Evaluation and Management of Skin Disorders PDF

Part 5 Evaluation and Management of Skin Disorders  Principles of Dermatologic Therapy (Chapter 39) Moist, wet lesions Burrow’s solution aids in drying lesion and provides soothing relief. Exudative skin disease Wet dressings—Suppress inflammation...

Part 5 Evaluation and Management of Skin Disorders  Principles of Dermatologic Therapy (Chapter 39) Moist, wet lesions Burrow’s solution aids in drying lesion and provides soothing relief. Exudative skin disease Wet dressings—Suppress inflammation Dry lesions Creams and ointments—Suppress pruritus Topical corticosteroids or systemic corticosteroids Antifungals Antivirals Biologic agents Retinoid medications Teratogenic, require careful contraception, monthly pregnancy testing, may need to avoid pregnancy for as long as three years after treatment complete.  Screening for Skin Cancer (Chapter 40) A skin cancer screening is a visual exam of the skin that can be done by oneself (self-skin examination) or a health care provider. Benefit of skin cancer screening is greatest in subgroups most likely to develop melanoma. ABCDE screening method Asymmetry (of the entire lesion) Border (irregularities) Color (variability within the lesion from a brown to black discoloration) Diameter (>6 mm [0.25 inch]) Elevation (recently raised) Suspicious skin lesion, such as BCC, warrants biopsy or referral  Discussion Question 1 Discuss the physical exam for skin cancer screening. What is the significance of the acronym ABCDE?  Adnexal Disease (Chapter 41) Epidermis has appendages known as adnexal structures that involve a complex of folliculosebaceous-apocrine units and eccrine glands that have their own distinct developments. Injury or disease associated with these structures is considered adnexal disease. Acne vulgaris—Most common dermatologic condition in the United States Prolonged acne and scarring may lead to low self esteem, social isolation, anxiety, depression, suicidal ideation. Rosacea—Persistent facial erythema but can have additional findings including inflammatory papules and pustules, flushing, edema, ocular inflammation, and more. Perioral dermatitis—Superficial monomorphous pustules on an erythematous base, sometimes with scale, around the mouth Folliculitis—Inflammation of the hair follicles Hidradenitis suppurativa—Chronic inflammatory disease of the hair follicle leading to recurrent abscess formation Hyperhidrosis—Excessive sweat production  Alopecia (Chapter 42) Alopecia—Abnormal hair loss Anagen phase disturbances Most common type—Hereditary thinning of hair in susceptible men and women and is related to an androgen receptor variation Types—Androgenetic alopecia, anagen effluvium, and alopecia areata Telogen phase disturbances Triggered by high fever, certain medications, endocrine abnormalities, anemia, childbirth, and malnutrition; can cause telogen effluvium hair loss Treatments Refer to dermatology or surgery to evaluate for hair transplant. Mental health referral for trichotillomania may benefit from SSRI. Ultraviolet B-light Pharmacologic management Minoxidil (Rogaine)—The only medication approved for women Finasteride (Propecia)—Pregnancy category X Cyclosporine, and topical and intralesional corticosteroids  Discussion Question 2 Discuss available treatment options for alopecia. What treatments are available for women with alopecia?  Burns (Minor) (Chapter 46) Disruption in barrier function resulting from trauma from electrical, thermal, or chemical agents Clinicians more commonly define burns by partial-thickness or full-thickness depth of injury. Nonprofessionals refer to depth of injury as first, second, and third degree. Severity, extent, and location of the burn guide the clinician's decisions for patient management. The American Burn Association classifies burn risk levels as major/high, moderate, and minor/low. Referral to burn center based on burn depth and percentage of total body surface area; burns that cause respiratory injury (inhalation or facial burns); burns of the hands, feet, genitals, or perianal area; full-thickness burns of more than 2% of the total body surface area (TBSA). Burns that take longer than 2 weeks to heal should be referred to a specialist.  Discussion Question 3 Discuss why it is important to educate patients and families about home safety. What are the safety items that should be discussed?  Eczematous Dermatitis (Chapter 48) A pruritic inflammatory skin disorder characterized by exacerbations and remissions of dry, itchy red skin Leads to lichenification if left untreated Non-pharmacologic management Patient education, rubbing and scratching exacerbate condition. Goal of management and treatment is to control pruritis. Moisturization for dryness and control of inflammation Pharmacologic management Antihistamines (pruritus management) diphenhydramine (Benadryl) and hydroxyzine (Atarax) are the drugs of choice. Nonsedating antihistamines such as cetirizine (Zyrtec) and loratadine (Claritin) Hydrocortisone ointment 1% (Cortaid) Nonsteroidal calcineurin inhibitor topical medications Systemic and topical antibiotics for infection Hydration—Tepid bath followed by application of bland emollient such as hydrated petrolatum or Aquaphor Referral to dermatology for failure to respond to topical treatments  Infections and Infestations (Chapter 49) Bacterial Fungal Cellulitis Tinea infections of the skin Erysipelas Tinea versicolor Impetigo Candidiasis Erythrasma Viral Intertrigo Herpes simplex Infestations Herpes zoster (Shingles) Lice Molluscum contagiosum Scabies Viral exanthem Verruca  Nail Disorders (Chapter 50) Herpetic whitlow Self-limited viral infection of the area between the fascial planes of the distal finger, usually surrounding the nail Paronychial infections Acute or chronic inflammation of the tissue surrounding the nail Onychomycosis Infection of the nails caused by a dermatophyte, yeast, or sometimes mold Nail changes Nail changes always warrant investigation, may indicate serious disease  Maculopapular Skin Disorders (Chapter 51) Seborrheic dermatitis—Greasy, slightly erythematous scaling that occurs in areas with the highest concentration of sweat glands or sebaceous glands, including the scalp, face, and postauricular and intertriginous areas Treatment—Topical antifungals or topical corticosteroids, antiseborrheic shampoos Psoriasis—Inflammatory papulosquamous eruption characterized by well-circumscribed erythematous macular and papular lesions with loosely adherent silvery white scale Treatment—Topical corticosteroids, oral retinoids, methotrexate, cyclosporine, biologic agents Pityriasis rosea—Mild and self-limiting disorder Treatment—Calamine lotion, antihistamines, consider acyclovir for 1 week Lichen planus—Chronic, maculopapular skin disorder, very pruritic Treatment—Antihistamines, intralesional Kenalog injections, topical corticosteroids, calcineurin inhibitors, oral prednisone, lidocaine mouthwash