-
integumentary system
- a covering
- includes skin and everything found in it
-
functions of skin
- protection
- retains H2O
- regulates temperature
- vitamin D
- sensory organ
- excretion of toxins
-
epidermis
active basal cell layer (melanocytes)
-
dermis
- sweat glands
- blood vessles
- sebaceous glands
- nerve endings
- vitamin D synthesis
-
subcutaneous layer
fat- if it collects too rapidly and stretches out the collagen and elastin= cellulite
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a derm history should include:
- location
- duration
- triggers
- relieving/aggrevating factors
- quality
- constitiutional symptoms
- timing
- weak chronic illness syndrome
-
physical exam should include:
- type, shape, arrangement, distrobution
- feeling
- general appearance of the patient
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Age of onset of acne
12-25 (mainly 16-18)
-
frequency of acne
79-95% of 16-18 year olds
-
body distrobution of acne
face, trunk, arms, back, upper chest, shoulders
-
pathogenic factors of acne
- bacteria
- sebum chemistry
- sebum quantity
- keratinocyte hyper proliferation, shedding, and clumping
- terrain
-
acne common differentials
- raised papules
- postules
- nodules
- open comedones-black heads
- closed comedones- white heads
-
acne treatment
- change the sebum (low glycemic diet)
- bacteria- antibiotics
- B6 for menstral acne
- detox- sauna
- botanicals supplements
-
how could you tell acne apart from the following:
- face: staph aureus, foliculitis, pseudofoliculitis brabae, rosacea, perioral dermatitis
- trunk: pityrosporum folliculitis, pseudomonas folliculitis, staph aureus foliculitis, keratosis pilaris
- single painful cyst: staph abscess, furuncle, rupture inclusion cyst, dental sinus cyst
-
age of onset of rosacea
30-50
-
frequency of rosacea
14% in women, 5% in men
-
distrobution of rosacea
FACE ONLY!!! mainly central
-
common differentials of rosacea
- erythema, telangiectasia, papulopostule, nodules, rhinothyma
- NO comedones
-
natural med etiology for rosacea:
terrain, genetics, poor digestion, toxic bowels
-
Rosacea is aggrevated by:
hot liquid, spicy food, alcohol, sun, niacin
-
what other symptoms are common with rosacea?
- migraines 3x more common
- occular symptoms
-
treatment of rosacea:
- ID and avoid triggers
- anti-inflammatory/elimination diet
- digestive enzymes
- probiotics
- niacinamide moisturizer
-
be able to differentiate rosacea from the following:
- papule/postule: acne, perioral dermatitis, folliculitis, mites
- flushing: seborrheic dermatitis, SLE, dermatomyositis
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Age of onset of perioral dermatitis
16-45 years, mainly women
-
distrobution of perioral dermatitis:
papulopostules on an erythematosus base around the mouth
-
perioral dermatitis is aggreavted by:
floride and NA lauryl sulfate in toothpaste
-
symptoms of perioral dermatitis:
occasional itching, burning, and tingling
-
treatment of perioral dermatitis
topical and systemic
-
be able to differentiate perioral dermatitis from:
algeric contact dermatitis, atopic deratitis, seborrheic dermatitis, rosacea, acne vulgaris, steroid acne, fungus, staphylococcus infection
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distrobution off hidradenitis suppurativa
axila, sometimes scalp and pilonidal sinuses
-
hidradenitis suppurativa is caused by:
chronic, suppuration, fibrous tissue of apocrine gland
-
early symptoms of hidradenitis suppurativa:
- erythema
- burning
- itching
- discomfort
- hyperhidrosis
-
mild hidradenitis suppurativa
- solitary nodule
- no abscess
-
moderate hidradenitis suppurativa
- multiple recurrent nodules
- pain and discharge
- abscess formation
-
severe hidradentitis suppurativa
- diffuse abscess formation
- chronic draining sinus tract
- chronic inflammation
-
conservative management of hidradenitis suppurativa
- like acne
- loose clothing
- warm compress
- zinc
- anti-inflammatory/elimination diet
-
be able to differentiate hidradenitis suppurativa from:
furuncle, carbuncle, lymphadenitis, rupture inclusion cyst, cat-scratch disease, lymphogranuloma venereum, donovanosis
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acute eczema/dermatitis
blisters, intense itch
-
subacute eczema/dermatitis
dry, redness, scaling, slight-moderate itch
-
chronic eczema/dermatitis
thickened skin, fissuring
-
types of contact dermatitis
irritant and allergic
-
predisposing factors for irritant contact dermatitis
- decreased protective lipid barrier on hands
- light colored skin
- history of atopic dermatitis
- mechanical irritant
- 80% of all dermatitis
- mainly on hands
-
prevention of irritant contact dermatitis
- avoid irritant (protective clothing)
- cloth diapers for diaper dermatitis
- barrier creams
- change job
-
topical treatment of irritant contact dermatitis
- inflammed- use powder
- dry- wet soaks with colloidal oatmeal
- exudative- wet gauze
- honey, olive oil, and beeswax
-
oral treatment for irritant contact dermatitis
corticosteroids
-
course of irritant contact dermatitis
- 1. healing within 2 weeks
- 2. healing within 6 weeks if chronic
- 3. occupational- only 1/3 have complete remission
-
distrobution of irritant contact dermatitis
anywhere on the body where the irritant touched
-
distrobution of allergic CD
- where the irritant touched
- common sites: face, neck, forearm, lower leg, top of foot, arm pit, necklace areas, watch areas, bra straps, underwear
-
allergic CD is what type of hypersensitivity
type IV (delayed)
-
allergic CD usually appears after how long?
24-48 hours after contact but up to 4-10 days
-
how long can it take to become reactive to an allergen?
up to a year
-
top 5 allergens
- 1. nickel sulfate
- 2. neomycin sulfate
- 3. balsam of peru
- 4. fragrance mix
- 5. thimerosal
-
allergic CD due to plants (APD)
- sensitization and dermatitis occur 7-10 days after first exposure
- dermatitis can occur in <12 hours after second exposure
-
what % of individuals are sensitized to Toxicodendron haptens?
70%
-
what are two signs of APD
- linear lesions
- acute vesicles
-
management of APD
- prevention
- identify and avoid plants
- wash entire body with water (no soap!)
- barrier creams
- trim fingernails
- blow dry lesions
- calamine
- burows solution
- cool compress
- oatmeal, starch, vinegar
- aloe gell
-
course of poison oak (APD)
- rash begins quickly
- lasts 3-4 days
- clears within next 5 days
- 1-2 weeks total with or without treatement
-
atopic dermatitis
- inflammation of dermis/epidermis
- unknown cause
-
frequency of atopic dermatitis
- increasing in western world
- 7-15% of general population
-
pathogenic factors of atopic dermatitis
- genetics
- terrain
- immune dysfunction
- epidermal barrier dysfunction
- IgE mediated hypersensitivity
-
distrobution of atopic dermatitis
face, popliteal fossa, front of elbows
-
features of atopic dermatitis
- pruritus
- typical distrobution
- chronic relapsing dermatitis
- family history
- keratosis pilaris (can exsist on its own)
-
infantile atopic dermatitis
- 2 months-2 years
- 50% of cases begin here (90% by age 5)
- face, scalp, extensor surface
- lesions red, finely vesicular, oozing, crusted, and extremely pruritic
- secondary infections
-
childhood atopic dermatitis
- 2-12 years
- antecubital and popliteal fossae, posterior neck
- near 80% develop allergic rhinitis
- 30-50% develop asthma
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