Taking skin health history
allergies, family issues, OLDCARTS, sun exposure, skin and hair care, what has been used.
skin, hair, and nails as well as mucous membranes
inflammatory, infectious, immunological, insect bite, exposure
questions of patient
appearance, vitals, duration, spread, pain?
abdominal exam as part of derm exam
to check spleen and liver for enlargement
for fungus id
widespread increased melanin
can be addisons disease
always check slcera- not only skin!
check thyroid function
- flat, discrete change in color of skin (freckle, etc)
primary lesions- patch
- larger than 1cm, flat, discrete lesion (just larger macule)
"Christmas tree" distribution
primary lesions- papules
discrete, raised areas, smaller than 1cm, elevated
slightly raised, flat, associated with scaling, larger than 1cm
primary lesions- wheals
flat, lighter color, puritic, less than 24hours (urticaria), central clearing
check for sob (risk for angioedema)
discrete palpable lesions of the skin, can be deep
larger than nodule, can be deep,
primary lesion- vesicle
smaller than 1cm, fluid filled, raised, usu. clear fluid,
larger than 1cm, fluid filled, usu. clear fluid
primary lesion- pustule
pus filled lesion, can be closed or weaping, may have well defined borders
primary lesion- cyst
varies in size, semisolid
evolve from primary lesions through changes
secondary lesion- lichenification
thickening of skin, dramatization of skin markings
hallmark of eczema
secondary lesion- excoriation
usu. from scratching, may be round or linear
linear cracks in epidermis, common with athlete's foot and corner of mouth (chelitis)
secondary lesion- erosion
partial break in epidermis
secondary lesion- ulcer
deeper loss of skin surface: stasis, chancre, pressure, small or large,
secondary lesion- crust
dried exudate, can be purulent, hemmoragic, or serous
1-3mm, round, dome shape or flat, no pulsation, may blanch some, trunk, no sig.
smaller red/purple lesions, usu. flat, not blanchable, variable distribution (blood outside vessel)
larger lesions (larger petechiae)
telangiectasia, radiating legs, will blanch, associated with liver problems, pregnancy, vitamin b def., never below waist,
bright red, usu in infants, goes away by 1yr (usu)
basal cell carcinoma
locally invasive, slow, seldom mets, shiny smooth glistening surface, translucent nodule with depressed center, common over 40, usu. face, ears/ sun exposed areas, telangictasia present
squamous cell carcinoma
?immunosupression, regional lymphadenopathy, mets possible, head/ears/lips. Persistent nodule/plaque, ulcer, grows more quickly than basal cell. Sun damaged areas.
can occur anywhere. Aggressive. ABCDE
Asymmetry, border, color, diameter, evolving.
consider type/locations in treatment- systemic or localized
vasomotor instability, sebacous gland instability, telactasias, 30-50yoa, more predominant in females, pustules, papules,
chronic scaling, flaking, errythematous dermatitis, face, ears, sometimes back and genitals.
Eczema. Errythematous papules, scaling, crusts, itching. In flexor surfaces, creases, patches, regional. History of personal/family asthma. Secondary colonization with staph.
from contact with irritant like poison ivy, erosions, leads to crusts, itching.
colored lesions, often in mouth, associated with AIDS but not always, can be macule, papule, nodule
precancerous plaque, elevated flat, needs removed, white
has ABCD characteristics but is not melanoma
gold honey crusted scaling pattern, staph or strep, consider location for treatment, caused by scatching a minor wound, leads to infection.
associated with GABHS, sandpapery redness, flushing, circumoral pallor, fine papular/macular errythema with desquamation, intensified at flexor folds.
sometimes rash is not visible, but can be felt.
rash that is linear, often at elbow or flexor folds.
associated with scarlet fever
deep skin infection. Usually staph/strep.
Group a strep, warm to touch, headache, fever, vomitting, located in the "triangle of death" eye area.
superficial pustular infection of hair follicle, localized, is bacterial, anywhere where hair is present, razor is common culpret, can be from hot tub (psuedomonis). Can do culture.
boil. Bacterical infection of skin. Can follow folliculitis.
furuncles that come together. Folliculitis spreads to furuncle, to carbuncle. Often staph.
"scaled skin". bacterial infection. Ill defined borders.
awful smell. Puncture wounds, bedsores.
associated with meningitis, systemic infection, over two nuchal rigidity, "toxic", petichiae and purpura (won't blanch), febrile, sore throat,
scrape skin scaling, place on slide with KOH, wait a few minutes, examine under scope, "spaghetti and meatballs"
yeast like fungus, common diaper rash, skin folds, errythemetous, macular/papular, well demarcated, some satilite legions, mild/moderate pruritis
flat eruption, hypo/hyperpigmented, "lifeguard suntan", will not tan or burn. May take years for repigmentation to occur if it will.
broken hair shafts, may drain, treat early to prevent perm. baldness
ringworm, on skin, area of central clearing, some itching
jock itch, well defined, errythematous, flat or raised,
intense itching, at night, not on face, finger webbing, under axilla, groin, toe webbing. Close contact. +burrows.
often only see nits, shake hair shaft- will not fall off, do follow up treatment in 10-14 days to kill eggs. Hard for patients to do all the cleaning, treatment necessary.
rickettsial rocky montain spotted fever
3-10 days post tick bite, fever, pain, rash, photophobia, n/v, starts on wrist, ankles and spreads inward, petichael rash, will get on palms/soles of feet.
tick bite. errythematous lesion with central clearing, "bull's eye", red papular lesions, will migrate, trunk, axilla, groin. Flu like symptoms. Early- ha, weakness. Intermediate- arthralgia, Late- meningitis, ms changes.
cold sore, vesicle lesions, can get anywhere on body, have to break vesicle and culture at base of lesion.
must have chicken pox first. Vesicles that follow dermatome on one side of body. Immunize over age 60.
umbilicated papule. Viral, spread through direct contact, very contagous. Usually same color as skin.
erythma infectiosum. Viral, sudden onset, macular red rash on checks, face, then 2-3days later on extremities, parovirus, circumoral pallor, stay away from pregnant women
viral? herald patch on trunk, flat patch with central clearing and scaling border, common in spring, fall and in teens, then papular discrete oval rashes on trunk, Christmas tree distribution
hhv-6 viral infection. 2-3 days fever in irritable infant, 104-105 fever, not "that sick" looking, then rash- pink, fades within 12-24 hours. Fever goes away with rash.
viral xantham. Starts on face, then caudilly, lymphadenopathy, postauricular nodes, not very sick, cannot be around pregnant women.
In mouth, present in rubella. Indicative of rubella.
measles. Cough, runny eyes, congestion. Photophobia, fever. Self-limiting. Sicker than rubella.
in bucal mucosa, white spots, indicative of rubeola.
chicken pox, flat macule, to papule, to vesicle, then scabs over. Contagious until last vesicle is scabbed over!
can be tender or pruritic, well demarcated, scaling, elbows, knees, hands, fingernails, scalp, hard for patients to deal with it, chronic autoimmune, plaques, papules.
inflammatory process, skin and mucous membranes, itching papules, flat-topped, white webbingin buccal mucosa, papule, purple, planar, pruritic, polyangular.
white cystic lesions in babies, will go away
associated with stress or illness, transverse lines in nails
brown ring distal ring, luna not always visible, CHF, liver, DM
inflammation of nail folds, red, swollen, acute or chronic,