Derm 1

Question 1

• Type of lesion
• Arrangement
• Distribution

Answer 1

• Vesicular, red, hot and inflamed, on trunk (not cross midline), follow dermatome
• Shingles, terrible pain for a while and then get rash, lots of nerve pain
• Vesicular, erythramateous, dermatome
• Keep cool, moist packs, water, antiviral, pain pill (NO CREAMS/OINTMENT), creams too much for the first day, not rub on it
• Capsaicin after lesion gone
  ​

Question 2

• Flat
  
  • Macule
  • Petechiae
  • Ecchymosis
  • Infarct
  • Sclerosis
• Depressed
  
  • Atrophy
  • Ulcer
  • Fissure
  • Erosion
• Elevated
  
  • Papule
  • Plaque
  • Nodule
  • Wheal
  • Vesicle, bulla
  • Pustule
  • Abcess
  • Lichenification
  • Crust (exudate)

Answer 2

• Flat
  
  • Macule: change in the color of the skin
  • Petechiae: small (1 - 2 mm) red or purple spot
  • Ecchymosis: larger red or purple spot
  • Infarct: small localized area of dead tissue resulting from failure of blood supply
  • Sclerosis: hardening of skin
• Depressed
  
  • Atrophy: thinning or depression of skin
  • Ulcer: sore with disintigeration of skin
  • Fissure: crack
  • Erosion: loss of superficial layers
• Elevated
  
  • Papule: dome shaped lesion
  • Plaque: solid, flat topped
  • Nodule: solid, more than 1 cm
  • Wheal: circular, red border, pale centers
  • Vesicle, bulla: circular, fluid filled, small
  • Pustule: pus filled
  • Abcess: larger, fluid/pus filled
  • Lichenification: thickening, perhaps from scratching
  • Crust (exudate): layer of dried serum

Question 3

Which does not describe:
A.Linear
B.Vesicles
C.Ulcer
D.Erythema

How treat?

Water and itch correlation

Answer 3

• Not an ulcer
• Rhu sensitivity
• Not put anything on it when it is weepy like this
• Water the first days, creams in the secondary days
• Water and itch
  
  • Cooling effect
  • Evaporates and vasocontricts, less itching mediators to surface

Question 4

Atopic Dermatitis

Answer 4

• AKA: Eczema
• Erythema
• Chapping
• Pruritus
• Papules
• Vesicles
• Excoriation
• Lichenification
• Infection (S. aureus)
• Chronic
• Redness in acute phase, dryness I
  
  • Excoriating, digging, thickening like elephant, from scratching, cause infection
• If not responding, might be infection
• Common spot is flexor surfaces
  ​

Question 5

Eczema: Definition

Answer 5

• Pruritic skin condition PLUS (3 or more)
  
  • Onset < 2 years of age
  • Skin crease involvement
    
    • Flexural dermatitis
• Generally dry skin
• Other atopic disease (personal or family member)

Question 6

When to Refer for Derm

Answer 6

• Severe
• Intense pruritus
• Extensive involvement
• <2 years of age
• Infected

Question 7

Atopic Dermatitis: Treatment

Answer 7

• Stop “itch-scratch cycle
• Hydration
  
  • during chronic phase
• Avoid triggers
  
  • Allergies
• Prevent infection
• Emollients
  
  • grease, petroluem jelly, Vaseline, mineral oil, Always
• Antihistamines
• Hydrocortisone
• Bath oils
  
  • get in water, prune up, then put on bath oil
  • Not waterproof yourself and then get in bath
• No soap
  
  • Cetaphil, baby soap, not wash away oils

Question 8

Xerosis:

Answer 8

• Pruritic
• Rough
• Scaling
• loss of flexibility
• “Cracked”
• ichthyosis

Question 9

Xerosis: Marker for Systemic Diseases

Answer 9

• Treat underlying cause, but in meantime, need to treat the xerosis
• Hypothyroidism
• Lymphoma
• Kidney disease
• Sarcoidosis
• Ichthyosis
• Atopic eczema
• Drug side effects
  
  • Lithium, Vit A, niacin

Question 10

Xerosis: Treatment

Answer 10

• AKA: Winter Itch
• Emollients (petrolatum, mineral oil, glycerine, propylene glycol)
• Keratinolytics (urea, lactic acid)
  
  • When really bad, breaks down skin to let emollients in
• Soap-free cleansers (Cetaphil)
• Steroids
• Antipruritics (systemic, topical (not))
  
  • Benadyrl, Sarna lotion
  • NOT topical because is a sensatizer, can get sensativities
• Less showers
  ​

Question 11

Scaly Dermatoses

Answer 11

• Dandruff
• Seborrheic Dermatitis
• Psoriasis
  
  • Normal skin turns over in 21 days
  • Psoriasis turns over in 3 days

Question 12

Dandruff: Treatment

Answer 12

• Better in summer, aggrevated by stress, difusse, pruitis, bald spots will have no dandruff, uncommon in children
• Wash
• Cytostatics
  
  • Pyrithione zinc
  • Selenium
  • Coal tar
• Kertatolytics
  
  • Least potent, use if super scaly
    
    • Salicylic acid
    • Sulfur
• Ketoconazole
  
  • Could encourage resistance, don’t use randomly

Question 13

Seborrheic Dermatitis: What it is and Treatment

Answer 13

• Yellow/oily lesions on red skin – hair line, nasolabial folds, scalp, axillae, sternam or goin
  
  • occurs where sebacous glands (scalp, face, trunk)
  • Red, scaly, itchy, well demarcated
  • Worse in winter
  • Parkinson’s, zinc deficiency, endocrine states associated with obesity, and HIV
• Wash/shampoo
  
  • will run down face
• Cytostatics
• Keratolytics
• Ketoconazole*
  
  • When immunocompromised or obvious overgrowth
• Steroids
  
  • because more inflammed
  • Kenlog aresol, looks less greasy

Question 14

Psoriasis

Answer 14

• Non-contagious, chronic inflammatory disease
• Causes: environment, infection, steroid withdrawl, stress, endocrine changes
• Start as papules and coelece to plaques, well demarcated, silvery scales (mineral mica)
• Extensor, back, trunk, scalp
• Nails: Onychomycosis
• Psoriasis arthritis: assymetric
• Treatments:
  
  • Emollients
  • Cytostatics
  • Steroids
  • Calcipotriol
  • Retinoids
  • PUVA, UVB
  • Methotrexate
  • Immunomodulatory Agents (alefacept, etanercept, etc.)

Question 15

Contact Dermatitis

Answer 15

• Inflammatory skin condition characterized by inflammation, redness, itching, burning, stinging and vesicle and pustule formation on dermal areas exposed to irritant or allergenic agents.
• ICD (irritant), ACD (allergic)
• Poison ivy, posion oak
• Inflamed, red, itchy, blisters
• Treatment:
  
  • General
    
    • Cool with water first, then use below
  • Topical anesthetics
    
    • NOOO!
  • Steroids
    
    • back of loggers hands, not work, too thick
  • Topical antipruritics
    
    • Calamine lotion
  • Astringents
  • Antihistamines
  • Bentoquam (Ivy Block)
    
    • you put on BEFORE

Question 16

Diaper Dermatitis

Answer 16

• Erythramateous, fussy, hot
• Reasons for diaper rash
  
  • Friction and Moisture
  • Overgrowth (killed good bacteria and bad overtook)
• Change diapers frequently, cool and dry it, get air time (lock him in the kitchen on lineoleum)
  
  • Vasocontrists during air time
• Wants protection
  
  • Not ointment, lock in moisture and not want fungi
• Use cream: Destin,
• Baby powders are okay, cornstarch can cause overgrowth (fungus and yeast love cornstarch)
• If in the creases, then yeast
  
  • Clotrimazole cream because ointment be bad because yeast like moisture
• Need to do both
  
  • Need antifungal cream, mix in steroid
  • 15g clotrimazole, 15 g, 1/2?% or 1%
  • Yeast love steroid by itself
  • Use ointment as a protectant (bag balm, desatin, etc.)
  • For refill, steroid not needed, just use antifungal cream

Question 17

UV Radiation

Answer 17

• UVC (200-290 nm band)
• UVB (290-320 nm band)
  
  • Sunburn radiation, skin cancer, aging
  • Vit D
• UVA (320-400 nm band)
  
  • Photosensitizing, skin cancer, aging

Question 18

Sunscreens

Answer 18

• MED – minimal erythema dose
  
  • 2 MED is red, 4 MED pain, 8 MED blister
• SPF – sun protection factor
  
  • MED protected/MED unprotected
  • SPF 10 means that it takes 10 times longer to get burned
• SPF 15 – 93% of UVB; SPF 30 – 96.7% of UVB; SPF 40 – 97.5% of UVB; SPF 70 – 98.6% of UVB
• UVA? (Broad Spectrum)
• Waterproof

Question 19

Sunscreens: Types

Answer 19

• Chemical
  
  • Aminobenzoic acid (PABA) – UVB; major sensitizer
  • Anthranilates – UVA (weak), combos
  • Benzophenones – UVB, UVA
  • Cinnamates – UVA, UVB
  • Dibenzoylmethane – UVA
• Physical – UVR
  
  • Zinc oxide, titanium dioxide

Question 20

Sunscreen Changes

Answer 20

• SPF only
  
  • Helps prevent sunburn
• Broad Spectrum SPF <15
  
  • Helps prevent sunburn
• Broad Spectrum SPF >15
  
  • Helps prevent sunburn, decreases skin cancer and early aging
• Water Resistant

Question 21

How Would You Evaluate?

Answer 21

A. Shape

B. Irreg. Borders

C. Color(s)/changing

D. > pencil eraser size (6 mm)

ABCD for melanoma

Question 22

What is the diagnosis?

A. Benign photoaging skin lesion

B. Possible malignant melanoma

C. Actinic keratosis

D. Seborrheic keratosis

Answer 22

• Yes, benign photoaging skin lesion
• Not melanoma, same color and regular border
• Not AK
• Yes, seborrheic keratosis

Question 23

Seborrheic Keratosis

Answer 23

Question 24

AK vs. SCC

Answer 24

• AK: actinic keratosis, was the front picture
  
  • bald areas, wrists and forearms
  • rough spot on ear/forehead
  • sting/rough when rub
  • Cryotherapy and freeze off, can go to SCC
• SCC: Squamous cell carcinoma, this picture
  
  • if freeze and comeback, need to biopsy
• Bottom Line: Refer

Question 25

What is this?

Answer 25

Basal cell carcinoma, pearly dome like leison on side of nose

Question 26

What is this?

Answer 26

* Melanoma * A: Asymmetric shape * B: Border irregular or poorly defined border * C: Color variation or change in color * D: Diameter larger than pencil eraser ​

Question 27

Burns

Answer 27

* 1st, 2nd, 3rd degree * Superficial * Superficial, partial thickness * Deep partial thickness * Full thickness * Minor, Moderate, Major * Treat OTC: 2% superficial, superficial partial thickness, not involving eyes, ears, face, genitalia, not chemical/electrical, healthy * Cool water * **NO OINTMENT** until later in treatment * Aleve for pain * Tetanus status?