Clinical Skills Lecture - Exam 2 (derm)

sebaceous (epidermoid) cyst

-closed sac lined w/ epidermis

-filled w/ fluid or semi-solid

-ruptures easy so don't squeeze!

Furuncle (boil)

infected sebaceous cyst

staph

carbuncle

many sebaceous cysts w/ multiple pockets

urticaria (hives)

-pruritic papules, plaques, and wheals

-if severe is angioedema which can be fatal

-IgE-mediated to allergen or idiopathic

HSV-1

oral

HSV-2

genital

Herpes zoster (shingles)

reactivation of varicella in immunocompromised

-unilateral b/c along dermatomes

-pain before rash occurs

scabies

female mites burrow under skin and lay eggs

-pruritus secondary to sensitization to eggs, mites, and their feces

-worse after hot shower or at night

-extremely contagious

main areas to check for scabies

hands

flexor surfaces

axillae

waist

inner thighs

feet

actinic keratosis

rough scaly papule secondary to sun exposure

pre-SCC

seborrheic keratosis

stuck on papules

acrochordon (skin tag)

pedunculated papules

lipoma

fatty tumor

benign, soft, rubbery, subq

verruca vulgaris

firm, hyper-keratotic pap

-dots are thrombosed capillaries

-spontaneous resolution

molluscum contagiosum

-epidermal viral inf

-looks like wart but has umbilicated center or white core

-spread via direct contact

pityriasis rosea

viral infection

-"herald patch" which is salmon colored oval on trunk/arms

-2 weeks later = generalized eruption of papules w/ centripetal scaling

"Christmas tree pattern"

erythema multiforme

reaction of blood vessels in the epidermis and mucous membranes

-drug reaction, infection, idiopathic

-"target lesions" palms, soles, mucous membranes

-resolve in 2-4 weeks

erythema nodosum

large, painful subq nodules w/ overlying erythema

-more in females 15-30

-strep, drug reactions, pregnancy, TB, sarcoidosis, IBS

contact dermatitis

pruritic vesicles due to allergic rxn

-plants, nickel, dyes

-immunologic rxn

cutaneous candidiasis

moist areas

-more in diabetes and immunocompromised

-pustule progresses to red eroded patch w/ satellite lesions

impetigo

staph or strep

-colonizes in minor breaks in skin

-honey colored crusts

-very contagious

vitiligo

-white macs and patches

-loss of pigment due to lack of melanin

-autoimmune

tinea

sharply marginated, peripheral enlargement with central clearing

pruritic

tinea capitis

fungal infection of scalp

-patches of alopecia

tinea corporis

scaling annular rash

"ringworm"

tinea cruris

jock itch

tinea pedis

athletes foot

-dermatophyte infection

-webs of feet

tinea versicolor

pityriasis versicolor

-chronic, asymptomatic yeast infection w/ scaling oval patches

-affected skin will lighten

-oily areas

rosacea

flushing, papules, pustules

-can be confused w/ acne

-thickened disfigured skin on nose (rhinophyma)

ocular rosacea

eye irritation

erysipelas

-dermis and epidermis w/ defined borders

-superficial edema and palpable

-strep

is a less severe cellulitis

cellulitis

bacterial infection of dermis and subcutaneous tissue

-red, hot, tender

-staph, strep, H. flu enters through break in skin

marked w/ pen to trace growth

decubitis ulcer

bedsore

-areas of high pressure @ bony prominences

-tissue becomes ischemic then necrotic

acne vulgaris

most common skin condition

-androgen stimulation, skin microbiome, innate cell responses, genetics, diet

open comedones

black heads

closed comedones

white heads

telangiectasia (spider angioma)

red body with "legs"

dilated small vessels that are red or blue

spider veins

blue superficial varicose veins with legs

petechia

1-3 mm when blood leaks out of vessels

transient

purpura

larger than petechiae

-blood leaks out of vessels here too

ecchymosis

bruising

-greater than 3 mm

-if associated w/ edema = contusion

hematoma

pool of blood under skin resulting in swelling

swollen bruise

cavernous hemangioma

-congenital, soft and spongy

-can contain alot of blood

-first few weeks of life, gone by age 9

head, neck, viscera, liver, pancreas

BCC

pink papule/plaque with pearly appearance and surrounding telangiectasias

SCC

firmer edges than BCC

-keratotic

malignant melanoma

30% pre-existing nevi

-increasing prevalence

what to inspect for on scalp

scaliness

masses

lesions

what to inspect for on skull

size

contour

deformities

depressions

masses

what to inspect for on face

facial expression

contours

symmetry

involuntary movements

masses

edema

examination for skin on face

color

texture

thickness

hair distribution

lesions

rashes

acne

4 functions of skin

1. retain body fluid

2. protect underlying tissue

3. synthesize vitamin D

4. help control body temperature

appendages of skin

hair

nails

glands

melanin

genetically determined

levels increase w/ sun exposure

oxyhemoglobin

reddening or erythema of skin

deoxyhemoglobin

pallor of skin

carotene

yellow pigment of skin due to vitamin A

eating carrots in kids

bilirubin

yellow-brown pigment from breakdown of RBC

jaundice

vellus hair

short, thin, light-colored barely noticeable hair

face hair

terminal hair

thick, long, and dark

during puberty, replaces vellus hair

beard and pubic hair

how long does it take the nail to grow from base to digital edge

3-4 months

skin ROS

rash

lumps

sores

pruritus

dryness

new lesions or changes to existing ones

hair and nail changes

skin color changes in skin ROS

pallor

erythema

cyanosis

jaundice

increased/decreased pigment

heliotrope

what is heliotrope

purple rash around the eyelids

lupus

inspection of hair

distribution

quantity - can be increased, sparse, or expected

palpation of hair

texture - silky, brittle, or coarse

-hair pull and hair tug test

hair pull test

-examines shedding from roots

-gently grab 50-60 hairs and pull away firmly from scalp

Abnormal = 6+ easily pull out

hair tug test

-hair fragility testing

-hold a group of hair in one hand and pull shafts with opposite hand

androgenetic alopecia

male pattern baldness

alopecia areata

sharply outlines hair loss that may regrow

alopecia totalis

total loss of hair

pediculosis

lice infestation

-direct contact

-inspect for nits, hair shaft and above ears and nape of neck

step 1 of skin exam - inspection - positioning patient

seated, dressed in a gown

step 1 of skin exam - inspection - examination

-head and neck including face and ears

-upper back

-shoulders, arms, hands

-chest and abdomen

-anterior thighs and legs

-feet and toes

step 1 of skin exam - inspection - final step

position patient in standing position

-lower back

-posterior thighs and legs

-genitalia

step 1 of skin exam - inspection - what to note

-color

-moisture (dry, diaphoretic, oily)

-edema

-excoriations

-scars

what are excoriations

scratches

what to note if rashes/lesions are present

number

size in cm

color

texture

distribution/location

configuration

ABCDEs of melanoma

Asymmetry

Border

Color

Diameter

Evolving (can be more HPI)

Nevus

congenital or acquired in highly pigmented area

-flat or raised

step 2 of skin exam - palpation

-temperature (compare backs of hands)

-texture (rough or smooth)

-mobility and turgor

-tenderness

-lesions for consistency

mobility and turgor of skin

increased = dehydrated

decreased = hydrated

rash descriptions

number

size

color

shape

texture

location

configuration

macule

flat, distinct colored area

less than 1cm

ex: freckle

patch

flat, distinct discolored area

over 1cm

ex: vitiligo

vitiligo description

say paler than surrounding skin

papule

elevated lesion

smaller than 1 cm

plaque

elevated lesion

larger than 1 cm

ex: psoriasis

psoriasis description

pink silvery-white scale

nodule

mass bigger than 0.5cm

deeper than papule

ex: rheumatoid nodule

wheal

irregular, transient, localized edema

ex: hives, mosquito bite

vesicle

lesion filled w/ serous fluid smaller than 1cm

ex: herpes zoster

bulla

fluid filled lesion bigger than 1 cm

ex: burn

pustule

pus-filled lesion

ex: acne

erosion

loss of epidermis

moist w/o bleeding

ex: ruptured blister

ulcer

deep loss of skin surface

can bleed and scar

ex: diabetic foot ulcer

fissure

linear crack in skin

crust

dried residue of serum, blood, or pus

IS A SCAB

scale

flakes of exfoliated epidermis

ex: cradle cap, sunburn, dandruff

lichenification

thick, rough skin

chronic scratching

increased visibility of normal skin furrows

measuring lesions

measure long axis then perpendicular to that axis