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Describe a macule
flat, circumscribed, <1cm diameter, white, red or brown
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what are macules the result of?
- A) hyperpigmentation (brown as in lentigos)
- B) depigmentation (vitiligo)
- C) vascular dilation (erythema)
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Describe Patches
flat, circumscribed >1cm diameter (large macules). Patches may have surface changes- slight scales or fine wrinkles...(eg Mongilion spots)
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Define Papules
small, circumscribed, solid/firm elevated <1cm diameter.
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What are some examples of Pauples?
wart, elevated mole, ringworm.
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What are prodromal symptoms?
symptoms that occurred before the outbreak
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what are some typical complaints of prodromal symptoms?
- -burning, tingling, pain
- -previous exposure to chicken pox/Hx of shingles
- -location on body of dermatophyte (fungal skin infection)
- -socical and environmental factors
- -Hx recent AB or immunosuppressand Rx
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What Medical Hx puts a pt. at risk for skin infection?
- -diabetes
- -CA
- -nutritional deficiencies
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What are primary lesions?
skin changes produced by a causative factor
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Define Plaque
flattened, raised lesion, surface area large in relation to height (i.e. psoriasis, sabborrheic keratosis). plateu-like elevation often formed by a convergence of pauples, as in psoriasis
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Define Nodule
- circumscribed infiltraiton of skin or sub-q tissue >1cm, wide and deeper than a papule.
- (i.e. cavernous hemangioma, lipoma (fatty tissue deposit))
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Define Cyst
Encapsulated, semisolid or fluid-filled mass in dermis or sub-q tissues (i.e. sebaceous cyst). A spherical or oval papule or nodule may be a cyst if, when palpated, is resilient (feels like an eyeball)
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Define Vesicle
small <1cm superficail circumscribed elevation. Serous or blood-tinged fluid (i.e. chicken pox, herpes, poison ivy/oak, dermatitis, blisters, second degree burns)
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Define Bulla
vesicle >1cm. fluid filled bleb, blister (i.e. second degree burn)
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Define Pustule
vesicle filled w/ puss (cloudy or purulent fluid, WBC) may or may not be infected (i.e. acne, impetigo, folliculitis)
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Define Wheals
round or flat topped and irregular shape evanescent (shiny) lesions. Form acute accumulation or edema fluid in upper dermis (i.e. mosquito/insect bites, allergic reaction)
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Define Tumor
solid, circumscribed, elevated, round or ellipsoid, located deep in dermis or sub-q (i.e. dermatofibroma)
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Define Secondary skin lesions
changes from alteration in primary lesions (i.e. rubbing, scratching, medication, invoultion)
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Define Scales
Secondary skin lesion: scales are flakes of dead, cornified (hard/firm) tissue being shed. Theyare dry and ususlly white. (i.e. psoriasis, ringworm, peeling sunburn). Scales usually indicate inflammatory change and thikening of the epidermis.
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Define Crust
- Secondary skin lestion: Crust: dried mass of serum, pus, dead skin, debris (broken vesicles or pustules)
- Crusts can be found surrmounting any lesion, i.e. eczema
- -other infectious dermatitis
- -impetigo
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What color characteristics will Crusts have?
yellow if from serum, green or yellow-green if from pus, brown or dark red if formed from blood
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Crusts are characteristic of what kind of infection?
Pyrogenic (fever-induced)
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Define Ulcer
- Irregular shaped excavation (depth) caused by loss of substance w/ gradual disintergration and necrosis of tissue (i.e. decubiti, stage 3 pressure sore).
- Ulcers usually result from the impairment of vascullar and nutrient supply to the skin.
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Define Fissure
Deep linear split through epidermis into dermis, (i.e. chapping, athlete's foot). Fissures usually result when something/somewhere is moist and you add and infection to the area and it never gets dry= hard to heal
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Define Scar
permanent dermal changes w/ production of excess collagen following damage to corium (i.e. vaccination, burn, deep scratch, cut, incision). A scar is the replacement of normal tissue by fibrous connective tissue at the site of injury to the dermis.
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What are the majority of bacterial infections in the skin caused by?
staphylococcus or streptococcus
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What is follicultitis?
a superficial staph infection of the upper hair follicle
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What are Furuncles
boils caused by staph that are deep in the hair follicle
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What are predisposing factors to Furuncles?
- *contact w/ oils, uncleanliness, maceration (skin area left wet)
- -common on face, neck, arms, legs, groin
- -Tx: warm compress (reduces inflammation and allows it to rupture)
- -ruptures: yellow purulent discharge (puss), then to serosanguinous fluid after hours/days
- -surgical Tx: incision and drainage (can also use topical AB, but first you need it to rupture)
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Define Cellulitis
- generalized nonfollicular infection- either staph or strep of deeper connective tissue.
- -teach pt. to bathe daily w/ antibacterial soap
- -allow to dry in-between Tx
- -position to promote circulation
- -teach to avoid tight garments
- -strict iso for MRSA (perform C&S to see if MRSA)
- -do not share contaminated articles
- -Tx: warm compress to incr. circulation and decr. swelling
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Rx for cellulitis
- Usually topical cream is enough to treat cellulitis, but you may need po or iv AB
- -neomycin
- -gentamycin
- -chloramphenicol
- -providoine-iodine and cream (i.e. silver sulfadiazine)
- -anti-inflammatory steroid Rx low to high doses
- -if severe po or IV AB necessary
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Define Impetigo Contagiosa
- (superficail bacterial infection)
- -due to staph, strep, or both
- -begins as discolored spots then vesicles or bullae taht rupture leaving a superficail moist erosion and that germ laden fluid spreads to surrounding skin.
- -exudate dries and forms heavy, honey-colored crust and scabs
- -most often on face, hands, perineum
- -pruritis common
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What is the Tx for Impetigo?
- -bacterial ointment topically, systemic if severe.
- -explain disease and Tx, hand washing esp.
- -soak crusts w/ warm water and remove crust carefully in order to get to the lesion, then apply AB ointment
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Define FUNGAL infections
- Many affect sperficail skin and are fast multiplying.
- "tinea" = fungal infection
- -tenia pedis: athletes foot:
- maceration and fussures between toes, pinhead-size vesicles in the plantar area and pruritis
- -tinea manus: hands
- -tinea cruris: groin (jock itch)
- -tinea capitis-scalp
- sx: scaly, circumscribed patches, bald spots, itching
- -tinea barbae: beard area
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Rx antifungal ointments/creams
- suffix "-azole" =anti-fungal medicine
- -clotrimazole, nystantin, ciclopirox, miconazole, econazole, tolnaftate, haloprogin, undecylenic acid
- -Tx of choice for dermophyte and yeast infection: antifunfal powders (Nystatin, tolnaftate) and oral preps (Nystatin, clotrimazole.
- -Yeast Candidasis-opportunistic infection of skin and mucous membranes (thrush in babies)
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Define ECZEMA
- atopic dermatits,sperficial inflammation
- -process involving epidermis
- -affected persons have lowered threshold for itching
- -lesions appear following irritation, itching, rubbing
- -appearance varies w/ age of child
- -family Hx of atopic dermatitis
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What are the s/sx of eczema?
- -intense itch
- -unaffected skin dry
- -rough skin
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What is urticaria?
An allergic rxn (rash, multiple swollen raised areas) that result from ezcema.
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Describe the infantile form (2mo-3yr) of urticaria.
- General distribution, esp cheeks, scalps, trunk, extensor surface (outer area of elbows/knees) of extremeties
- -erythema
- -vesicles, papules
- -weep and ooze
- -crusting and scaling
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Describe the childhood form of urticaria (up to about 12 yo)
- distributed flexural areas, antecubital & popliteal fossae, neck, wrists, ankles, feet
- -clusters sm. erythematous, flesh color papules or scaling patches
- -dry and hyperpigmented
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What is lichenification?
Cutaneous thickening and hardening of skin from continued irritation (usually result of urticaria)
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Describe the adolescent form of urticaria
- distribution: face, sides of neck, hands, feet, antecubital and popliteal fossae
- -color same as childhood
- -dry, thick lesion common
- -confluent papules
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What is the Tx for eczema?
- Not curable, we just want to treat the itching.
- -decr. pruritis w/ antihistamines, mild baths
- -use mild soaps that hydrate skin w/ emollients, limit bathing (dries)
- -topical corticosteroid oint.
- -prevent sec. infection
- -diet modification-fingernails clean and short, gloves, mittens
- -do not overheat (causes itching)
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What is a comedone?
- A noninflamed acne lesion.
- a) compact masses of keratin, lipids, fatty acids or bacteria
- b) closed= dilated follicular duct (whitehead)
- or open= blackhead
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What are the characteristics of an inflamed acne lesion?
- -proliferation of P. acnes draws in neutrophils and dilates folicular wall
- -produces papules, pustules, nodules, cysts
- -possible scarring from macrophages that digest inflamed skin
- -secondary staph infection complicates lesion
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Discuss Tretinoin (Retin-A)
- Tx for acne.
- -interrupts follicular keratinization (prevents it from closure/white-heads
- -s/e: skin irritation, burning
- -educ: wear sunscreen daily, apply sparingly
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Discuss Benzoyl peroxide (antibacterial solution)
- -treats P. acnes bacteria
- -s/e: bleaches clothing (not skin)
- -less likely to cause antibiotic resistant bacteria (bc it's a topical AB)
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Discuss systemic AB used to treat acne
- Tetracycline, doxycycline, erythromycin.
- -used for mod to severe cases
- -s/e: higher chance of antibiotic resistant strains
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Discuss oral contraceptive pills in regards to acne Tx
- -used to treat mild to mod acne
- -ortho tri-cyclen FDA approved for females >14yo
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Discuss Acutane
- -highly tetrigenic, pt must be on birth control if also if on Acutane
- -20 wk Tx for remission of symptoms
- -s/e: dry eyes, skin, muc. memb., visual changes, HA, hyperlipidemia, mood changes, depression, suicidal ideation, severe birth defects
- -Nursing care: must have pre and during Tx preg. tests, and monitor for visual, mood changes
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Define SCABIES
- -endemic infestation of scabies mite:
- -impregnated mite burrows intro stratum corneum of epidermis, lays eggs
- -Host (person) is sensitized to mite and inflammatory response occurs, 30-60 days after initial contact
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What are the s/sx of SCABIES?
- -pruritis
- -lesions: minute gray-brown, thread like burrow
- -black dot at end
- -eczamatous eruption-in infants it's distributed intradigit, in axilla, popliteal and inguinal areas
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What is the Tx for SCABIES?
- Scabicide. Apply Kwell to cool, dry skin
- Treat all hosehold members.
- -ointment to decr. itch/prevent scratching
- -cut fingernails and keep clean
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Define PEDICULOSIS (lice)
- -head, body, or pubic crab lice
- -oval shaped lice 2-4mm
- -lay hundreds of eggs= nits near hair shafts
- -common s/sx= pruritis that may lead to excoriation
- -Tx: lindane (Kwell or RID) topical malathion
- -must wash linen, clothes, hair wear, combs, use HOT water on articles
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