Derm 1

Macule

flat, distinct, discolored area of skin <1 cm in diameter

Patch

flat, distinct, discolored area of skin, 1 cm or greater

Plaque

raised/elevated flat spot on the skin that is 1cm or greater

Papule

solid or cystic raised/elevated spot on skin, <1 cm

Nodule

solid or cystic raised/elevated spot on skin 1cm or greater

Nodule

What is larger and deeper than a papule that may extend into the dermis and subcutaneous tissue?

Vesicle

fluid filled raised epidermal lesion <1 cm

Bullae

fluid filled raised epidermal lesion 1 cm or greater

Pustule

pus filled vesicle

Wheal

well-circumscribed, firm elevation due to edema in skin. eg: hives

Cyst

elevated, circumscribed, encapsulated lesion in dermis or subQ filled with liquid or semi solid material

Excoriation

abrasion or scratch mark

Lichenification

rough, thickened epidermis secondary to chronic rubbing or itching

Scale

desiccated thin plates of epithelial cells

Crust

dried serum, blood, or pus usually from an infection

Erosion

loss of epidermis; moist, often depressed, superficial

Atrophy

thin skin without normal markings

Scar

healing skin defect, fibrotic replacement of normal tissue

Keloid

hypertrophied scar

Ulcer

loss of epidermis and dermis; concave

Fissure

deep linear cleavage in skin that extends into dermis

Confluent

arranged in clusters

Reticulate

lacy pattern

Dermatomal

following a dermatome

Discrete

few scattered about

Serpiginous

snake like

Type 1

What skin type always burns, never tans, is sensitive to UV exposure, and at a high risk of skin cancer?

Type 2

What skin type burns easily and tans minimally?

Type 3

What skin type burns moderately and tans to pradually to light brown?

Type 4

What skin type burns minimally and is always tan well to moderately brown?

Type 5

What skin type rarely burns and tans profusely to dark?

Type 6

What skin type never burns and is deeply pigmented?

Inspection and palpation

What exam technique to use to examine skin?

Skin turgor

Non invasive screening test for dehydration

< 3 seconds

What should the time for a normal skin turgor recoil?

Yellow discoloration

This in nails may indicate smoking, psoriasis, fungal infection, or chronic respiratory disease?

Darkening diffusely

This in nails may indicate candida, increased bilirubin levels, chronic trauma, antimalarial drugs

Green-black discoloration

This in nails may indicate pseudomonas infection

Dark bands

A rapid onset of this in nails may indicate melanoma

Capillary refill

This in nails should be less than 2-3 seconds

Nail clubbing

An increase in the angle between the finger and the cuticle. True version is seen bilaterally

Pulmonary disease

What is the most common cause of nail clubbing?

Schamroth Test

Which test is for nail clubbing?

Normal skin flora

What is the most common causative organism for all skin infections?

Strep pyogenes (group A beta hemolytic strep) and staph aureus

What are normal skin flora?

Culture and sensitivity (C&S)

What is the diagnostic method for a bacterial infection of the skin?

Staph aureus

Most common cause of Impetigo

Impetigo

An acute, highly contagious, honey-colored crust infection, commonly found around the mouth in school age children, which starts as a vesicle

Red and weeping

What is the surface under impetigo like?

Yes

Does impetigo heal without scarring?

Yes

Is regional lymphadenopathy common with impetigo?

Clinical diagnosis

How do you diagnose impetigo?

First line topical treatment

Impetigo may require C&S to determine exact organism if not responding to ___

Mupirocin ointment

First line treatment of impetigo

Retapamulin

Alternative impetigo topical treatment

PO keflex and dicloxacillin

Treatment of extensive or unresolving impetigo may require

MRSA

What should be considered in recurrent or progressive cases of impetigo?

Doxycycline, clindamycin, and bactrim

Treatment for MRSA

Bullous Impetigo

A localized staph scalded skin syndrome that causes upper skin layers to separate and scattered thin walled vesicles to appear containing yellow or slightly yellow fluid and a thin red halo

Intertriginous

What sites is bullous impetigo more common?

Mupirocin ointment

Treatment of bullous impetigo

Keflex or dicloxacillin

What treatment do we consider when patient has bullous impetigo with many vesicles/bullae widespread or very large lesions

Ecthyma

Ulcerative pyoderma of the skin that extends into the dermis and is often found on lower extremities

Strep pyogenes (group a b-hemolytic)

Most common cause of ecthyma

Ecthyma

What condition has the risk factors of edematous limb, arthropod bites

C&S

How to diagnose Ecthyma

Keflex and dicloxacillin

PO treatment of ecthyma

Maybe

Will ecthyma scar after healing?

Bacterial folliculitis

A usually superficial pyoderma within a hair follicle that causes a tiny dome shaped pustule at the follicle opening

Staph aureus

What is the most common cause of bacterial folliculitis?

Antibacterial wash and topical antibiotic (mupirocin, clindamycin)

What is the treatment of uncomplicated superficial/localized bacterial folliculitis?

Po cephalexin

What is the treatment for widespread or non responsive to topical therapy bacterial folliculitis?

Staph

Purulent bacterial infections are typically caused by what bacteria species?

Abscess

Acute or chronic localized inflammatory collection of pus with tissue destruction; area is tender, erythematous, and warm to the touch; also referred to as a boil

Furuncle

Deep seated infection that occurs around a hair follicle, typically evolving from a folliculitis, and often found in areas of friction and perspiration

Staph aureus

Most common cause of abscess or furuncle

Carbuncle

Multiple furuncles occur and coalesce

Carbuncle

Which is more extensive, furuncle or carbuncle?

Incision and drainage

Treatment for purulent infections

Pocket of pus

You cannot do an I&D until a ___ has formed

MRSA

This mainly causes skin and soft tissue infections but also can cause sepsis and necrotizing fasciitis

I&D and systemic meds

Treatment of MRSA

MRSA

Drugs to treat this include SMX-TMP, Doxycycline, clindamycin, and vancomycin IV

MRSA Carriers

What should you consider in those with frequent infections and recurrent infections in household members?

Mild

This severity of purulent infections is without sepsis, altered mental state, or hemodynamic instability

Moderate

This severity of purulent infections has signs of sepsis

Severe

This severity of purulent infections has sepsis, failure of po abx, immunocompromised or failure of I&d to resolve infection

Strep pyogenes or staph aureus

Non purulent infections are most commonly caused by these

Mycobacterium

This species can cause cellulitis with water immersion injuries

Pasteurella

This bacteria can cause cellulitis with animal bites

Gram neg bacilli

This species can cause cellulitis in diabetic and immunocompromised hosts

Cellulitis

A non purulent, acute spreading infection of the dermis and subQ tissue; usually starts from a small lesion or open area, and the skin is red, hot, tender, and swollen

Group B strep

Most common organism that causes cellulitis in neonates

Cellulitis

With this condition, you may see systemic signs like fever, chills, malaise, anorexia, and elevated WBC

Erysipelas

A non purulent infection of the superficial dermis along with significant lymphatic involvement

Strep pyogenes

Erysipelas is usually caused by this organism

Face and lower legs

Erysipelas is most commonly found where?

Cephalexin (Keflex)

Treatment of cellulitis and erysipelas

Augmentin

Treatment that is also considered for erysipelas

Sharp

The borders of erysipelas are ___