MS2 - dermatology

What skin changes happen with age?

thinner, less elastic, less collagen, and drier

What skin components becomes flattened as we age?

epidermal rete pegs / dermal papillae

What are the two common skin probelms that occurs with aging?

Xerosis (dry skin) / Pruritus (itching)

Hypo-pigmentation in

soles and palms

Hyperpigmentation in

creases of soles and palms

Nail changes

Diffuse pigmentation

Linear dark bands

Oral mucosa may appear

blue or blue-gray

Rash =

Temporary eruption of skin (contact dermatitis, allergic reaction)

Lesion =

patho or traumatic loss of normal tissue (primary or secondary)

Secondary lesions includeS

scales, scab, excoriation, fissure

scales

scab

exocoriation (scratching skin surfaces)

fissure (linear cracks within dry calluses)

Dermatitis is ______; eczema is ________

exogenuous (contact); endogenuous (atopic dermatities)

Patients with Overactive Immune Skin Responses present with all of the following except:

thining skin (lichenification)

dermatitis

eczema

Adverse Drug Reactions symptoms are ususlly

mild, accompanied by pruritus, and resolve promptly when the drug is stopped

Adverse Drug Reactions can develop into life-threatening diseases such as

Toxic epidermal necrolysis (TENS) / Stevens–Johnson syndrome (SJS)

Common causes of adverse drug reactions include

Sulfa-based drugs

Penicillin

Anticonvulsants

N S A I D s

Psoriasis is a chronic condition that involves lesions that appear as

round, erythematous, dry, scaling plaques covered by silvery white scales

Common locations for psoriasis =

Scalp, nails, extensor surfaces of extremities, elbows, knees, umbilical, and sacral regions

Patients with psoriasis may also have

psoriatic arthritis

What are the two types of Psoriasis?

Pustular and nonpustular type

Treatment for psoriasis includes

Systemic and topical steroids;

immunosuppressives

Ultraviolet therapy

Coal tar product

Urticaria (hives) can be

acute or chronic

Urticaria (hives) involves

Pruritic edematous pink or red wheals

Common causes for urticaria

• Foods • Medications • Allergens • Chemicals • Cold pack • Adhesives

Urticaria (hives) treatment involves

antihistamine

What is the most common benign epithelial tumors?

seborrheic keratosis

Initially Seborrheic Keratosis =

flat, welldemarcated, small, brown pigmented areas

Over time Seborrheic Keratosis

become raised, darker, with a soft, crumbly surface

What population is Seborrheic Keratosis common in?

older adult

Skin Tag (cutaneous papilloma / fibroma) are

Soft, round, Same as skin color (or tan / brown), and Benign tumors ranging from 1 mm to 10 mm

What populations are skin tags common in?

elderly and obese

Is medical treatment necessary for skin tags?

NO but avoid torsion with manual therapy/modalities

Lipoma are

Single or multiple fatty tumors

Develop slowly, easily movable beneath skin

Painless

Nevi (moles)

Light-dark brown

Flat – round

With/without hair

(A)BCDE method to detect melanoma

Asymmetrical

most early melanomas are asymmetrical

A(B)CDE method to detect melanoma

Border

most melanomas are uneven

AB(C)DE method to detect melanoma

Color

shades of brown, tan, black can be first sign of melanomA

ABC(D)E method to detect melanoma

Diameter ≥6 mm

larger than common moles

ABCD(E) method to detect melanoma

Evolving

changing in size, shape, color, bleeding, crusting

Skin cancers named after

skin cells in which cancer develops

Albinism is a congenital disorder affecting =

skin, hair, and eyes

Lack the enzyme to synthesize melanin

Melasma =

Acquired light or brown hyperpigmentation (on face)

Melasma causes include

exposure to sunlight (exacerbates)

pregnancy, oral contraceptives

idiopathic

Melasma may disappear after

cessation of contraceptives or childbirth

Ephilides (freckles)

• Indicates skin damage from sun exposure • Monitor for subtle changes that may indicate pathology

Lentigines (liver spots)

• Small brown lesions

• In areas frequently exposed to sun

• Back of hands, neck, and face

Mongolian Spots

• Congenital blue-gray macular lesions in lumbosacral area

• Caused by melanocytes

• Typically disappears by age 5

• If present, almost always in infants of Native American, Indian or Asian origin

Vitiligo

• Loss of melanocytes • Distinct borders on face, neck, axillae, extremities • Inherited

Vitligo may also be seen with

Thyroid disease • Pernicious anemia • Diabetes

Tinea Pedis (athlete’s foot)

• Primarily affects interdigital spaces and plantar feet •

Contracted by walking barefoot or wearing occlusive footwear

• Spores can live up to 1 year in skin scales

Tinea Pedis (athlete’s foot)

• Erythema, pruritus, scaling, maceration, and/or bulla formation

Treatment for Tinea Pedis (athlete’s foot)

antifungals (topical, sometimes systemic)

Candidiasis (yeast infection)

Uncontrolled proliferation results in local infection especially in skin folds or under occlusive dressings

Candidiasis (yeast infection) presentation

• Red, pustular, well-defined scaling eruptions on skin • White, cheesy adherent masses on mucosa

High risk of yeast infection include those with

ecreased immunity, diabetes, infection, chronic steroid use, those who work with frequent exposure to water, long course of antibiotics

Treatment for yeast infection

antifungals