Exam 4- Skin, Hair and Nails- Abnormalities (part 3)

Inflammation of the paronychium

Paronychia

Acute paronychia is from

History of nail trauma

Chronic paronychia is from

History of repeated exposure to moisture

Invasion of bacteria between the nail fold and nail plate

Paronychia

Fungus grows in the nail plate causing it to crumble

Onychomycosis

Most common form of onychomycosis causes the distal nail plate to?

Turn yellow or white as hyperkeratotic debris accumulates

What causes the nail to separate from the nail bed in onychomycosis?

Hyperkeratotic debris accumulates

Onychomycosis is often associated with?

Tinea pedis

What is it when the nail pierces the lateral nail fold and grows into the dermis

Ingrown nails

What can cause ingrown nails

Lateral pressure by poorly fitting shoes, improper or excessive trimming of lateral nail plate or trauma

Ingrown nail commonly involves the

Large to

Trauma to the nail plate severe enough to cause immediate bleeding and pain

Subungual hematoma

A subungual hematoma may be severe enough to?

Cause separation and loss of nail plate

How long does the hematoma remain with a subungual hematoma

Until the nail grows out

What does a subungual hematoma look like?

Discolored, dark nail (red to purple, black, brown)

White sports on the nail from minor injury

Leukonychia punctata

Dial deformity as result of nail picking or biting habit

Median nail dystrophy (groove up the middle of the nail)

Median nail dystrophy often occurs where? Correlated with?

Thumb

Correlated with depression

Name for nail picking

Onychotillomania

Name for nail biting

Onychophagia

Loosening of the nail plate with painless separation from the nail bed that begins at the distal groove

Onycholysis

Onycholysis is most commonly associated with?

Repeated minor trauma to long fingernails

Central depression of the nail with lateral elevation of the nail plate

Koilonychia (spoon nails)

Another name for spoon nails

Koilonychia

Spoon nails are associated with?

IRON DEFICIENCY ANEMA

Syphilis, fungal dermatoses, hypothyroidism

Transverse depression in the nail bed due to temporary interruption of the nail formation

Beau lines

Things that could cause beau line

Systemic disease (all nails affected)

Local infection or trauma- 1 or few nails

With beau lines the grooves disappear when?

Nails grow out

Transverse white bands on the nails

White banding (terry nails)

White banding (terry nails) is associated with

Cirrhosis, chronic congestive heart failure, adult-onset diabetes mellitus, AGE

-basically means you don't have that good of circulation to the area

White banding (terry nails) look like

Tans were white bands that cover the nail except for narrow zone at distal tip

Psoriasis on the nails looks like

Pitting, discoloration

Yellow scaly debris accumulates that elevates the nail plate

Epidermal neoplasms caused by viral infection, Human Papilloma virus (HPV)

Warts

Where do warts occur when involving the nails

Nail folds and extend under the nail

What are cysts that contains a clear jelly-like substance in the nail

Digital mucous cysts

Where do cysts occur on the nails

Proximal nail fold or dorsal-lateral aspect of distal finger

-longitudinal nail groove may occur from cysts located at proximal nail fold

Benign dermatosis that usually arises late in the 3rd trimester of first pregnancy

Polymorphic Eruption of Pregnancy

Polymorphic eruption of pregnancy resolves when?

Promptly after delivery

Polymorphic eruption of pregnancy has what presentation

Begins on abdomen, spreads to thighs, buttocks, and arms

Periumbilical area is spared

There often is________________ is polymorphic eruption of pregnacy

Halos of blanching around papules

Benign dermatosis that usually arises late in the 3rd trimester of a first pregnancy and NOT RELATED TO HERPES VIRUS INFECTION

Herpes gestationis (pemphhigoid gestationis)

Seborrheic dermatitis most commonly occurs in?

Infants within first 3 months

Scalp lesions are scaling, adherent, thick, yellow and crusted in an infant younger than 3 months?

Seborrheic dermatitis

What is it when there are scalp lesions that are scaling, adherent, thick, yellow and crusted with Seborrheic dermatitis?

Cradle cap

Seborrheic dermatitis is localized?

Where sebaceous glands are concentrated

What is caused by sweat retention from occlusion of sweat ducts during periods of heat and high humidity in babies?

Miliaria Rubra (prickly heat)

What causes impetigo

Staphylococcal or streptococcal infection of epidermis

What is a common contagious superficial skin infection in babies or children?

Impetigo

Impetigo usually occurs where?

Face

-itches and burns

Big thing with impetigo

Lesion crusts with characteristic honey color

Impaction and obstruction of outflow of sebum

Acne vulgaris

Acne vulgaris most commonly is reported in?

Adolescents

A patient reports __________ in acne vulgaris

Comedones (plugged follicles- blackheads and white heads)

Acne vulgaris has what characteristic scarring?

"Ice pick" scarring

Acute, highly communicable disease common in children and young adults caused by varicella zoster virus?

Chickenpox (varicella)

Chickenpox remains dormant where after infection?

Sensory nerve roots for life

Popular lesions and vascular lesions on trunk, extremities, face, baccalaureate mucosa, palate or conjunctivae is characteristic of?

Chickenpox (varicella)

Pruritic rash that started on the scale and then moved to extremities is a feature of?

Chickenpox (varicella)

How does measles (rubeola) virus infect?

Invasion of the respiratory epithelium

Incubation period of measles (rubeola)

18 days

Big symptoms of measles (rubeola)

Fever followed by red blotchy rash, first on face then spreading to trunk and extremities

What kind of rash is seen on the face with measles (rubeola)

Macular rash

What can you see on buccal mucosa of a patient with measles (rubeola)

Koplik spots

What is a mild, febrile, highly communicable viral disease that is most contagious while the rash is erupting?

German measles (rubella)

Symptoms of German measles (rubella)

Low grade fever

Reddish spots occur on soft palate during prodrome or fist day of rash

Big complication of German measles (rubella) and pregnacy

During 1st trimester, it may lead to infection of fetus and produce a variety of congenital anomalies

Loss of scalp hair that can be caused by physical manipulation via twisting around finger and pulled or rubbed until it breaks off?

Hair pulling (trichotillomania)

Hair pulling (trichotillomania) may indicate

Tension

Anxiety

Emotion stressors

What does the area look like that is affected by hair pulling (trichotillomania)

Irregular border

Hair density is greatly reduced but not bald

What is important to do for noticing patterns of injury in physical abuse?

Examine skin usually covered by clothing

What occurs in older adults on the lower legs with venous insufficiency?

Stasis dermatitis

Symptoms of stasis dermatitis

Fullness, dull aching in lower legs

Increase in pigmentation and redness

Erythematous, scaling, weeping patches on lower extremity

Ulceration

What occurs secondary to chronic sun damage and is a slightly raised erythematous lesion usually less than 1 cm in diameter with irregular rough surface

Actinic keratosis (solar keratosis)

Actinic keratosis (solar keratosis) is most common to occur?

Dorsal surface of hands, arms neck and face

Most lesions of actinic keratosis (solar keratosis) remain superficial but can progress to?

Squamous cell carcinoma

Epidermal "tumor" of older skin

Seborrheic keratosis

Raised dark brown or tan plaques with a waxy appearance on the trunk, head and neck of older patients? Epidermal "tumor" of older skin

Seborrheic keratosis

Macular butterfly eruption on face with fine scaling (butterfly rash)

Systemic lupus erythematosus

Systemic lupus erythematosus is common in?

30 yr females 40 yr males

More common in blacks

More common in females

Macrophage containing droplets of lipids and a metabolic disorder or local cell dysfunction

Xanthoma

Two classification of xanthoma

Normolipoproteinemic xanthoma

Xanthoma due to hyperlipoproteinemia

Xanthoma with yellow subcutaneous tumors on the extensor tendons of digits, varying from round to longitudinal, or Achilles tendon

Xanthoma tendinosum

Xanthoma with yellowish-purple nodules located especially on elbows and kness

Xanthoma tuberosum

Xanthoma with dome shaped nodules with yellow center and red hallow, ASSOCIATED WITH DIABETES MELLITUS

Xanthoma Eruptivum

Xanthoma with yellow-orange, flat or slightly elevated infiltration of creases of the palms and fingers

Xanthoma striatum palmare

-just imagine the caress of your palm turned yellow

Another name for ichthyosis vulgaris

Xeroderma (Dry skin)

Xeroderma (dry skin) with fine white scaling, normal skin color but with fish-scale pattern?

Increased number of creases in palms and soles, follicular keratosis

Ichthyosis vulgaris

What can help with ichthyosis vulgaris

Urea containing lotions and ointments

Autoimmune blistering disease usually in adults older than 70

Bullous pemphigoid

Bullous pemphigoid is associated with

Many drugs

Autoimmune blistering skin disorder of pregnancy

Pemphigoid gestationis

Other names for pemphigoid gestationis

Herpes gestationis

Gestational pemphigoid

Rare autoimmune disease that is a chronic, nonhealing painful mouth ulcers and progressive blistering bullseye and erosions of the skin

Pemphigoid vulgaris

What is the big thing with pemphigus vulgaris

Prognosis is poor without treatment

-75% mortality at 1 year