Derm 1
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Questions and Answers

What is the correct order of the four stages in skin cell formation?

  • Keratinization, cell division, desquamation, cell differentiation
  • Desquamation, cell differentiation, keratinization, cell division
  • Cell division, cell differentiation, keratinization, desquamation (correct)
  • Cell differentiation, keratinization, desquamation, cell division

    • Which of the following is NOT a primary skin lesion?

  • Papule
  • Scale (correct)
  • Wheal
  • Macule

    • Which layer of the skin contains the sweat glands and nerve endings?

  • Dermis (correct)
  • Subcutaneous layer
  • Epidermis
  • Stratum corneum

    • What is the term used to describe skin lesions that are raised and palpable?

    <p>Papular (A)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of skin lesions used for accurate description?

    <p>Size (D)</p> Signup and view all the answers

    What is the difference between a nodule and a tumor?

    <p>Nodules are smaller and less than 2cm in diameter, while tumors are larger and more than 2cm in diameter (D)</p> Signup and view all the answers

    Which of these is NOT a condition discussed under the category of papulo-squamous diseases?

    <p>Erythema multiforme (D)</p> Signup and view all the answers

    Which of these skin lesions is NOT classified as a secondary lesion?

    <p>Vesicle (D)</p> Signup and view all the answers

    What is the term used to describe a flat, non-palpable skin lesion that is less than 1 cm in diameter?

    <p>Macule (A)</p> Signup and view all the answers

    Which type of skin lesion is characterized by a circumscribed superficial cavity filled with purulent exudate?

    <p>Pustule (A)</p> Signup and view all the answers

    What is the term used to describe a flat or barely elevated plaque that is often associated with conditions like atopic dermatitis?

    <p>Patch (A)</p> Signup and view all the answers

    What is the term used to describe a palpable, solid, fatty or cystic lesion that is larger than 1 cm in diameter?

    <p>Nodule (A)</p> Signup and view all the answers

    What is the term used to describe a dried serum, blood, or exudate on the skin?

    <p>Crust (D)</p> Signup and view all the answers

    Which type of skin lesion is characterized by an epidermis defect that heals without a scar?

    <p>Erosion (A)</p> Signup and view all the answers

    What is the term used to describe a defect in the dermis or deeper layers of skin that heals with a scar?

    <p>Ulcer (D)</p> Signup and view all the answers

    What term describes a fibrous tissue replacement, often visible after a skin injury?

    <p>Scar (C)</p> Signup and view all the answers

    What does the term 'confluence' refer to, when describing skin lesions?

    <p>The merging of individual lesions (B)</p> Signup and view all the answers

    Which of the following is NOT considered a characteristic of palpation when evaluating skin lesions?

    <p>Color (D)</p> Signup and view all the answers

    What are the two main categories of lesion arrangement?

    <p>Grouped and disseminated (D)</p> Signup and view all the answers

    What does 'margination' refer to, when describing skin lesions?

    <p>The sharpness or sharpness of the border of a lesion (A)</p> Signup and view all the answers

    Which of the following is used to describe the type of skin lesion?

    <p>Macule (B)</p> Signup and view all the answers

    What is the term for the extent and distribution of a skin lesion?

    <p>Location (B)</p> Signup and view all the answers

    When assessing skin lesions, what does the 'single vs multiple' category refer to?

    <p>The number of lesions present (B)</p> Signup and view all the answers

    Which of the following characteristics is assessed during palpation?

    <p>Temperature (D)</p> Signup and view all the answers

    Which of these is NOT a common site for Lichen Simplex Chronicus?

    <p>Feet (B)</p> Signup and view all the answers

    Which of the following is associated with a coin-shaped plaque of grouped small papules and vesicles on an erythematous base?

    <p>Nummular Eczema (B)</p> Signup and view all the answers

    Which of the following conditions is often associated with venous insufficiency?

    <p>Stasis Dermatitis (D)</p> Signup and view all the answers

    Which of the following treatment options is commonly used for both Nummular Eczema and Stasis Dermatitis?

    <p>Topical corticosteroids (B)</p> Signup and view all the answers

    Which of the following factors can elicit or exacerbate Atopic Dermatitis?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following conditions is often seen in immunosuppressed individuals, such as those with HIV or Parkinson's Disease?

    <p>Seborrheic Dermatitis (B)</p> Signup and view all the answers

    What is the common term used to describe the itch-scratch cycle often seen in Atopic Dermatitis?

    <p>The itch that rashes (A)</p> Signup and view all the answers

    Which of these options is a common treatment for severe cases of Contact Dermatitis?

    <p>PO prednisone (A)</p> Signup and view all the answers

    Which of the following conditions is NOT typically associated with a chronic or relapsing course?

    <p>Contact Dermatitis (D)</p> Signup and view all the answers

    Which of these conditions is often associated with a personal or family history of allergies, such as allergic rhinitis or asthma?

    <p>Atopic Dermatitis (C)</p> Signup and view all the answers

    Which of these medications may be prescribed for disabling oral lesions in Erythema Multiforme?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the primary treatment approach for Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)?

    <p>Aggressive fluid and electrolyte management (A)</p> Signup and view all the answers

    What distinguishes Stevens-Johnson Syndrome (SJS) from Toxic Epidermal Necrolysis (TEN)?

    <p>The extent of epidermal detachment involved (C)</p> Signup and view all the answers

    What is a common symptom experienced by patients with Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) early in the disease course?

    <p>Conjunctival burning and itching (A)</p> Signup and view all the answers

    Which of the following is NOT a potential trigger for Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)?

    <p>Antidepressants (A)</p> Signup and view all the answers

    What is Nikolsky's sign and what does it indicate?

    <p>The ability to extend the area of superficial sloughing by gentle lateral pressure (C)</p> Signup and view all the answers

    Which of these is NOT a characteristic of Erythema Multiforme (EM)?

    <p>Typically affects the palms of the hands and soles of the feet (D)</p> Signup and view all the answers

    What is the key characteristic that must be present for a diagnosis of acne vulgaris?

    <p>Presence of comedones (C)</p> Signup and view all the answers

    Which of these medications can be effective in treating moderate acne vulgaris, but should be used with caution during pregnancy?

    <p>Tazarotene (A)</p> Signup and view all the answers

    Which of the following is a potential side effect of benzoyl peroxide gel?

    <p>Bleaching of fabrics (D)</p> Signup and view all the answers

    Which of the following medications is NOT typically used in the treatment of acne vulgaris?

    <p>Metronidazole (C)</p> Signup and view all the answers

    What is the primary reason for the occurrence of comedones in acne vulgaris?

    <p>Follicular plugging (A)</p> Signup and view all the answers

    Which of these factors is NOT a known contributor to the pathogenesis of acne vulgaris?

    <p>Vitamin D deficiency (B)</p> Signup and view all the answers

    Which of the following is a common presentation of pemphigus?

    <p>Flaccid, weeping bullae that rupture easily (D)</p> Signup and view all the answers

    Which of the following is a characteristic of pemphigoid, but NOT of pemphigus?

    <p>Often presents with pruritis (D)</p> Signup and view all the answers

    Which of the following statements accurately describes the Nikolsky sign?

    <p>A positive result when a gentle pressure on the skin causes the outer layer to separate (D)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of toxic epidermal necrolysis (TEN)?

    <p>Usually presents with significant pruritis (B)</p> Signup and view all the answers

    Flashcards

    Papulo-squamous diseases

    Skin disorders characterized by papules and plaques such as eczema, psoriasis.

    Desquamation

    The process of shedding dead skin cells from the outer layer of skin.

    Vesicular bullae

    Fluid-filled blisters that can occur in conditions like pemphigus and pemphigoid.

    Acneiform lesions

    Skin lesions resembling acne, including acne vulgaris and rosacea.

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    Primary skin lesions

    Initial skin changes, including macules, papules, and vesicles.

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    Secondary skin lesions

    Changes that occur after primary lesions such as crusts and scales.

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    Epidermal layers

    The layers of skin where cell division and differentiation occur.

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    Skin cell formation steps

    Four steps: cell division, cell differentiation, keratinization, desquamation.

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    CLAMPS TN

    An acronym for characterizing skin lesions using Color, Location, Arrangement, Margination, Palpation, Shape, Type, and Number.

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    Macule

    A non-palpable skin lesion < 1 cm in diameter, with varied pigmentation, no elevation or depression.

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    Papule

    A palpable skin lesion < 1 cm in diameter, which can be isolated or grouped; a pustule is a type of papule.

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    Pustule

    A circumscribed superficial cavity with purulent exudate, can have various colors of discharge.

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    Plaque

    A plateau-like elevated lesion often associated with psoriasis, can be thickened and rough.

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    Nodule

    A palpable, solid lesion larger than a papule (1-2 cm), can be fatty or cystic.

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    Wheal

    An irregularly-shaped, elevated lesion that is edematous and disappears within 24-48 hours, often seen in hives.

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    Vesicle/Bulla

    A blister; a vesicle is < 0.5 cm, while a bulla is larger, both have a thin roof.

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    Location/Distribution

    The extent and pattern of skin lesions on the body.

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    Arrangement

    The formation of skin lesions as grouped or disseminated; includes confluence.

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    Margination

    The clarity of the edges of skin lesions, classified as well-defined or ill-defined.

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    Palpation

    The assessment of skin lesions' qualities: consistency, temperature, mobility, tenderness, and depth.

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    Shape

    The geometric form of skin lesions, crucial for identification.

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    Type of lesion

    Categories of lesions such as papule, macule, or pustule.

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    Single vs Multiple lesions

    The distinction between whether a lesion is singular or there are several.

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    Color

    The hue of the skin lesions, which can indicate different conditions.

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    Erythema Multiforme

    A condition causing target-like lesions on the skin and mucous membranes, often due to infections or medications.

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    Stevens-Johnson Syndrome (SJS)

    A severe skin reaction causing necrosis and detachment, often drug-induced, with mucous membrane involvement.

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    Toxic Epidermal Necrolysis (TEN)

    An extreme form of SJS with more than 30% epidermal detachment, causing severe skin loss.

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    Clinical Diagnosis

    Identifying a condition based on physical examination and symptoms without lab tests.

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    Biopsy

    A procedure to remove a small sample of tissue for diagnostic examination.

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    Nikolsky Sign

    A sign indicating skin fragility; lateral pressure causes sloughing at uninvolved skin.

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    Mucous Membrane Involvement

    A condition where lesions develop on mucosal surfaces such as eyes, mouth, or genitals.

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    Continuous Antiviral Therapy

    Ongoing treatment to prevent recurrence of conditions like HSV-related Erythema Multiforme.

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    Lichen Simplex Chronicus

    Localized thickening of the skin from chronic scratching.

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    Symptoms of Lichen Simplex Chronicus

    Thickened skin and excoriations in circumscribed plaques.

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    Numular Eczema

    Chronic, inflammatory skin condition with coin-shaped plaques.

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    Acute vs Chronic Contact Dermatitis

    Irritant or allergen-induced skin irritation, can be immediate or delayed.

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    Symptoms of Stasis Dermatitis

    Related to venous insufficiency with papules and hyperpigmentation.

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    Atopic Dermatitis

    Chronic skin condition characterized by itchy, inflamed skin.

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    Triggers of Atopic Dermatitis

    Factors include inhalants, foods, and emotional stress.

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    Seborrheic Dermatitis

    Chronic condition affecting oily areas of the skin, such as scalp.

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    Treatment for Lichen Simplex Chronicus

    Includes preventing scratching and using topical steroids.

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    Common Areas for Contact Dermatitis

    Occurs on hands, face, and areas exposed to irritants.

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    Pemphigus

    A chronic bullous autoimmune disease often starting in the mouth.

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    Bullous pemphigoid

    An autoimmune disease in elderly patients characterized by large, tense blisters.

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    Acne vulgaris

    Inflammation of pilosebaceous units, leading to comedones, cysts, and pustules.

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    Comedones

    Blocked hair follicles that appear as blackheads or whiteheads.

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    Flare-ups

    Exacerbations of acne often triggered by seasonal changes or menstruation.

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    Propionibacterium acnes

    Bacteria that contribute to acne development by triggering inflammation.

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    Treatment for mild acne

    Includes topical antibiotics and benzoyl peroxide to manage symptoms.

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    Moderate acne treatment

    Combines topical therapy with oral antibiotics to combat more severe cases.

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    Follicular keratinization

    A process contributing to acne, involving the formation of keratin plugs in follicles.

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    Study Notes

    Dermatology 1

    •  The course is Dermatology 1, taught by Professor Jacobus, MSBS, PA-C.
    •  The course is offered at South College.

    Topics

    •  Papulo-squamous diseases: Dermatitis, eczema, drug eruptions, lichen planus, pityriasis rosea, and psoriasis.
    •  Desquamation: Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis.
    •  Vesicular bullae: Pemphigoid and pemphigus.
    •  Acneiform lesions: Acne vulgaris, rosacea, and folliculitis.

    Instructional Objectives

    •  Identify and describe the etiology, epidemiology, clinical features, differential diagnosis, and management of selected skin disorders.
    •  Identify and accurately describe skin lesions using standard terms:
      • Number: single, multiple
      • Pigmentation/color: white, flesh-colored, pink, pearly, erythematous, tan-brown, salmon, black, purple, violaceous, and yellow
      • Shape and arrangement: annular, round/discoid, linear, oval, iris/target, zosteriform, serpiginous, stellate, reticulate, and morbilliform
      • Texture: consistency, mobility, temperature, tenderness, depth
      • Borders/margins: well-defined, ill-defined
      • Type: Primary lesions (macule, tumor, patch, wheal, papule, vesicle, plaque, bulla, nodule, pustule, cyst, and telangiectasia) or secondary lesions (crust, fissure, scale, ulcer, lichenified, keloid, erosion, hypertrophic scar, atrophy, and excoriation)
      • Arrangement/location/distribution: localized, regional, and generalized
      • Associated changes

    Skin layers

    •  The layers of the skin include the epidermis, dermis, and subcutaneous tissue.
    •  Epidermal layers include the stratum corneum, granular layer, spinous layer, and basal layer.

    Skin cell formation

    •  Keratinocytes divide in the deepest (basal) layer
    •  Cells move up the dermis, changing shape and composition
    •  Cells secrete keratin proteins and lipids to form a protective matrix
    •  Outermost skin cells die and shed.

    Skin Exam

    •  Be thorough; examine patients in gowns.
    •  Use good lighting; consider magnification.
    •  Check scalp, palms, soles, and nails.
    •  Document any findings in detail, photograph, and monitor changes over time.

    Approach to Diagnosis

    •  Use the CLAMPS TN method: color, location/distribution, arrangement, margination, palpation, shape, type, and number.

    Types of Skin Lesions (examples)

    •  Crust
    •  Cyst
    •  Macule
    •  Papule
    •  Pustule
    •  Ulcer
    •  Vesicle
    •  Wheal

    Macule

    •  Non-palpable
    •  <1 cm diameter
    •  Varied pigmentation from surrounding skin
    •  No elevation or depression
    •  Patch: macule > 1 cm diameter

    Papule

    •  Palpable
    •  <1 cm diameter
    •  Isolated or grouped
    •  Pustule: small, circumscribed papule containing purulent material

    Pustule

    •  Circumscribed superficial cavity with purulent exudate.
    •  Exudate can be white, yellow, greenish-yellow, or hemorrhagic.

    Plaque

    •  Plateau-like elevation
    •  Lichenification - less defined large plaque (thickened, rough skin)
    •  Patch – flat or barely elevated plaque

    Nodule

    •  Palpable, solid, fatty or cystic
    •  Round or ellipsoidal
    •  Larger than a papule
    •  Tumor: nodule > 2 cm

    Wheal

    •  Irregularly-shaped, elevated, edematous
    •  Erythematous or paler than surrounding skin
    •  Well-demarcated borders
    •  Disappears within 24-48 hours

    Vesicle/Bulla

    •  Blister
    •  Vesicle <0.5cm; Bulla >0.5 cm
    •  Well-defined
    •  Thin roof
    •  Serum and blood

    Secondary Skin Lesions

    •  Crust-dried serum, blood, or exudate
    •  Scales-flakes
    •  Erosion - epidermis defect (heals without scar)
    •  Ulcer - defect in dermis or deeper (heals with scar)
    •  Scar - fibrous tissue replacement
    •  Atrophy - diminution of some or all layers of skin

    History

    • Demographics: age, race, sex, occupation, hobbies.
    • Chemical/toxin exposure?
    • Constitutional symptoms (acute vs chronic).
    • History of skin lesions - OLD CARTS.

    HX of Skin Lesion (OLD CARTS)

    • When did lesion appear (first noticed)?
    • Where did lesion appear (site of onset)?
    • Does it come and go, or is it constant?
    • Does it itch, hurt, or bleed?
    • How has it spread (pattern/evolution)?
    • How have individual lesions changed?
    • What are provocative factors?
    • What are previous treatments (topical, systemic)?

    Papulosquamous Disease

    • Eczema/ Dermatitis
    • Drug eruptions
    • Lichen planus
    • Pityriasis rosea
    • Psoriasis

    Eczema/Dermatitis

    • Dyshidrotic eczema
    • Lichen simplex chronicus
    • Nummular eczema
    • Contact dermatitis
    • Stasis dermatitis
    • Atopic dermatitis
    • Seborrheic dermatitis
    • Perioral dermatitis

    Desquamation

    • Erythema multiforme

    • Stevens-Johnson Syndrome (SJS)

    • Toxic Epidermal Necrolysis (TEN)

    • Erythema multiforme - presentation, history taking, target lesions

    • Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) – acute, life-threatening mucocutaneous reaction, necrosis & detachment of epidermis, differentiating SJS from TEN, rare, present, idiopathic or drug-induced, higher incidence in HIV & active cancer, F>M.

    • Nikolsky sign-ability of sloughing to expand.

    Vesiculobullous Disease

    • Bullous pemhigoid- autoimmune, elderly patients, large, tense bullae

    • Pemphigus- chronic or acute, bullous autoimmune disease, adults 40-60, predilection scalp, face, chest, axillae, groin, umbilicus. painful. PE- vesicles and bullae, easily rupture, flaccid and weeping, Nikolsky sign

    • Acne & Related Disorders - acne vulgaris, rosacea, hidradenitis suppurativa

    • Acne vulgaris - inflammation of pilosebaceous units, comes (open = blackheads, closed= whiteheads) ,can result in pits, depressions, scars or hyperpigmentation, more severe in males than females;less often in Asians; cystic acne can be familial.

    • Factors in pathogenesis- follicular keratinization, androgens, Propionibacterium acnes

    • Contributing factors - meds (lithium, isoniazid), steroids, OCP, androgens; stress; occlusion/pressure; cosmetics; pomade; sweat, worse in winter, comedones necessary diagnosis; labs- none, course clears by early 20's, flares with winter or menses- treatment, removal of plugs, topical antibiotics, topical retinoids; combination therapy works best.

    • Treatment- moderate: same + PO antibiotics (minocycline, doxycycline, tapered to 50mg/d as acne lessens.

    Rosacea

    • Chronic inflammation of facial pilosebaceous units. • 30-50 y/o, F>M. • Episodic erythema, flushing & blushing, stages I, II, & III, persistent erythema, telangiectasias, papules, tiny pustules, nodules. • Note, no comedones • Triggered by hot liquids, spicy foods, alcohol/wine, aged cheese, exposure to sun & heat, stress • Duration: days, weeks, months • Late stage: rhinophyma • Treatment: reduce or eliminate alcohol/caffeine, topical antibiotics, PO antibiotics better than topical, PO isotretinoin for severe disease, surgery for rhinophyma/telangiectasias (lasers)

    Folliculitis

    • Inflammation or infection of superficial hair follicles. • Perifollicular papules and/or pustules with surrounding erythema; hair bearing skin; often pruritic • More common in males • Risk factors: prolonged antibiotic use, topical corticosteroids, hot tubs • Etiology: most common staph aureus; hot tub-->> pseudomonas auruginosa. •Treatment: Benzoyl peroxide wash (bleaches) topical mupirocin, clindamycin, erythromycin. If no improvement -- >PO Cephalexin.

    Hidradenitis Suppurativa

    • Chronic, suppurative • Apocrine gland skin. • Axillae, inguinocrural, anogenital, inframammary, rarely scalp • F (axillae)>M (anogenital) • FHx: NC acne & HS • Unknown etiology • Risk factors: obesity, smoking, genetic predisp. to acne. • Lesions: tender open & double comedones, red nodules/abscesses, sinus tracts, “bridge” scars, hypertrophic & keloidal scars, contractures. • Pathogenesis: follicle plugging > dilated follicle & apocrine duct inflammation > bacterial growth > extension > ulceration, fibrosis, sinus tracts > scarring. • Treatment (combination): intralesional steroids, then I&D abscess, prednisone for severe pain, & inflammation, surgery, PO antibiotics, Isotretinoin, adalimumab

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    Description

    Test your knowledge on skin cell formation and various skin lesions with this quiz. Explore the stages of skin cell development, the characteristics of primary and secondary lesions, and the terminology used in dermatology. Perfect for students studying skin biology or dermatology.

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