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Flat, colored lesion < 2 cm in diameter
Macule
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Large macular lesion > 2 cm
Patch
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Minute hemorrhagic spots in the skin
Petechiae
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Purplish patch caused by extravasation of blood to the skin--essentially large petechiae
Ecchymosis
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Dilated, superficial blood vessels (i.e. spider veins)
Telangiectasia
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Small, solid lesion < 1 cm in diameter
Papule
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Large papular lesion (1-5 cm)
Nodule
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Flat-topped raised lesion > 1 cm in diameter; edges may be distinct (i.e. psoriasis) or gradual (i.e. eczema)
Plaque
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Solid, raised growth > 5 cm in diameter
Tumor
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Raised, erythematous papule or plaque, usually related to short-term derma edema
Wheal
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Small, fluid filled lesion < 1 cm in diameter
Vesicle
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Larger vesicular lesion, > 1 cm in diameter (i.e. blister)
Bulla
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Vesicle filled with leukocytes; puss filled or filled with purulent materials
Pustule
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Soft, raised, encapsulated lesion filled with semisolid or liquid contents
Cyst
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Dried exudates of body fluids (usually red or yellow)
Crust
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Small, thin plate o fhorny epithelium, cast off from the skin
Scales
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Leather, thickening of the skin characterized by hyperkeratosis
Lichenification
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Any loss of skin "substance"
Atrophy
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Loss of epidermis without associated loss of dermis
Erosion
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Linear, angular erosions (may be covered by scratching)
Excoriation
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A deep furrow, cleft, or slit
Fissure
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Loss of epidermis and at least a portion of the underlying dermis
Ulcer
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The order of vehicles in order of moisturizing to drying: W/O emulsions, oil-free emulsions with emollient esters, alcohol solutions, oleaginous bases, strictly oil-free emulsions, and O/W emulsions
- Oleaginous bases
- W/O emulsions
- O/W emulsions
- Oil-free emulsions with emollient esters
- Strictly oil-free emulsions
- Alcohol solutions
-
Describe oleaginous or water-free products
- semisolid= ointments
- liquid= oils
- barrier-like product that is moisturizing
- generally very greasy
- Prevents water loss and creates moisturizing properties
-
Describe absorption bases
- Water free products + lanolin or cholesterol
- Slightly less greasy and less moisturizing
-
Describe emulsions
- Hydrophobic and hydrophilic end
- Allows the dispersion of two immiscible compounds
-
What is the name of a cream or lotion in which the "external" phase is oil? What type of skin is it recommended for?
- W/O emulsions
- Less greasy that water free products but still strong moisturizers
- Moderately dry skin
-
What is the name of a cream or lotion in which the "external" phase is water? What type of skin should it be used on?
- O/W emulsions
- Less greasy than W/O preparations
- Mild moisturizers that are designed for normal or slightly dry skin
-
Describe Oil Free products
- Strictly oil free: drying bases used for oily skin
- Borderline oil-free: contain emollient esters
-
Describe solutions
- Oil free products that have a drying effect due to evaporation of solvent
- Water soln= mildly drying
- Alcohol soln= very drying
-
What is a clear, non-oily solid composed of long-chain molecules and a small amount of solvent?
- Gels
- Mildly drying and useful for oily to normal skin types
-
Are ointments or creams more potent?
Ointments--due to occlusive effect
-
What is a humectant?
- Non-oily ingredient designed to help the skin retain water
- Shifts an existing product to be more moisturizing
-
Which was does powder shift a product: more drying or more wetting?
Drying
-
What is the M.O.A. of topical corticosteroids?
- Inhibition of transcritpion factors involved in the activation of pro-inflammatory genes.
- Suppression of arachidonic acid release from phospholipids
- Inhibit leukocyte migration to sites of inflammation
- Interfere witht he functions of endothelial cells, granulocytes, mast cells and fibroblasts.
-
How do topical steroids help on inflamed skin?
Inhibit migration of macrophages and leukocytes into the area by reversing vascular dilation and permeability
-
How often should topical steroids be applied? Duration?
-
What increases the absorption of topical corticosteroids?
- Increased skin temperatures
- Hydration
- Application to inflamed or denuded skin
- Intertriginous areas
- Skin surfaces with a thin stratum corneum layer
-
What are common side effects of topical corticosteroids?
- Burning, itching, irritation, erythema, dryness
- Skin atrophy -- decreases the thickness of the epidermis
- Hypertrichosis
- Hypopigmentation
- Ocular hypertension, glaucoma, cataracts
- Worsening of cutaneous infections
-
What can occur if topical corticosteroids are used after skin atrophy?
- Prolonged therapy can decrease barrier function of the skin
- Vascular dilatation-- striae, telangiectasia, purpura
-
What is it called when an itch originates in the skin from skin damage (i.e. inflammation, dryness)
Prurioceptive itch
-
What is it called with an itch originates froma lesion or abnormality at some point in the afferent neuronal pathway?
- Neuropathic itch
- example: shingles
-
What is an itch that originates from a central mechanism but without obvious neural pathology?
- Neurogenic
- Example: opioid induced itch
-
What is a psychogenic itch?
Delusional in nature
-
What is the primary mediator of itching?
Histamine
-
Describe the pathophysiology of an itch
- Cross talk between dermal mast cells and afferent C neuron terminals
- Scratching and rubbing the skin inhibits itch by stimulating myelinated A neurons
- Termpoarirly inhibit neuronal circuits involved with itch
- Also activates nociceptors --> reduce itch via the spine
- Pain inhibits itch
-
What symptoms appear if pruritus is histamine induced?
wheal and flare
-
What is the first and second line treatment for treating pruritus?
- 1st: H1 antihistamines
- 2nd: Topical corticosteroids--> relieve itching secondary to inflammatory skin disease
-
In what patients can cholestyramine be used to relieve itch?
Patients who have generalized itching and renal failure
-
What desensitizes nociceptive nerve endings and acts as a antipruritic? Use is limited by tolerability
Capsaicin
-
What is a potent antihistamine and effective antiprutitic limited by it's anticholinergic side effects?
Doxepin
-
Rash characterized by wheals with or without angioedema. Spectrum of superficial pink wheals that itch to angioedema of the subcutaneous and submucosal tissues
Urticaria
-
How are most symptoms of urticaria mediated?
Via H1 receptors on nerves and endothelial cells
-
What type of urticria has wheals present for most days and can be due to drugs, food, and viral infections? Duration < 6 weeks
Acute urticaria
-
In what patient population is acute urticaria more prevalent?
Patients with atopic diseases
-
Describe chronic urticaria
- > 6 weeks duration
- Wheals present daily or most days
- Symptoms may be continuous or recurrent
- diet, infection, and non-infectious chronic inflammatory disorders have been implicated
-
What type of physical urticaria is due to shearing forces?
Dermographic
-
What type of physical urticaria is due to vertical pressure?
Delayed pressure urticaria
-
What type of physical urticaria is due to cold air, water, or wind?
Cold contact urticaria
-
What type of physical urticaria is due to localized heat?
Heat contact urticaria
-
What type of urticaria is due to brief increases in body core temperature?
Cholinergic
-
MOA of H1 antagonists
- Decreased capillary permeability
- Decreases histamine mediated exocrine secretions
-
Narrow angle glaucoma, stenosing peptic ulcers, and symptomatic BPH are contraindications to what drugs?
1st generation antihistamines
-
What are some warnings for antihistamine medications?
- COPD, asthma
- Anticholinergic (drying effects)
-
What is xerosis?
Dehydration of the stratum corneum
-
What part of the body does xerosis most affect?
Lower extremities and forearms
-
Describe the appearance of xerosis.
- Skin covered in dry scales
- More severe can cause cracks, fissures, decreased suppleness
-
What are preventative measures that can be taken for xerosis?
- Low room temperature
- Use of a humidifier
- Bathing in warm, not hot water, no more than every 1-2 days
- Reduce excessive exposure to soap, solvents, and other drying agents
- Use emollients frequently
-
How do you treat xerosis?
- Soak affected area 5-10 minutes and then immediately apply W/O type of medication
- Topical corticosteroid ointment may be used for symptoms especially associated with eczema
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