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Bates - Chapter 6 -Skin

Terms in this set (72)

Causes of General Itching (Without Apparent Rash)
Dry skin, pregnancy, uremia, jaundice, lymphomas and leukemia, drug reaction, lice and less commonly, diabetes and thyroid disease
Approximately half of________ are initially detected by the patient
Melanomas
"Ugly Duckling Sign"
A mole that looks different from the typical moles seen in a given patient
6-mm Cutoff
"A diameter criterion of a suspicious skin lesion larger than 6 mm is still a useful guideline for the early detection of cutaneous melanoma"
Artificial Light
Can distort color and mask jaundice
Biopsy
Consider biopsy for any lesions that are suspicious for carcinoma or, when needed, as an aide to diagnosis
Pallor
Results from decreased redness in anemia and decreased blood flow, seen in fainting or arterial occlusion
Central Cyanosis
Causes include advanced lung disease, congenital heart disease, and hemoglobinopathies, COPD , pulmonary edema
Cyanosis of Heart Failure
It is usually peripheral, reflecting deoxygenation or impaired circulation. In COPD and pulmonary edema, hypoxia may give rise to central cyanosis
Jaundice
Suggests liver disease or excessive hemolysis of red blood cells. Makes the skin diffusely yellow and mostly seen in the sclera
Carotenemia
Yellow color that accompanies high levels of carotene, look at the palms, soles and face
Hypothyroidism
Dryness, coolness, roughness of skin
Sparse hair
Acne (Skin)
Oiliness in acne, affects the face, upper chest, and back
Hyperthyroidism (Skin)
Generalized warmth in fever, skin velvety in texture
Fine, silky hair
Inflammation or Cellulitis (Skin)
Local warmth
Scleroderma
Decreased mobility in edema
Dehydration (Skin)
Decreased turgor in dehydration
Psoriasis
Affects the knees and elbows (among other areas)
Candida Infections
The intertriginous areas (places where two skin rub together)
Herpes Zoster
Vesicles in a unilateral dermatomal pattern
Necrosis
Local redness of the skin warns of impending necrosis, although some deep pressure sores develop without antecedent redness. Inspect closely for skin breaks and ulcers
Alopecia
Refers to hair loss - diffuse, patchy or total
Cafe-Au-Lait Spot
A slightly but uniformly pigmented macule or patch with a somewhat irregular border, usually 0.5 to 1.5 cm in diameter; benign
Tinea Versicolor
Common superficial fungal infection of the skin, causing hypo- or hyper pigmented, slightly scaly macule son the trunk, neck and upper arms
Vitiligo
Depigmented macules appear on the face, hands, feet extensor surfaces, and other regions and may coalesce into extensive areas that lack melanin. The condition may be hereditary
Cyanosis
The somewhat bluish color that is visible in these toenails and toes
Erythema
Red hue, increased blood flow,
Heliotrope
Violaceous patches over the eyelids in the collagen vascular disease dermatomyositis
Pityriasis Rosea
Reddish oval ringworm-like papules or plagues
Psoriasis - Apperance
Silvery scaly papules or plaques, mainly on the extensor surfaces
Skin Lesions- Patterns and Shapes
Linear: linear epidermal nevus
Clustered: grouped vesicles of herpes simplex
Geographic: Mycosis fungoides
Serpiginous: Tinea corporis
Annular, Arciform: Annular plaque of tinea faciale
Macule
Small, flat spot, non palpable lesion up to 1.0 cm with changes in skin color (hemangioma, cafe-au-lait spot, vitiligo)
Plaque
Elevated lesion 1.0 cm or larger often formed by coalescence of papules (psoriasis)
Papule
Elevated lesion up to 1.0 cm (psoriasis)
Cyst
Nodule filled with expressible material, either liquid or semisolid (epidermal inclusion cyst)
Nodules
Knot-like lesion larger than 0.5 cm, deeper and firmer than a papule (Dermatofibroma)
Wheal
A somewhat irregular, relatively transient, superficial area of localized skin edema (Urticaria)
Vesicle
Up to 1.0 cm, filled with serous fluid (Herpes Simplex and Herpes Zoster)
Bulla
1.0 cm or larger; filled with serous fluid (Insect bite)
Pustule
Filled with pus (Yellow proteinaceous fluid filled with neutrophils) Acne and small pox
Burrows
A minute, slightly raised tunnel in the epidermis, commonly found on the finger webs and on the sides of the fingers (scabies)
Primary Skin Lesions
Macule, Plaque, Papule, Nodule, Cyst, Wheal, Vesicle, Bulla, Pustule, Burrow
Secondary Skin Lesions
Scale, Crust, Scars, Lichenification, Keloids, Erosions, Excoriation, Fissure, Ulcer
Scale
A thin flake of dead exfoliated epidermis (Ichthyosis vulgaris and dry skin)
Crust
The dried residue of skin exudate such as serum, pus or blood (Impetigo)
Lichenification
Visible and palpable thickening of the epidermis and roughening of the skin with increased visibility of the normal skin furrows (often from chronic rubbing) neurodermatitis
Scars
Increased connective tissue that arises from injury or disease
Keloids
Hypertrophic scarring that extends beyond the borders of the initiating injury
Erosion
Non-scarring loss of the superficial epidermis; surface is moist but does not bleed (aphthous stomatitis, moist area after the rupture of a vesicle as in chickenpox)
Excoriation
Linear or punctate erosions caused by scratching (cat scratches)
Fissure
A linear crack in the kin, often resulting from excessive dryness (Athlete's foot)
Ulcer
A deeper loss of epidermis and dermis; may bleed and scar (Stasis ulcer of venous insufficiency, syphilitic chancre)
Vascular Lesions
Spider Angioma: fiery red, central body, sometimes raised, surrounded by erythema and radiating legs
Spider Vein: size variable, from very small to several inches, may resemble a spider or be linear, irregular cascading
Cherry Angioma: Bright or ruby red, may become purplish with age, 1-3 mm, round, flat or sometime raised, may be surrounded by a pale halo
Purpuric Lesions
Petechia/Purpura: Deep red or reddish purple, fading away over time, (petechia, 1-3 mm and purpura are larger) rounded, sometimes irregular, flat
Ecchymosis: purple or purplish blue, fading to green, yellow, and brown with time. Variable size, larger than petechiae, rounded, oval or irregular; may have a central subcutaneous flat nodule
Skin Tumors
Actinic keratosis, seborrheic keratosis, basal cell carcinoma, squamous cell carcinoma
Benign Nevus
Common mole, usually appears in the first few decades. Round or oval shape, sharply defined borders, uniform color, especially skin-colored, tan or brown, diameter <6 mm but >10 mm if congenital, flat or raised surface
Malignant Melanoma
ABCDE's of melanoma (asymmetry, border, color, diameter, and evolution)
Stage 1 Pressure Ulcer
Presence of a reddened area that fails to blanche with pressure, and changes in temperature (warmth and coolness), consistency (firm or boggy), sensation (pain or itching), or color (red, blue, or purple on darker skin; red on lighter skin)
Stage 2 Pressure Ulcer
The skin forms a blister or sore. Partial-thickness skin loss or ulceration involving the epidermis, dermis, or both
Stage 3 Pressure Ulcer
A crater appears in the skin, with full-thickness skin loss and damage to or necrosis of subcutaneous tissue that may extend to, but not through, underling muscle
Stage 4 Pressure Ulcer
The pressure ulcer deepens. There is full-thickness skin loss, with destruction, tissue necrosis, or damage to underlying muscle, bone, and sometimes tendons and joints
Alopecia Areata
Clearly demarcated round or oval patches of hair loss, usually affecting young adults and children. There is no visible scaling or inflammation
Trichotillomania (Trichotillosis)
Hair loss from pulling, plucking, or twisting hair. Hair shafts are broken and of varying lengths. More common in children, often in settings of family or psychosocial stress
Tinea Capitis ("Ringworm")
Round scaling patches of alopecia. Hairs are broken off close to the surface of the scalp. Usually caused by fungal infections from Trichophyton tonsurans from humans, less commonly from microsporum canis from dogs or cats. Mimincs seborrheic dermatitis
Paronychia
A superficial infection of the proximal and lateral nail folds adjacent to the nail plate. Usually from staph. aureus or strep. species and most common infection of the hand
Clubbing of the Fingers
Clinically a bulbous swelling of the soft tissue at the nail base, with loss of the normal angle between the nail and the proximal nail fold. Seen in congenital heart disease, interstitial lung disease and lung cancer, inflammatory bowel disease and malignancies
Onycholysis
A painless separation of the whitened opaque nail plate from the pinker translucent nail bed. Local causes include trauma from excess manicuring, psoriasis, fungal infection and allergic reactions to nail cosmetics. Systemic causes include diabetes, anemia, photosensitive drug reactions, hyperthyroidism peripheral ischemia, bronchiectasis and syphilis
Terry's Nails
Nail plate turns white with a ground-glass appearance, a distal band of reddish brown and obliteration of the lunula. Seen in liver disease, usually cirrhosis, heart failure, and diabetes.
White Spots (Leukonychia)
Trauma to the nails is commonly followed by nonuniform white spots that grow slowly out with the nail. Spots in the pattern illustrated are typical of overly vigorous and repeated manicuring.
Transverse White Bands (Mees' Lines)
Curving transverse white bands that cross the nail parallel to the lunula. Arising from the disrupted matrix of the proximal nail, they vary in width and move distally as the nail grows out. Seen in arsenic poisoning, heart failure, Hodgkin's disease, chemotherapy, carbon monoxide poisoning and leprosy.
Transverse Linear Depressions (Beau's Lines)
Transverse depressions of the nail plates, usually bilateral, resulting from temporary disruption of proximal nail growth from systemic illness. As with Mees' lines, timing of the illness may be estimated by measuring the distance from the line to the nail bed (Nails grow approximately 1 mm every 6 to 10 days). Seen in severe illness, trauma, and cold exposure if Raynaud's disease is present
Pitting
Punctate depressions of the nail plate caused by defective layering of the superficial nail plate by the proximal nail matrix. Usually associated with psoriasis but also seen in Reiter's syndrome , sarcoidosis, alopecia areata, and localized atopic or chemical dermatitis.
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