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WVSOM - Skin

Skin: The Meaning Beneath

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