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WVSOM - Skin
Skin: The Meaning Beneath
| Question | Answer |
|---|---|
| Risk of geriatrics | Infections, injuries, need special assistance, pyschological problems, degenerative disorders, disease, disability, death |
| _______ can increase the speed and degree of physical changes of aging | Disease |
| What can affect the physical changes of aging? | Lifestyle, nutrition, economic status, social environment |
| Two types of skin aging | Intrinsic aging, extrinsic aging |
| Changes that occur due to normal maturity and occur in all individuals | Intrinsic aging |
| Changes induced by UV light exposure, smoking, and other environmental pollutants | Extrinsic aging |
| What are some histologic changes of the skin that occur with aging? | Dermis = acellular, avascular, less dense with loss of functional elastic tissue; decline in nerves, microcirculation, sweat glands, growth of nails; SQ fat atrophies on cheeks, distal extremities, hypertrophies on waist (men) and thighs (women) |
| What are some integumentary system changes that occur? | New skin cell prod. decr., oil/sweat glands less active, circ. decr., hair loss & color loss, skin less elastic & dry, itching, dark yellow/brown spots appear, fatty tissue decr., lines & wrinkles appear, nails = thick, tough, brittle, incr. temp. senst. |
| Senile lentigines | Liver spots |
| Macule | < 1 cm; flat, circumscribed area |
| Patch | > 1 cm; flat, circumscribed area |
| Papule | < 1 cm; elevated, firm, circumscribed area |
| Nodule | 1-2 cm; elevated, firm, circumscribed area |
| Tumor | > 2 cm; elevated, firm, circumscribed area, solid (+/- demarcation) |
| Cystic | Elevated, firm, circumscribed area, filled with liquid / semi-solid material |
| Vesicle | < 1 cm; elevated, circumscribed, superficial lesion filled with serous fluid |
| Bulla | > 1 cm; elevated, circumscribed, superficial lesion filled with serous fluid |
| Pustule | Elevated, superficial lesion filled with purulent fluid |
| Petechiae | < 0.5 cm; red-purple NON-BLANCHABLE discoloration |
| Purpura | > 0.5 cm; red-purple NON-BLANCHABLE discoloration |
| Ecchymosis | Variable (usually > 0.5 cm); red-purple NON-BLANCHABLE discoloration |
| Plaque | > 1 cm; elevated, firm, rough lesion with flat top surface |
| Wheal | Variable diameter; elevated, irregular-shaped area of CUTANEOUS EDEMA; solid, transient |
| Scale | Accumulation of keratinized cells; flaky skin; irregular, thick / thin; dry / oily; variable size |
| Lichenification | Thickened epidermis secondary to persistent rubbing, itching, skin irritation; often on flexor surface of extremities |
| Erosion | Loss of part of epidermis; depressed, moist, glistening; usually follows rupture of vesicle / bulla |
| Ulcer | Loss of epidermis and dermis; concave; variable size |
| Crust | Dried serum, blood, exudate; any size / color present on skin surface |
| Nevus | Mole; variable size and degree of pigmentation; present on most people regardless of skin color; located all over body; can be flat, slightly raised, dome-shaped, smooth, rough, hairy; colors = tan, gray, brown, black |
| Dysplastic nevi | Contain mixture of color, irregular borders, > 5 mm, occur anywhere on body, common on back of males and legs of females, appearance is variable |
| Halo nevus | Depigmented halo around mole; usually benign; biopsy indicated b/c same process can occur around melanoma |
| Intradermal nevus | Dome-shaped; raised; can be pedunculated; cells limited to dermis |
| Describing skin lesions | Size, shape, color, character, location |
| Four factors that increase risk for skin diseases | Atherosclerosis, diabetes mellitus, HIV, CHF |
| Solar lentigo | Benign, < 5 mm, well demarcated, brown macules, SUN-EXPOSED AREAS (hands, arms, face), older lesions may be darker, present in > 90% fair skinned adults > 60, no treatment necessary |
| Lentigo maligna | Melanoma in situ; consists of malignant cells; no invasive growth (remain so for yrs); found in elderly (9th decade); located in SUN-EXPOSED AREAS; transition to melanoma = appearance of bumpy surface; treatment = surgical excision, radiotherapy |
| Seborrheic keratosis | Benign; tan, gray, black; WAXY / warty papules / plaques; described as "stuck on" appearance; treatment = usually none, can be treated with cryotherapy / shave excision |
| Actinic (solar) keratosis | Poorly circumscribed; variable rough; scaly; flesh colored / erythematous; macules / papules; SUN-EXPOSED AREAS; benign (can b pre-malignant for SCC); treatment = cryotherapy, topicals, excision |
| Squamous cell carcinoma | Variable appearance; chronic erythematous papules, plaques, nodules w/ scaling, crusting, ulceration; SUN-EXPOSED AREAS; malignant; treatment = surgical excision |
| Squamous cell carcinoma metastatic rates | Trunk / limbs = 4.9%, ear = 11%, lips = 13.7%, from chronically injured tissues = 40% |
| Basal cell carcinoma | Variable appearance; superficial ulcer w/ rolled borders; nodular (pearly); morpheaform (scar-like); malignant; low risk metastasis (but locally invasive); treatment = surgical excision |
| Four types of melanoma | Superficial, lentigo, acral, nodular |
| Description of melanoma | Variable appearance; high level of suspicion w/ new pigmented lesion / change in existing lesion; malignant w/ high risk of metastasis |
| Treatment of melanoma | Surgical excision; adjuvant therapy based on depth and spread |
| Seborrheic dermatitis | Erythema and scaling; commonly appears in areas rich in sebaceous glands (scalp hairline, forehead, nasolabial fold, ears, midline of chest) |
| What causes seborrheic dermatitis? | Malessezia furfur (maybe) |
| What can seborrheic dermatitis cause? | Blepharitis |
| Can seborrheic dermatitis be treated? What can you treat it with? | YES,but not cured; selenium sulfide, ketoconazole, tar shampoos |
| Rosacea (acne rosacea) | Recurrent facial flushing, edema; variety of triggers (sun exposure, alcohol, certain medications); usually affects nose, forehead, cheeks, chin; cause unknown; papules, pustules, telengiectasias; co-exist w/ seborrheic dermatitis; F > M |
| What are some clinical presentations of rosacea? | Conjunctival injection, blepharitis, episcleritis, chalazion (bump on eyelid), hordoleum (bump on eyelid) |
| Treatment of rosacea | Avoid irritants; reduce sun exposure; oral / topical antibiotics; topical agents; isotretinoin; laser therapy |
| Herpes zoster (shingles) | Acute, painful infection of sensory nerve & dermatome; activation of latent varicella-zoster virus; UNILATERAL DISTRIBUTION |
| Which region is commonly affected by herpes zoster? | Thoracic region (can also affect cervical, trigeminal, lumbar, sacral regions) |
| Total duration of herpes zoster | ~3 weeks |
| When must treatment for herpes zoster be started? | Within 72 hours |
| How does one treat the acute eruption of herpes zoster? | Acyclovir oraly 800mg 5X daily for 7 days / valacyclovir 1 gram TID for 7 days |
| How does one treat postherpetic neuralgia of herpes zoster? | Prednisone 60mg daily, taper over 3-4 weeks for prevention, various topical & oral agents |
| Age group affected by bullous pemphigoid | > 60 years old |
| Mortality rate of bullous pemphigoid | 20-30% |
| Cause of bullous pemphigoid | Deposition of complement and all classes of Ig at dermo-epidermal junction |
| Treatment of bullous pemphigoid | Topical steroids, tetracycline antibiotics, nicotinamide, damson, azothioprine, methotrexate, high doses of IV immunoglobulin |
| Steps for caring for skin | Use mild soap; bath oils / emollients,; brush hair daily; shampoo as often as needed for cleanliness & comfort; care for sores / injuries immediately; socks, sweaters, lap blankets, layers of clothing will help w/ feeling cold |
Created by:
JaneO
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