Skin

inspection

• color of lesion (pink, red, purple, white, tan, yellow, uniform, varigation)

• margination (well or ill defined)

• consistency (soft, firm, hard, board like)

• shape

• arrangement (grouped or scattered)

• distribution (single or pattern)

vesicles/bullae

Primary skin lesion

• fluid filled

• small

• often grouped together

bullae

Primary skin lesion

• fluid filled

• larger in side

pustules

skin lesion filled with a purulent type fluid are called…

wheals

Primary skin lesion

• Diverse distribution

• Commonly seen in allergic reactions to drugs

plaques

Primary skin lesion

• excess skin accumulation

tumor

Primary skin lesion

• irregular shape

• raised

macules

Primary skin lesion

• Flat

papules

Primary skin lesion

• Above level of skin

irregular boards

Red flag for skin lesions

nodules

Primary skin lesion

• abrupt

• big

• raised above skin

scales

Secondary lesion

• dead skin flaking off

lichenifivation

Secondary lesion

• toughened/rough skin

crustations

Secondary lesions

• look “honey-like”

• seen in impetigo

erosions

Secondary lesions

• deeper

• skin is worn down

ulcer

Secondary lesion

• dermal penetration

• wound

fissures

Secondary lesion

• cracks

atrophy

Secondary skin lesion

• age related

scars

Secondary lesion

• occurs after healing

keloid

Secondary lesion

• overgrown scar tissue

• firm

beaus lines

• nails have a lined appearance (white lines)

• can be one or multiple fingers

• can be caused by iron or protein deficiency

onychia

• inflammation of nail matrix, leading to shedding of nail

oncholysis

• separation of nail plate from nail bed

onychomycosis

• tinea unguium

• requires systemic antifungals

• nail could also be removed

takes 1 yr for nail to fully grow out

paronychia

• marginal infection of tissue around nail

• they need ABX

koilonychia (spoon nail)

• can be congenital, hereditary, related to iron deficiency

clubbing

• large club like finger tips

• may have cardiac, respiratory, or GI etiology

diascopy

Skin exam technique

• press microscope slide over lesion

  • if it blanches, it is r/t capillary dilation (vascular condition)

  • no blanching is r/t extravasation of RBCs (purpura)

woods lamp

Skin exam technique

• a UV light

• Often a setting on ophthalmoscopes

acetowhitening

Skin exam technique

• application of 5% acetic acid (white vinegar) turns viral lesions white

dermatographism

Skin exam technique

• associated w/ urticaria

• a scratch will cause a welt

dariers sign

Skin exam technique

• papule turns into wheal after rubbing it

nikolsky phenomenon

Skin exam technique

• lateral shearing pressure causing erosion

auspitz sign

skin exam technique

• removal of scaly lesion, reveals punctate bleeding points - classic w/ psoriasis

koh (potassium hydroxide)

Positive in the presence of yeast

sterile saline

When swabbing a wound for culture, it should first be cleaned with…

and then swabbed edge to edge

scabies

Skin condition

• intense nocturnal itching

• scratch off a sample

tzanck smear

A dye used to identify giant multinucleated cells / confirm HSV, HZ

skin ca red flags

__ red flags

• sores that do not heal

• persistent lump or swelling

• new/preexisting nevi w/

  • different colors

  • irregular border

  • nodule w/ erosion or ulceration

  • bleeding

  • change in color, size, or thickness

melanoma risk factors

__ risk factors

• Previous hx, family hx

• immune suppression

• blistering sunburn before age 14

MMRISK

• Moles: atypical (dysplasic) nevi >5

• Moles: common moles >50

• Red hair: red hair and freckling

• Inability: inability to tan (skin phototypes I and II) - darker skin individuals

• Sunburn: severe sunburn, esp before age 14

• Kindred: family hx of melanoma

superficial spreading

type of melanoma

• MC

• flat/macular

• irregular borders/color

• shades of black and brown

nodular

type of melanoma

• usually starts as a raised area

• dark black/blue or bluish/red

• some are not colored

lentigo maligna

type of melanoma

• usually occurs in older adults

• commonly on face, neck, arms - sun exposed areas

• abnormal skin areas usually large, flat, and tan w/ areas of brown

acral lentiginous

type of melanoma

• least common

• usually found on palms, soles, and even under fingernails

ABCDE

• Asymmetry

• Border irregularity

• Color is variegated

• Diameter > or = 6mm

• Elevation

basal cell (malignant cutaneous neoplasm)

Common on face/sun exposed areas

• often starts as papule → telangiectasis (star pattern of superficial vessels), shiny appearance → rolled/raised boarder → central erosion/ulcer

squamous cell (epithelial malignant tumor)

Common sun exposed areas

20% of all cancers

• soft, mobile, and elevated w/ surface scale

• more aggressive/rapid growth

rules of thumb

If it is dry → wet it

If it is wet → dry it

Treat w/ antifungal

Treat w/ topical steroids or antihistamines

Refer to derm when that fails or if in doubt it may be skin CA

strep

Pus from this organism is often thin and serous

staph

Pus from this organism is often gelatinous

pseudomonas

pus from this organism is often blue-green, smelly