MA study material

lat

towards the outside of the body

lateral

mid

towards the center of the body

medial

dorsal

relating to the BACK of a structure

ventral

relating to the FRONT of a structure

superior

sup

towards the head

inferior

inf

away from the body

anterior

ant

front of the body

posterior

post

back of the body

glabella

Smooth area between the eyes

radix of nose

#1

root/base of the nose

tip of nose

#3

nasal sidewall

sides of nose

dorsum

#2

bridge of the nose

nasal ala

flared cartilage on each side of the nostril

nasolabial fold

skin crevice between the nose and the corner of the mouth

aka smile lines

nasal sill

base of the nostril opening (below the nasal ala)

columella of the nose

most anterior portion of the nasal septum

helix of ear

outside part of the auricle

made of cartilage

crura of antihelix

scaphoid fossa

antihelix

tragus

lobule of ear

aka earlobe

antitragus

concha

the deepest depression of the ear

cymba concha

smaller depression anterior to the concha

triangular fossa

AK description

rough, crusty or scaly lesion (can be mac or pap)

BCC

basal cell carcinoma

NMSC; most common skin cancer

gradual growth from UV light exposure

usually skin color or red raised, flat lesion "shiny pap"

symptoms: bleeding tender and persists w/ LN2

tx: for superficial bcc or scc in situ--> mohs vs excision (exc) vs ED&C vs brachytherapy vs field tx (best is mohs & excision)

BCC description

pearly, erythem pap

twice a day

BID

biopsy

bx = h/o bx; BX = no h/o bx

DF

Dermatofibroma - scar-like lesion usually arise from previous injuries like bug bites or inflammatory; pink pap w/ (+) dimple sign

diffuse AD

all over sun damage

DN

dysplastic nevus = abnormal mole when observed under the microscope but not considered malignant melanoma, usually irregular, non-uniform, flat or raised

graded mild, moderate or severe atypia

tx: mild atypia––observed, excision

moderate atypia––observed if margins are cleared or excision if recommended by pathologist

severe atypia––excision; like malignant melanoma

h/o

history of

also means handout

irritated seborrheic keratosis

iSK

if you freeze an SK it becomes an iSK on physical exam & pn page

iSK description

waxy or scaly brown, black or light tan colored paps

They appear gradually usually on the face, neck, chest or back.

liquid nitrogen

LN2

macule

mac

= flat lesion

<1 cm

malignant melanoma

mm

monitor

mon

no evidence of recurring disease

NERD

nevus

benign mole

flat or raised

tx: not necessary unless pt requests removal

papule

pap

= raised lesion

>1 cm

post-inflammatory erythema (=redness)

PIE

same

S = Ø

without

s bar symbol

SCC

squamous cell carcinoma

NMSC; second most common to BCC

gradual growth or rapid growth from UV light exposure, metastatic form

usually red crusty and scaly lesion "erythem pap"

symptoms of tender, bleeding, and persists with LN2

SCC description

scaly, erythem pap

SK

seborrheic keratosis = benign growth of the skin, can go from tan to dark brown (brn) color, stuck on papule flat or raised

can be itchy or catch on clothing (can be removed via LN2 --> iSK)

SK description

tan stuck-on pap

symptoms

sx

3 times a day

tid

tolerated

tol

treatment

tx

VV

verruca vulgaris (aka wart)

tx: trails of LN2 vs curettage vs bleomycin vs cantharidine vs topical salicylic acid and glacial acetic acid

->

pt agrees with plan/course of tx agreed upon

seborrheic dermatitis

red, itchy, scaly scalp/brow/perioral area (aka dandruff)

tx: topical ketoconazole shampoo or cream for daily use as maintenance and acute topical steroid use (lidex solution, desonide cream, etc)

eczema

form of dermatitis that usually occurs with dry skin or change of envt

tx: acute topical steroids and moisturize daily

if significant, may require oral antibiotics and prednisone

dermatitis, NOS

localized inflammation of the skin that can be due to irritants or dry skin, usually present itself with plaques, excoriations or redness

tx: acute topical steroids (clobetasol, triamcinolone, desonide, etc) and moisturize daily

dermatitis, eyelids

localized inflammation of the eyelids can be due to irritants or allergens, usually present itself with redness and flaking

tx: acute topical steroids (desonide or westcort) and moisturize daily

dermatitis, hands

inflammation of the hands, usually present itself with redness, dryness, fissures, etc

tx: acute topical steroids (clobetasol or triamcinolone) and moisturize daily

NOS

not otherwise specified

rash or rash unspecified

unspecified or nonspecific inflammation of the skin could be due to irritants, med rxn, or systemic

usually present all over the body

tx: trial w/ topical use, if no improvement can consider oral antibiotic or prednisone

if still persists can perform punch bx, bloodwork, chest x-ray, exc as work up

rosacea

facial redness, genetically origin for more fair skin type in adults

usually present with redness, telangiectatic (blood vessels) pattern, rhinophyma (big nose), or acne-like bumps

tx:

moderate to severe cases––doxycycline or minocycline or oracea

mild cases––topical metro-gel (metronidazole)

IPL or cautery to blood vessel components

psoriasis

autoimmune condition that attacks the skin

usually persists with scaly plaques on body, scalp, and occasional face

tx: noncurable therapy only to control symptoms

acute topical steroids (cloex, clobetasol, triamcinolone, dovonex, etc) and vit D (sun exposure or vertical) if under control

oral prednisone vs methotrexate in addition to topical steroids if not well controlled with only topicals

for severe cases can consider biologics (stelara, humira, enbrel, etc)

personal h/o skin cancer

people with history of NMSC like SCC or BCC that are already treated

personal h/o malignant melanoma

people with history melanoma that's already treated

onychodystrophy

disfigured finger or toe nails that we have not done a nail clip to confirm fungal or bacterial

tx: nail clips for diagnosis prior to tx

if dx isn't fungal or bacterial, can consider topical urea nail film to thin nail to trim vs injectable kenalog to reduce inflammation that causes disfiguration

onychomycosis

confirmed fungal infection after nail clip

tx: topical (cnl8) ciclopirox nail film vs oral lamisil with close monitoring bloodwork

onycholysis

abnormal lifting of the nail(s) can be due to trauma or fungal infection

tx: trim nail(s)

Telangiectasia

spider veins, usually present on cheeks & nose

tx: not necessary but cautery or IPL if bothersome

angioma or hemangioma

cherry red blood vessels

no tx required but cautery vs shave removal if bothersome

lentigo

sun spot

usually present flat, light brown, or dark brown, patch(es)

often times can resemble atypia or melanoma (lentiginous melanoma)

tx: if suspicious bx to confirm otherwise LN2 vs hydroquinone (fading cream) vs IPL

lichen simplex chronicus

chronic rubbing due to rash

present as thickening of the skin

tx: acute topical steroids and daily moisturizer; kenalog if severe

chondrodermatitis

aka chondrodermatitis nodule helices

overdevelopment of the cartilage in the ear due to some form of pressure

lesion presents itself very painful and sensitive to touch

can resemble SCC so often will bx to confirm dx

tx: kenalog injection vs nitroglycerine ointment

aging skin

genetic aging that leads to wrinkles or damaged skin

tx: different range of topicals including tretinoin, anti-aging serum, or anti-oxidants

cosmetics

any tx involving injectables or laser therapy to treat aging skin

tx: injectables-- botox vs restylane vs juvederm vs sculptra vs belatero vs laviv; IPL

pruritus

itching of the skin without any clinical rash on exam

symptoms usually involve systemic abnormalities including CNS, thyroid, kidneys, liver

tx: work up with bloodwork and chest x-ray to rule-out systemic, punch bx for dx

trail with topicals vs oral prednisone or cyclosporine

infection

after culture results show growth little to heavy growth of bacteria or fungal or yeast

tx: oral antibiotic or topical antibiotic (mupirocin or vancomycin) to treat bacterial infections

topical antifungal/yeast to treat fungus or yeast, if severe fungal infection can consider oral econazole or fluconazole

melasma

brown pigmentation usually bilateral patches on the face

has a genetic origin, and worsens with exposure to sun

tx: topical remedies including hydroquinone (fading cream) and tretinoin

coldsores

viral infection from Herpes Simplex Virus 1 (HSV-1)

most common in perioral area

present as a group of crusty vesicles when flare

tx: oral antiviral including Valtrex vs acyclovir vs valacyclovir

Neoplasm of uncertain behavior

any biopsies done in office are considered new development

or something when patient is recommended to monitor, biopsy at follow up

comedones

dilated pores (blackheads or whiteheads)

tx: extraction or topical tretinoin as preventative medicine

acne

inflamed papules on face, back, or chest

most common in teenagers, but on occasion adults

tx: topical remedies, (aczone, acanya, ziana, epiduo, differin, clindamycin, tazorac, benzoyl peroxide, glycolic acid, etc)

oral antibiotics (doxycycline, minocycline, Bactrim)

if severe can consider isotretinoin

milium

encapsulated tiny cyst mainly located on face

tx: extraction or topical tretinoin as preventative medicine

cyst/acne

macromilium (large milium)

tx: extraction or topical tretinoin as preventative medicine

cyst

subcutaneous (under skin) nodule (bump) caused by clogged hair follicle and increase of keratinous debris inside a lining

if continuous rubbing can lead to inflammation or even rupture

tx: surgically remove if bothersome otherwise no tx necessary

if inflamed-- incision and drainage and oral antibiotics (doxycycline) to reduce inflammation, the surgery to clear the lining if pt prefers

neurofibroma

skin color or colored papule arising from the nerve

herpes simplex

viral components anywhere on body

symptoms include painful or discomforting localized area

tx: oral antiviral (valtrex or acyclovir vs valacyclovir)

shingles

painful stinging unilateral sensation due to chicken pox virus affecting the nerves

only people with h/o chicken pox

tx: oral antiviral (valtrex or acyclovir vs valacyclovir)

acrochordon

skin tags can be located on neck or armpits

tx: scissor snips if bothersome otherwise no tx necessary

hypertrophic scar of skin

raised scar after a procedure or injuries

prone areas= chest, back shoulders

can become itching itchy over time

tx: kenalog injection to reduce itching and can flatten scar

keloid

overgrowth of scars

tx: kenalog injections to flatten scar

scar & fibrosis of skin or scar on skin NOS

scar left by a procedure or injuries

scabies

contagious and severe itching/rash caused by mites or burrowing of the skin

tx: anti-parasitic therapy including topical elimite and oral ivermectin

lipoma

fatty tumor underneath the skin

description = soft subcutaneous nodule mobile or nonmobile

tx: surgically remove if bothersome otherwise no tx necessary

ecchymosis

bruising of the skin

usually self-resolving

Xanthelasma

yellow patches builds to periocular (around eyes) due to hypercholesterolemia (high cholesterol)

tx: dermatologically not harmful but should have cholesterol lowered by primary care

removal of build ups if cosmetically bothersome