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SK
most common benign tumor in older adults
Leser-Trelat
adenocarcinoma, black greasy plaques
Dermatitis
""inflammation of skin""; acute (days), subacute (weeks) or chronic (months)
Signs of acute eczema
edema, erythema, pruritis, papules, bullae, burning, vesicles
Signs of chronic eczema
crusts (erythema subsides), plaques, hyperkeratosis, pigmentation changes (HYPERpigmentation first)
lichenification
thickening of skin due to chronic irritation/friction
Primary Irritant contact dermitis
not immune mediated; often occupationally acquired (roofing cement), Poison Ivy first exposure
Allergic contact dermitis
second exposure, T-cells; ex./ Temporary tattoo
Metallic allergens
patch testing; nickel sulfate in earrings, Potassium dichromate in cement and leather, Cobalt chloride
allergens in medications
Avoid Tincture of benzoin-skin adherents
Contact dermatitis common location
Dorsum of foot
eczema
bubbling over of the skin
pruritis
itching
acute asteotic eczema
""without oil""; found about ankles, legs, feet
Chronic asteotic eczema (""winter itch"")
brown discoloration, diffuse, aged skin from excessive bathing
Venous ulcers
non-painful medial ankle ulcer; found 3 finger breadths above the medial malleolus, post-partem ""milk leg""
Long-term care of venous ulcers
BK support stockings
Acute care of venous ulcers
BK Unna Book weekly
Topical agent used for dry skin
urea lotion
Grade 1 Pressure Ulcers
discoloration of skin (""think pink""), warmth, hardness, edema may be present
Grade 2 Pressure Ulcers
partial thickness skin loss, superficial ulcer (ex./ blister, erosion, shallow crater), Treatment: pressure relief and Bacitracin ointment topically
Grade 3 Pressure Ulcers
Full thickness skin loss, damage or necrosis to superficial fascia, DEEP crater, Pressure relief/would care/Oral AB
Grade 4 Pressure Ulcers
Full thickness skin loss, Extensive destruction (Treatment: consider IV, X-rays, Surgery)
Verrucae
velvety roughened surfaces, asymmetrical locations, morphology varies with VIRAL serotype, Dermal/ Epidermal lesion that disrupt dermatoglyphic lines (ex./ Periungual)
Verrucae virology
caused by HPV, weakly contagious to suspectible persons, ""Autoinoculation"", 71% located on hands, highest incidence between 5-16 years
Common warts
HPV type 1,2,4; 0.25 to 1cm; location is hands and forearms
Periungual warts
autoinoculated, more frequent in nail bitters
flat warts
2-4mm papules
filiform warts
fingerlike, horny growths; located around eyes and eyelids
Solitary plantar verrucae
HPV 1; endophytic, ""pinpoint bleeding"", currettable
Mosaic plantar verrucae
chemical destruction preferrered; HPV 2 or 4
Genital warts
condyloma accuminata; Treatment: topical Aldara (imiquoid) immunomodulator cream
Epidermodysplasia Verrucaformis
AD, genetically predisposed to HPV, favors sun exposed areas, 1/3 degenerate into squamous cell carcinoma
Plantar warts DD
kaposi's sarcoma, porokeratosis plantaris discreta
common and flat warts DD
squamous CA, actinic keratosis
Key histological features of Verrucae
viral inclusion bodies in upper epidermis (hyperplasia of stat rum granulosum, centripetally arranged rate ridges)
Physician performed verrucae therapy
chemical destruction (lactic acid, salicylic acid), surgical curettage (laser ablation and coagulation), Cryosurgery (liquid nitrogen, NO)
OTC Patient applied therapies of Verrucae
Salicyclic and lactic acid, Duofilm, mole skin plasters, Drying agent (10% formalin solution)
DM and PVD findings (""class finding"")
an absent pedal pulse, thinned skin, cool toes, decreased hair growth
Corns and calluses
Not medical terminology
Callous
tyloma (larger, 2-3cm in diameter), clear yellow thickening of epidermis, caused by weight bearing stress and friction, Thinned with sanding disk
IPK (Isolated Plantar Keratosis)
""corn medical term""1-2cm, over bony prominence, Deep conical shaped central horny nodule (""core""), may be blood tinged, enucleating center relieves pain
Porokeratosis Plantaris Discreta
special Pressure induced plantar keratosis, NOT plugged eccrine duct nor cysts
Tyloma
MTPJ, 2-3cm, NO bleeding, NO pain, Prominent lines
IPK
MTPJ, 1-2cm, NO bleeding, PAIN, Lost lines
PPD
Sole of foot, 1-3mm, NO bleeding, PAIN, lost lines
Verruca
any location, 2-10mm, BLEEDING, PAIN, lines anywhere
Herediatry palmar plantar keratses
genetic disorder of keratinization, clones of abnormal skin cells, more common in African Americans, pressure accentuated
Grade 3 PPD
extends through dermis herniates into subcutaneous layer, may rarely require total excision with 3mm punch
HD4
(heloma durum HD4) often 1 cm circumscribed localized hyperkeratotic plaque, ""knuckle pad"" has little overlying hyperkeratosis
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