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Heep Dermatology

Dermatology Heep Survey of Western Clinical Sciences Bastyr

Functions of Skin? –Homeostasis –Protect fluids –Protects invasion to body –Controls body temperature –Vit D synthesis
What is the Heaviest organ? Skin. 16% of body weight!
Describe Skin Layers: epidermis, dermis, subcutaneous tissue:
Describe Epidermis: •Keratinized horny layer •Cellular layer with melanin and keratin
Describe Dermis: rich in blood vessels, glands and hair follicles.
Describe Subcutaneous layer of the skin: adipose or fat layer
What are Skin appendages: –Hair –Nail –Sebaceous glands –Sweat glands
What makes skin color? Skin color: melanin, carotene, hemoglobin, deoxyhemoglobin –Cyanosis
Define Cyanosis: is a bluish coloration of the skin due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface.
Define Peripheral Cyanosis: When cutaneous blood decreases or slows •cold, Raynaud's, anxiety, carpal tunnel syndrome
Define Central Cyanosis: When the oxygen saturation of arterial blood falls below 85%. • hypoxia, CO poisoning
Describe Glands of the skin: •Sebaceous –Fat secretion through hair follicles. –Not on palms and soles. •Sweat: eccrine, apocrine –Eccrine direct to skin. –Apocrine through hair follicle; • axillary and genital • body odor.
3 conditions of skin lesions: Based on skin level: Flat, Elevated, Depressed
Causes of Uticaria: contact dermatitis = allergy, exercise induced, idiopathic
Red flags of Uticaria: systemic symptoms: throat swelling, lip and tongue swelling, shock: CALL 911 If localized, treat with corticosteroids or anti-histamines (benadryl) topically or orally, identify trigger/cause
Define ACNE VULGARIS: Acne, papules, vesicles or Comedo
Pathogenesis of ACNE VULGARIS: Follicular hyperkeratinization, Increased sebum production, Propionibacterium acnes (P. acnes) within the follicle, Inflammation
Causes of ACNE VULGARIS: increased androgens
Treatment of ACNE VULGARIS : topical ABX, retinoin (vitamin A derivative)
Describe Psoriasis: Most people with psoriasis have thick, red skin with flaky, silver-white patches called scales.
S/Sx of Psoriasis: thick silvery scales typically on extensor surfaces (elbows, knees, scalp, areas of frequent trauma), itching, redness, comes and goes, sometimes with joint pain (psoriatic arthritis), nail pitting
CAUSE of Psoriasis: Medications, viral or bacterial infections, excessive alcohol consumption, obesity, lack of sunlight, overexposure to sunlight (sunburn), stress, general poor health, cold climate, and frequent friction on the skin
Tx of Psoriasis: corticosteroids (topical and oral), immunosuppresants, UV treatments, bitter melon
Describe SCABIES A mite that burrows under your skin, that results in inflammation from a hypersensitivity to it.
How does scabies spread? Spread from contact with skin of infected person or clothing, bedding, carpet (can survive for 4 days off body) S/Sx of Scabies:
Tx of Scabies: referral to physician for diagnosis and treatment •Permethrin, ivermectin •Antihistamines for the itch
Describe skin Color changes: –Pigmentation: hyper vs hypo - Addison's disease, Thalassemia, Cushings / Albinism –Yellow (Jaundice): Hepatitis, Gilbert's (eyes), Fatigue (eyes), Carotenemia (palms and soles)
Skin changes in Moisture: dry - clammy
Skin changes in Temperature: warm - cold {Define Turgor:
DDx of skin Redness (Erythema) –Regional, local: cellulitis, infection, insect bite, dermatitis, rosacea, folliculitis, abscess, furuncles (boil) –General: drug reaction, hyperthermia, viral, Autoimmune
DDx of skin Itch: senile dry skin, cancer such as lymphoma or leukemia, liver and gall bladder problems, parasite, dermatitis, scabies, uremia
DDx of Pustules: acne, rosacea, folliculitis, impetigo, candidiasis.
DDx of Vesicles: shingles, herpes simplex.
DDx of White spots: tinea versicolor, vitiligo.
DDx of Purpura: thrombocytopenia, vasculitis - bruises and subcutaneous –Bruises and subcutaneous bleeding can be due to medication such as aspirin and Coumadin.
Describe ROSACEA: inflammation of glands and vessels in the face, unknown etiology
S/Sx of Rosacea: papules and pustules with marked erythema and telangiectasia, facial flushing,
S/Sx of Pustules: similar in mechanism to acne vulgaris with inflammation and rupture of the sebaceous gland leading to clogging of sebum.
Ddx of Rosacea: acne, lupus, folliculitis
Tx of Rosacea: avoid triggers: spicy foods, alcohol, hot weather, sauna, topical antibiotics (decrease inflammation)
What causes Folliculitis: Skin infection caused by staph and pseudomonas.
What are complication of Folliculitis: – Furuncle - Carbuncle
Where is Folliculitis: •Around hair follicles •Spread deeper and become more confluent •Furuncle and carbuncle are very tender •
Describe Carbuncle: is an abscess •Need Abx and drainage
Describe Impetigo: Acute pustular eruptions of the perioral skin of children usually with inadequate perioral hygiene
Pathogens that cause Impetigo: Streptococcus pyogenes and Staphylococcus aureus are the most common pathogens.
Treatment for Impetigo: Abx
What skin infections are deeper than Impetigo: Erysipelas
What layer of skin do you find Erysipelas: •Both in epidermis and dermis
What pathogen causes Erysipelas: Caused mostly by group A strep
Describe Erysipelas: Bright red, angry, swollen lesion with fever and chills. •Tx for Erysipelas:
What causes Cellulitis: Staph and strep Bacterial infection of skin in deeper layers: dermis and subQ
how does Cellulitis spread: Can spread very fast esp. in immune compromised patients such as elderly, chemo patients and HIV.
Sx of Cellulitis: fever and LAP, tenderness, erythema, warm and swollen.
Complication of Cellulitis: Can cause sepsis –
Tx of Cellulitis: needs urgent Abx. Drab circle around circled area with sharpie and mark time.
What pathogen caused candidas: Candidiasis is an infection caused by fungi. •Most common species is Candida albicans.
Where do you find candidasis: Infections can be in several different parts of the body.
Who gets Candidasis: Severity of infection varies according to general health, but healthy individuals are at risk too!!!!
Describe Types of Candidiasis: •Thrush- mouth infection caused by Candida albicans. Can also spread to esophagus. •Cutaneous - •diaper rash •hands exposed to moisture •groin areas and buttocks exposed to moisture •Intertriginous folds
Symptoms of Candidiasis: itchy, trouble swallowing •Signs: red, swollen, white patches that are adhered, when removed, usually bleed a little
Associated disease: IC
Tratment for Candidiasis: Treatment: Antifungals, keep area dry, improve immune system
Cause of Shingles: Caused by the herpes zoster virus (aka varicella), Same virus that causes chicken pox.
Is Shingles contagious: It is NOT contagious unless you have never had chicken pox.
What is the characteristic pattern of Shingles: Shingles follows a dermatomal pattern
Sx of Shingles: prodrome: pain, tingling or burning sensation, flu-like symptoms, then a rash 2-3 days later (vesicles, that ooze and crust)
Risk for Shingles: More in people > 60yo, IC
DDx for Shingles: poison ivy, herpes simplex, contact dermatitis,
Tx for Shingles: none and it will usually resolve, though post-herpetic neuralgia may remain –acyclovir, famciclovir, valcyclovir –acupuncture, gabapentin, TCA, topical capsaicin
Where is Herpes Type 1: oral
Where is Herpes Type 2: genital
Where does Herpes Simplex reside: The virus remains in the cell bodies of nerves, causing repeated attacks of the blisters.
Tx of Herpes Simplex: No established therapy, beyond topical lotions for pain relief, has been developed. –Oral acyclovir, valcyclovir
Describe Human Papilloma Virus: The virus that causes warts
Describe Tinea: Infection of the skin with fungus, Can be of hands, feet (athlete’s foot), scalp, groin (jock itch), body (ringworm)
Is Tinea contagious: Yes it is Contagious
DDx of Timea: dermatitis, candida, psoriasis, drug reaction
Tx of Tinea: keep area dry, wash household items, anti-fungals (clotrimazole, miconazole)
Describe Tinea versicolor/Pityriasis versicolor: Is a common infection of the skin that can occur at any age. •Typically it appears as a pale or dark colored rash on the chest, back, face, neck or arms. •The disease is usually more active during the warm humid summer and improves during the winter.
What causes Tinea versicolor: Caused by superficial fungal infection resulting in depigmentation, which does not tan during sun exposure
Tx of Tinea veriscolor: For the typical healthy person, Tinea versicolor is a harmless disorder. It is not related to cancer and it does not involve internal organs.
Describe Vitiligo or leukoderma: •Chronic skin disease that causes loss of pigment •Possibly auto-immune, genetic and environmental factors •Incidence in the United States is between 1% and 2%.
Describe Molluscum Contagiosum: Pearly, skin-colored, cone shaped pcompromised
Tx of Molluscum Contagiosum: liquid nitrogen
Types of HPV: –Condylomata acuminata: anogenital and oral warts –Verruca (common, flat and plantar) –Cervical condylomata •Over growth of the epithelial layers •Subtypes 6 , 11, 16 and 18
What do HPV subtypes 6 11 cause: Genital warts
What do HPV subtypes 16 18 cause: Cervical Cancer
Types of Skin Cancers: •Basal Cell Carcinoma (BCC) •Squamous Cell Carcinoma (SCC) •Melanoma, 4% - invasive and noninvasive –ABCDE for detecting melanomas •Sun Protective Factor –ratio of the number of minutes for treated versus untreated skin to redden with exposure to UV-
Describe Basal Cell Carcinoma: •A very common form of skin cancer •Usually secondary to sun exposure, genetic predisposition
Appearance of Basal Cell Carcinoma: Pearly flesh-colored or pink nodule. Telangiectasia +/- ulceration. 70% on the face
Tx Basal cell Carcinoma: Curable skin cancer by excision (slow to metastasize)
Describe Squamous Cell Carcinoma: Arise from the epidermis. 2nd most common skin cancer More dangerous than BCC because they are highly metastatic.
Describe Squamous cell carcinoma: Red, scaly, plaque or nodule that itches, weeps, and never seems to heal. Mostly on the head, neck and upper back (sun exposed areas)
Describe Melanoma: Cancer of melanocytes – so, it usually looks dark brown, black or blue-black. Flat or raised and often has irregular borders. A melanoma can arise on a patch of normal skin, or on an existing freckle or mole.
Describe the Danger signs that a freckle or mole is turning cancerous: –a change of shape (becoming raised or getting more irregular borders) –a change of color (getting darker, for instance) –bleeding or itching –a mole appears for the first time over the age of 30.
What is the ABCDE of Skin Cancer: –A: asymmetrical –B: borders irregular –C: color, uniform color? –D: diameter more than 6 mm –E: elevated
Where can a Melanoma occur: •Can arise anywhere in the body, not just on sites exposed to the sun. •Sole of the foot, the palm of the hand or under the nails.
How does Melanoma spread: It can grow quickly and spread to nearby lymph nodes, or via the bloodstream to distant organs like the bones, liver, lungs or brain.
Pathology of Melanoma: •Caused mostly by UV-B –Intensity increased at midday •UV-A causes photo-aging •UV-C extremely carcinogenic, but blocked by ozone layer.
Which type of UV ray is most likely to cause melanoma? UV-B
Created by: bastyr41