Week 5 - Integumentary

stage I

pressure ulcer with non-blanchable erythema of intact skin

stage II

pressure ulcer with partial-thickness skin loss involving the epidermis, dermis, or both.

stage III

pressure ulcer characterized by full-thickness skin loss involving damage or loss of subcut tissue

stage IV

pressure ulcer characterized by full-thickness skin loss with damage to muscle, bone, or supporting structures

keloids

elevated, rounded, and firm clawlike skin tags that extend beyond original site of injury, more common in dark skin

pruritus

also known as itching, one of the most common symptoms of skin disorders and is triggered by chemical mediators like histamine

allergic contact dermatitis

a type IV delayed hypersensitivity rxn that occurs when skin is exposed to allergen which the person has been sensitized; response triggered by T cells and can lead to redness, swelling, and blistering of the skin.

irritant contact dermatitis

nonimmune inflammatory rxn caused by direct damage from an irritating substance

stasis dermatitis

inflammatory condition caused by chronic venous insufficiency, most commonly affecting lower legs; venous pooling leads to inc. pressure, edema, and inflammation - think of nursing home; best treated with activity, elevation of limbs, and compression

seborrheic dermatitis (cradle cap)

chronic inflammatory condition affecting areas rich in sebaceous glands like scalp/eyelids/ears; characterized by flaking and greasy scales; treated with topical antifungals to decrease yeast like ketoconazole shampoo/cream or selenium sulfide

psoriasis

chronic immune-mediated disorder where T-cell activation causes inflammation and excessive proliferation of epidermal cells causing raised plaques/scales

mild psoriasis treatment

topical therapy = first line; includes corticosteroids (“-sone/-lone”) to reduce inflammation/excessive proliferation and vitamin D analogs (calcipotriene) to slow proliferation

moderate-severe psoriasis treatment

may require systemic therapy that target the abnormal immune response; commonly uses immunosuppressants, biologics, or Acitretin (teratogenic and dangerous for pregnancy)

pityriasis rosea

benign, self-limiting inflammatory disorder often begining with a “herald patch” followed by smaller lesions in a characteristic “Christmas tree” pattern; usually resolves on its own

lichen planus

chronic inflammatory disorder affecting skin and mucous membranes that is thought to involve a T-cell mediated immune response; characterized by intensely pruritic, purple/violet, flat-topped papules

rosacea

chronic inflammatory disorder that primarily affects central face and is characterized by facial flushing, persistent erythema, visible small BVs, papules, and pustules; may also involve eyes and is triggered/worsens in the sun

rosacea treatment

topical treatments include metronidazole and azelaic acid to reduce inflammation; system treatments include doxycycline for severe cases

Discoid Lupus Erythematosus (DLE)

primarily affects the skin and is characterized by red, scaly, disk-shaped lesions that may cause scarring and changes in pigmentation

systemic lupus erythematosus (SLE)

systemic autoimmune disease that manifests on skin as a malar (“butterfly”) rash

Lupus treatment

sun protection, skin lesion treatments by topical corticosteroids/calcineurin inhibitors; hydroxychloroquine to reduce skin manifestations and disease activity but should be cautious of retinal toxicity

erythema multiforme

acute, immune-mediated inflammatory disorder most commonly triggered by herpes simplex (HSV); characterized by distinctive “target” or “bullseye” lesions; usually self-limiting but if associated with HSV, then antivirals

folliculitis

bacterial superficial infection of a hair follicle

furuncle (boil)

deeper bacterial infection of a hair follicle that forms a painful, pus-filled nodule

carbuncle

cluster of interconnected furuncles involving deeper skin and subcut tissue

cellulitis

bacterial infection of the dermis and subcut tissue that causes spreading erythema, warmth, swelling, and tenderness

impetigo

superficial, highly contagious bacterial infection that often produces honey-colored crusted lesions

erysipelas

superficial form of cellulitis with raised, sharply defined erythematous borders

Herpes Simplex virus (HSV)

viral oral/genital infection characterized by painful, grouped vesicles (blisters) that may rupture and ulcerate; after initial infection it becomes latent and periodically reactivates; treated with antivirals like acyclovir

Herpes Zoster

virus that causes shingles and occurs when varicella zoster (chickenpox) reactivates; causes painful vascular rash

warts

benign skin growths caused by HPV; there is verruca vulgaris (common _____) and condyloma acuminata (genital _____)

tinea infections

has dermatophytes which are fungi that infect keratinized tissues; dermatophyte infections are called _____ and are then named according to area of the body affected

candidiasis

fungal infection caused by Candida species that occurs do to an overgrowth of normal Candida in the body; risk factors include antibiotics, warm/moist environments, DM

cutaneous vasculitis

inflammation of small vessels of skin, often due to an immune-mediated response that damages vessel walls; characterized by palpable purpura and red-purple lesions that do not blanch with pressure

urticaria

characterized by hives and result from mast cell activation and histamine release; may be triggered by allergens/meds and is primarily treated with antihistamines

scleroderma

autoimmune connective tissue diease that causes thickening, hardening, and tightening of skin, swollen fingers, and raynaud phenomenon; systemic sclerosis may affect skin and internal organs

Crest syndrome

cutaneous systemic sclerosis that is caused by many different types of sclerosis happening at once

insect bites/stings

cause local rxns that result from inflammatory/allergic responses to saliva/venom, some may develop anaphylaxis in which Epi is used; antihistamines and corticosteroids to treat

(topical) corticosteroids

drugs that treat immune/inflammatory response

malaria

parasitic infection transmitted by infected mosquitoes, parasite infects and destroys RBCs causing life threatening organ complications

yellow fever

viral infection transmitted by infected mosquitoes and occurs primarily in Africa/South America; can only be treated with supportive care bc no known cure

dengue fever

viral infection transmitted by infected mosquitoes and is common in tropicak/subtropical regions; causes bleeding, shock, and organ dysfunctin and has no known cure

lyme disease

bacterial infection caused by B.burgdorferi that is transmitted through bite of infected ticks; characterized by erythema migrans (bullseye rash) and may be accompanied by fever, fatigue, headache and myo/joint aches; treated with antibiotics

zika virus

viral infection typically transmitted by mosquitoes but also through sex and transplacentally; may have mild/no symptoms but causes serious fetal complications w no known cure

seborrheic keratosis

benign skin growth that has a waxy, raised “stuck-on” appearance and is common with aging

nevi (moles)

benign growths of melanocytes that may be flat or raised and vary in color, changes in a mole should be evaluated

actinic keratosis

precancerous lesion caused by chronic UV sun exposure; rough scaly patch on sun exposed skin that may progress into squamous cell carcinoma

keratoacanthoma

rapidly growing, crater-shaped skin lesion that often occurs on sun-exposed skin; resembles squamous cell carcinoma and is typically removed/evaluated

basal cell carcinoma (BCC)

most common form of cancer that is slow-growing and barely metastasizes; often occurs on sundried skin

squamous cell carcinoma (SCC)

arises from keratinocytes and is often associated with chronic UV exposure; can invade surrounding tissue and metastasize

malignant melanoma

cancer of melanocytes that is less common but more likely to metastasize

kaposi sarcoma

vascular malignancy associated with HHV-8 and produces red, purple, or brown lesions; more common with significant immunosuppression

surgical removal

what is main treatment for all skin cancers?

superficial partial-thickness burns

involve epidermis and upper dermis and is red, moist, blistered, and very painful; usually heal without signifcant scarring

deep partial-thickness burns

extend deeper into dermis and may appear red/white, blistered, and less moist; pain may be decreased as nerve endings are damaged

full-thickness burns

destroy the epidermis and dermis, and may extend into deeper tissues; skin may appear white, brown, black, dry, or leathery; may be painless due to destroyed nerves

rule of nines

method used to assess the percentage of total body surface area affected by burn

burn shock

early response, extensive burns cause increased capillary permeability shifting fluids into tissues causing edema, hypovolemia, and elecrolyte imbalances

frostbite

freezing injury caused by prolonged exposure to cold, causes vasoconstriction and decreased tissue perfusion resulting in cell and tissue damage; treated by removing from cold and rapidly rewarming in running warm water

androgenic alopecia (male-pattern hair loss)

common/genetic hair loss that occurs because follicles have increased sensitivity to androgens (DHT), causing follicles to miniaturize and thin; treated with topical minoxidil (rogain) or oral finasteride

topical minoxidil (Rogaine)

promotes hair growth and slows hair loss, but continued use is necessary to maintain results

oral finasteride (propecia)

decreases conversion of testosterone to DHT which helps slow follicle miniaturization and hair loss; pregnant women should not use crushed/broken tablets

female-pattern alopecia

common form of progressive hair thinning in women that is influenced by genetic and hormonal factors, follicles gradually miniaturize, typically on crown and top of scalp; treated first-line with topical minoxidil (Rogaine)

alopecia areata

autoimmune, T-cell mediated disorder that targets hair follicles and causes sudden, well-defined patches of hair loss; treated with corticosteroids to suppress immune/inflammatory response

hirstuism

excessive growth of coarse, dark hair in women on androgen-dependant areas (i.e. beard/chest); treatment depends on underlying cause often involves hormonal therapy or cosmetic solutions.

paronychia

inflammation/infection of tissue surrounding the nail and may be acute (typically bacterial) or chronic; causes redness, swelling, tenderness, and sometimes pus

onychomycosis

fungal infection of nail that causes nails to become thickened, discolored, brittle, or distorted; treated with topical antifungals or oral terbinafine if extensive

acne vulgaris

common inflammatory disorder of pilosebaceous follicles and is most common in adolescence and early adulthood; primarily affects areas with many sebaceous glands; typically a result of bacteria C.acnes

noninflammatory ance

type of acne vulgaris characterized by open/closed comedones (pimples) caused by plugging of hair follicles

inflammatory acne

type of acne vulgaris where inflammation develops in/around plugged follicle and may include papules/pustules/nodules

causes of acne vulgaris (inflammatory)

follicular hyperkeratinization, increased sebum production, C.acnes proliferation, and inflammation

acne conglobata

rare, severe form of inflammatory acne characterized by large, painful nodules and abscesses, draining lesions, and scarring; requires dermatologic treatment with oral isotretinoin (Accutane)

topical retinoids

ex: tretinoin, adapalene; prevent follicular plugging and formation of comedones but may cause dryness, irritation, and photosensitivity; avoid during pregnancy

benzoyl peroxide

decreases C.acnes and inflammation and is available as a gel, cream, or wash; may cause dryness/irritation and bleach cloth

topical antibiotics

clindamycin is most commonly used for inflammatory acne, should be used with benzoyl peroxide to reduce development of bacterial resistance

oral antibiotics

may be used for moderate to severe inflammatory acne (ends in “-cycline”) and is usually combined with benzoyl peroxide and/or a topical retinoid; time spent using should be limited as much as necessary

moderate inflammatory acne treatment

oral tetracycline antibiotic used with benzoyl peroxide, continued topical retinoid treatment for long-term maintenance, and potential hormonal therapy in females

severe acne treatment

oral isotretinoin for severe, scarring, or resistant acne; is highly teratogenic so avoid during pregnancy

atopic dermatitis (eczema)

chronic, relapsing inflammatory disorder that involves skin-barrier dysfunction and an abnormal immune response characterized by intense pruritus, erythema/dry skin, crusting, and thickened skin

atopic dermatitis management

avoid triggers, maintain skin-hydration barrier, use topical corticosteroids for acute flares, topical calcineurin inhibitors, antihistamines, possible systemic/biologic therapy

dupilumab (Dupixent)

monoclonal antibody given by subcut injection, blocks IL-4 and IL-13 signaling to decrease inflammation; used for moderate-to-sever atopic dermatitis

oral JAK inhibitors

end in (“-citinib”) reduce inflammatory signaling involved in moderate-to-severe atopic dermatitis

diaper dermatitis

inflammatory skin rxn in diaper area that is most commonly caused by irritant contact dermatitis; prolonged exposure to moisture, urine, and feces damages the skin

staphylococcal scalded-skin syndrome (SSSS)

serious skin disorder caused by S.aureus where its exfoliative toxins cause separation of the superficial layers of epidermis (most common in infants/children); loss of skin barrier increases risk for fluid loss and infection; treated w prompt systemic antibiotics

molloscum contagiosum

contagious viral skin infection caused by a poxvirus and is spread by direct skin-to-skin contact or with contaminated objects; small, firm, dome-shaped papules; usually resolves within 6-18 months

rubella

viral infection spread through droplets and usually causing mild illness, esp in children; manifests as low-grade fever, postauricular/cervical lymphadenopathy, and fine pink/red maculopapular rash from face down; prevented with MMR vaccine

rubeola (measles)

highly contagious viral infection spread by airborne route and manifests as high fever, cough, runny nose, koplik spots (small white on buccal mucosa), and maculopapular rash from face down; prevented with MMR vaccine

roseola

viral illness occurring in infants/young children; characterized by sudden high fever that lasts days, pink/red macular rash from trunk to neck/extremities

scabies

contagious infestation caused by mite S.scabiei; spread primarily through prolonged skin-skin contact where female mites burrow and cause inflammation; first-line is Permethrin 5% cream and washing all clothes/sheets

pediculosis

parasitic infestation caused by lice that feed on human blood and spread primarily through close contact; treated with topical pediculicide and removing nits with fine toothed comb

flea bites

caused by fleas that infest animals, humans, and environment; occurs in clusters/groups (esp on lower legs/ankles) and manifests as intensely pruritic, red papules/wheals; treated by washing area, antihistamines, and topical corticosteroids

bed bugs

caused by blood-feeding insect C.lectularius and typically hides in mattresses, bedding, and furniture; bites cause inflammatory rxn that is typically not treated but all environmental infestations must be removed

infantile hemangiomas

benign vascular tumors caused by abnormal proliferation of blood vessels; shrink overtime but treated with oral propranolol (beta blocker) as first-line

port-wine stain (capillary malformation)

congenital capillary malformation present at birth; flat, pink to red/purple lesion on face or neck that doesnt fade spontaneously; laser therapy may be used

salmon patch (nevus simplex)

common, benign capillary malformation with flat, pink/red lesion that is present at birth but typically fade with time; common on nape of neck “stork bite” or eyelids “angel kiss”

miliaria (heat rash)

caused by blocked eccrine ducts which traps sweat within skin; common with heat, humidity, and excessive sweating; _______ crystallina is the most superficial form with little inflammation/redness while ________ rubra (“prickly heat”) is a deeper obstruction with inflammation