids-teratogen

b. methotrexate

c. cyclosprine

d. monoclonal antibodies and fusion


Term
Drug Eruptions 
Definition

-papulosquamous 

-present in

a. aceinform,

b. eczamatous 

c. lichenoid

-can mimic all morphology

-immunological reaction

Term
Morbilliform Eruption
Definition

-Most common,resembles viral infections

-due to ampicillin, isoniazid, phenytoin, quinidine, sulfonamides and thiazides

-maculopapular rash, itchy

-treat with antihistamines plus mild steroids 

Term
Urticarial Eruption 
Definition

-an anaphylactic IgE dependent reaction

-aspirin, PNC and blood product cause it 

-treat with antihistamines and steroids and cpinepherine 

Term
Fixed Drug Eruptions 
Definition

-present with a single/multiple, round red plaques appear soon after the drug exposure, and reappear in the same site each time the drug is ingested 

-may occur anywhere 

-teracycline and contrimoxazole frequently cause this rxn 

Term
Mononucleosis and Drug Reaction
Definition

-caused by amoxicillin or ampicillin

-a rash all over the body

Term
Dermatophytes 
Definition

-fungi that infect the startum corneum layer of the skin, hair and nails

-can come from animal and/or soil

Term
Dermatophyte organism that cause infection
Definition

-epidermophyton

-microsporum

-trichophyton

Term
Tinea
Definition

-are on exposed areas of the body

-exposure to an infected cat can occur

- trichophyton is the causative organism

 

Term
Candiasis
Definition

-superficial fungal infection caused by C. albicans

-most common fungal pathogen that affects humans

-opportunistic yeast that is part of the gastrointestinal tract, skin, and mucous membranes 

 

Term
Candida Treatment
Definition
-topical nystatin or oral fluconazole
Term
"Tanner Treatment for Candida"
Definition
mixture of low-potent steroid and ketoconazole cream-use on bone dry skin and follow up with zeozorb powder 
Term

Tinea Presentation 

1st pattern

Definition
-round annular (shaped like a ring)  lesions that begin as flat, scaly papules that slowly develop a raised border and clear in the center, extends in all directions 
Term
Tinea 2nd presentation
Definition
-deep inflammatory, round, elevated, boggy, pustular surface-usually seen on the scalp due to an infection of a hair follicle 
Term
Tinea-Versicolor/ Pitriasis Versicolor
Definition

-caused by an overgrowth of normal skin flora

-factors lower skin resistance allowing organisms to proliferate 

Term

Tinea Versicolor

History/Physical

Definition
-sharply demarcated lesions for weeks to months. seen on the trunk arms and neck and abdomen 
Term
Tenia Versicolor Diagnostics
Definition

-Woods lamp reveals blue-green fluorescences 

-KOH reveals spaghetti and meatballs 

Term
Tinea Versicolor Treatment 
Definition

Mild disease-topical anti-fungal shampoo

-severe case-oral anti-fungal plus topical 

Term
Bullous Pemphigoid 
Definition

-uncommon autoimmune disease where IgG attacks the structural proteins in the DEJ junction (hemodesmosomal proteins)

-effects the olderly

Term
Bullous Pemphigoid Treatment
Definition

1. Protect against secondary infection

2. oral steroids-this is the best treatment until blistering stops 

Term
Desquamation 
Definition

-erythema Multiforme

-Steven-Johnson Synderome

-Toxic Epidermal Necrolysis

Term
Erythema Multiforme
Definition

-an acute inflammatory hypersensitivity syndrome of multifactorial etiology

-patient presents with a complain of "target" like lesions predisposed to the hands, feet and forearms, face, elbows knees and genitalia 

-must note whether mucuos membranes are involved 

Term
Erythema Multiforme Treatment
Definition

-Oberved for TEN and SJS

-supportive 

-stop offending drugs

-treat with valtrex for HVS

-typically resolves in a month

-widespread disease may respond to systemic steroids 

Term
Steven Johnson Syndrome (erythema multiforme major)
Definition

-severe blistering mucoutaneous syndrome envolving at least 2 mucous membranes 

-more common in young adults and children 

-rare but serious 

Term
SJS history and physical
Definition

-fever, couch or sore throat, appear 1-3 days prior to any cutaneous lesions.

-burning rash that begins symmetrically on the face and the upper part of the torso. 

Term
Toxic Epidermal Necrolysis 
Definition

-overall mortality is 30-50 percent

-treatment focused on pain control, removal of possible offending agent, maintaining fluid balance and local wound care

-treated in the burn unit

Term
TEN
Definition

-rare, life treatening disease wide spread blistering and sloughing of skin

-typically related to drug ingestion, mycoplasma, streptococcal or syphilis infecton

 

Term
SJS Treatment
Definition

-uncomplicated cases resolve in 1 month

-focus on removing the offending drug

-maintaining fluid, electrolytes, nutrition

-protect against secondary skin infections 

Term
Tinea Manuum 
Definition
Tinea of the hands
Term
Tinea Barbae
Definition
-face and neck
Term
-Tinea Curis
Definition
tinea of the groin
Term
Tinea Faciei 
Definition
tinea of the face
Term
onychomycosis 
Definition

-tinea of the nails

-trichophyton infection of the nails

-treatment with systemic anti-fungals 

Term
Tenia Pedis
Definition

-athlete's foot

-wear opened toed shoes

-dry between the toes

-zeozorb powder daily

-mild/moderate-topical antifungal

moderate/severe-oral antifungal for at least two weeks 

Term
Tinea Capitis
Definition

-tinea of the head

-treatment with oral grisoelulving 20 mg/kg/day for 2 to 4 months

-must continue treatment for total time!!!

Term

Tinea Corporis

 

Definition

chest and back

person to person contact

Treatment

mid/moderate-anti-fungal cream

moderate to severe- oral anti-fungal

Term
types of secondary lesions
Definition
scale, lichenfication, keloid, scar, excoriation, fissure, erosion, ulcer
Term
Primary Lesion
Definition
macule, papule, patch, plaque, wheal, nodule, tumor, vesicle, bulla, pustule, cyst, telangiecstasia 
Term
What is a secondary lesion?
Definition
changes in the appearance of the primary lesion and can occur with normal progression of the disease
Term
what is a primary lesion?
Definition
intial reaction to an underlying problem that alters one of the structural components of the skin 
Term
Neoplasms
Definition

Basal Cell Carcinoma

Squamous Cell Carcinoma

Melanoma 

Term
Basal Cell Carcinoma
Definition

-most common malignancy in humans

-sun exposed areas show most activity for BCC

-slow growing and rarely metastasizes 

 

Term
Superficial BCC
Definition

-scaly, patches or papules

-pink to red/brown, often with central clearing 

-common on the trunk/arms

-mimics psoriasis or eczema 

-slow to progress and do not fluctuate in appearance 

Term
BCC treatment
Definition
depends on location and subtype
Term
Morpheaform and Inflitrating BCC
Definition

-aggressive subtype

-sclerotic plaques or papules

-border-ill defined

-ulceration, bleeding and crusting are uncommon

-maybe mistake for a scar 

Term

Basal Cell Carcinoma

Nodular BCC

Definition

-most common and usually occurs on the head/ back/neck

- waxy papules

-pearly

-erosion or ucler

-bleeding 

-crusting 

-rolled/raised borders

-hx of bleeding with minor trauma 

-translucency 

Term
Pigmented BCC 
Definition

-same features as Nodular BCC

-increase of brown and/or black pigment

-most common in individuals with dark skin 

Term
Basal Cell Carcinoma Pathology 
Definition

-UV induced mutation in the TP53 gene

-believed to arise from pluripotent cells in the basal layer of the epidermis 

Term
Squamous Cell Carcinoma
Definition

-second most common skin cancer

-carries a significant risk of metastasis,most go to the lungs 

Term
SCC pathophysiology
Definition

-UV induced mutation in the PT53 tumor suppressor gene

-malignant tumor of the epidermal keratinocytes

-most SCC's arise from the sun-induced precancerious lesions known as actinic keratoses 

Term
SCC Location
Definition
Scalp, face, neck, ears and arms 
Term
SCC in situ
Definition
-no invasion into the dermis
Term
Invasive SCC
Definition
-raised firm pink keratotic plaques with crusting, ulceration or cutaneous horn
Term
Periungal SCC
Definition
-mimics a wart (verruca) and frequently misdiagnosed 
Term
perioral SCC
Definition
usually arises at the vermillion border, intraoral usually appears as white plaques (resembles thrush)
Term
SCC Treatment
Definition

-depends on the pathology report and level of invasion

-scc is situ- cryotherapy

-metastatic disease requires multidisciplinary treatment

Term
Melanoma________ is the primary mode of therapy for localized cutaneous melanoma
Definition
surgery
Term
Types of Melanoma 
Definition

-superficial spreading melanoma

-nodular melanoma

-lentigo melanoma

-acral letiginous melanoma

Term
Melanoma ABCDE
Definition

A-asymmetry

B-border

C-color

D-diameter

E-elevation 

Term
Treatment of Melanoma
Definition
-depends on the pathology report and level of invasion
Term
Nodular Melanoma
Definition

-accounts for 15-30 percent of patients

-seen most commonly on legs/trunk

-rapid growth

-manifest as brown to black dome shaped nodules, may ulcerate or bleed 

-lacks the typical ABCDE of melanoma

 

Term
Superficial Spreading Melanoma
Definition

-common for ages 30-50

-manifested as a flat or raised slightly elevated brown lesion with variegated pigmentation

-generally greater than 6 mm

-irregular borders 

Term
Melanoma Pathophysiology
Definition

-sequence of events where normal melanocytes transform into melanoma cells

-is a multi-factorial and related to risk factors 

 

Term
Lentigo Maligna Melanoma
Definition

-Head, neck, and arms in fair skinned people, usually older individuals

-usually presents in a lentigo that has been present for 10-15 years 

-variegated pigmentation 

Term
Acral Letiginous Melanoma
Definition

-least common overall but most prevalent in non-whites 

-palms, soles and beneath a nail plate

-Hutchinson's sign-hallmark for ALM

Term
Pigmented Lesions 
Definition

-Lentigos

-Nevi

Term
Types of Nevi
Definition

1. Congenital

2. Common Acquired/compound/ intradermal
3. Junctual

4. Atypical

Term
Congenital Nevi
Definition

-vary in size from small to large/giant

-thin-evenly pigmented 

-extending into the subcut fat- have array of colors and cannot be distinguished from melanoma

Term
Junctional Nevi
Definition

-macular and thinly papular

-range from brown to brownish-black

-simultaneously hyperpigmented

Term
compound/intradermal nevi
Definition

-display elevation relative to surrounding tissue 

-often lighter in color than other junctional nevi

-tan to brown

Term
Atypical Nevi
Definition

1. Exhibits ABCDE of melanoma

2. biopsy to rule out MM

3. if moderately or severely displastic-treat like MMIS and follow up with q 3 months for first year

Term
Lentigo
Definition

-small, sharply pigmented macule surrounded by normal appearing skin

-hyperplasia of the epidermis and increase pigmentation of the basal layer

-may evolve slowly

"sun spots"

Term
Verrucous Lesions
Definition

Seborrheic Keratosis

Actinic Keratosis

Term
Seborrheic Keratosis Treatment
Definition

-distruction with cryosurgery

-excisional biopsy

Term
Seborrheic Keratosis Description 
Definition

-sharply defined, light brown, flat macules, maybe be sparse or numerous

-velvety to finely verrucuous surface, uneven warty surface

-appearance of being "stuck on" the skin

-vary from pale brown w/pink to dark brown or black

Term
Pathophysiology of Seborrheic Keratosis
Definition
-epidermal growth factors or their receptors have been implicated in the development of seborrheic keratosis 
Term
Seborrheic Keratosis 
Definition

-most common benign tumor in older individuals 

-appear to be "stuck on" the skin

Term
Treatment of Actinic Keratosis
Definition

-Cryosurgery

-excision biopsy

-Medical Treatment

Term
Actinic Keratosis Description
Definition

-begin as barely percieved rough spots on the skin, feel like sand paper and felt better than seen 

-later lesions become erythematous scaly plaques that may enlarge to several cm

Term
Actinic Keratosis Pathophysiology
Definition

-shares features with squamous cell carcinoma

-epidermal lesion

-keratinocytes at the basal layer may extend upwards to involve the granular and cornified layers 

Term
What is Actinic Keratosis? 
Definition

-UV-light inducing lesion of the skin that may progress to invasive squamous cell carcinoma

-most common lesion with malignant potential to arise on the skin

-seen in fair-skinned individuals in ares of long term sun exposure

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