N202 Skin, Hair Nails pg 5-9
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If any lesions are present note....
- Color- skin tone, white, black, blue etc..
- Elevation- flat, raised, predunculated (stalk- such as a skin tag)
- Configuration- shape or pattern
- Size- metric (mm, cm)
- Number- 1 or numerous
- Location- (body part) & distribution (localized vers generalized)
- Discharge or exudate ( describe color, odor)
A primary lesion is....
- A lesion that develops on previously normal structures
- It is the initial lesion
A secondary lesion is......
- A lesion that changes over time because of a factor such as scratching or infection.
- Results from changes in the primary lesion
Name the primary lesions?
- Flat lesions: Macule, Patch
- Raised lesions: Papule, Plaques, Nodule, Tumor, Wheal, Urticaria
- Fluid Filled lesions: Vesicle, Bulla, Pustule, Cyst
What are the two types of Flat lesions?
Macule: flat circumscribed, discolored, less than 1cm. (ex freckles, nevi, solar lentigens "liver spots", petechia
Patch: flat, irregular, larger than 1cm (ex vitiligo, Mongolian spots, cafe au lait spot, measle rash)
What are the 6 types of raised lesions?
- Papule: solid, elevated, circumscribed, less than 1cm. (ex elevated nevus, wart (verrucal))
- Plaques: coalesced papules greater than 1cm (ex psoriasis)
- Nodule: solid, elevated, 1-2cm (lipoma = fatty growth)
- Tumor: larger than a few cm, firm or soft (lipoma)
- Wheal: Superficial, raised, erythematous, irregular ( allergic rxn, PPD, mosquito bite)-causes interstiial edema
- Urticaria: (hives) wheals coalesce (or grow together) to form extensive rxn, intensive allergic rxn
What are the 4 types of Fluid filled lesions?
- Vesicle: elevated cavity with clear fluid, up to 1cm. (ex herpes simplex, varicella (chix pox), herpes zoster (shingles), contact dermatitis (posion ivy)
- Bulla: elevated cavity with fluid, larger than 1cm (blister, burns)
- Pustule: contains pus, filled with leukocytes (ex acne, impetigo)
- Cyst: encapsulated fluid filled cavity in dermis or sub-q (ex sebaceous cyst), elevates skin
What are the 8 secondary lesions?
- Crust: Thickened dry exudate (dried serum/blood/pus) on top of primary lesion (scab) (ex. rupture of herpes vesicles results from crust with erythematous base, impetigo (staph & strep))
- Scale: compact flakes of skin ( ex. psoriasis (white-silvery), seborrheic dermatitis (yellow-greasy), seborrhea (dandruff))
- Fissure: linear crack (cheilosis (corners of mouth), callused heels, tinea pedis (athletes foot)-between toes)
- Erosion: shallow depression, moist, no bleeding, no scar (effects epidermis, varicella rupture)
- Ulcer: deep depression into dermis, leaves scar (stasis ulcer, pressure sore)
- Excoriation: superficial abrasion (dermatitis) -red open sores
- Scar: conncetive tissue replacing normal tissue (two types: atrophic & hypertrophic)
- Lichenification: thickening of skin (eczema (atopic dermatitis), chronic sun exposure)
A scar is a secondary lesion, there are two types of scars we learned about, what are they and give examples.
- Atrophic: depressed scar - stretch marks (striae)
- Hypertrophic: excess scar tissue secondary to increased collagen formation (keloid)
What is an annular pattern?
- Ring, clear center
- An ex is tinea corporus (ring worm), pityriasis rosea
What is a semiannular pattern?
What is a discrete pattern?
What is an confluent pattern?
lesions run together (urticaria or hives)
What is a grouped pattern?
- clusters of lesions
- ex vesicles of contact dermatitis
What is a gyrate pattern?
coiled, spiral, snake like
What is a Iris or target pattern?
- solid center, like a bulls eye
- ex. erythema multiform
What is a linear pattern?
scratch, streak, line or stripe
What is a webb pattern?
like lace pattern (mottled appearance) ex sitting in the hot tub too long
What is a zosteriform pattern?
- Linear vesicles along a nerve route
- ex. shingles (herpes zoster)
- Vaccine available to prevent shingles for 60 years and older
What is a Wood's light and what so you use it for?
- An ultraviolet light filtered through a special glass
- Use it to detect fluorescing lesions
- Coral red color = bacterial
- Blue/ green color = fungal
What is the KOH test and what does it find?
- It is a microscopic examination of skin scrapings, it helps diagnose superficial fungal infections.
- Use sharp sterile blade and lightly scrape the scale from edge of the lesion
- Place on clean slide
- Add a drop of KOH
- Fungal infection can be seen under microscope
What is tinea corporis?
Ringworm, It is a fungal infection
What is tinea cruris?
Jock itch - often spread from feet (put socks on before pants)
What is tinea pedis?
What is tinea capitus?
- Fungal scalp infection
- ex cradle cap
What is malignant melanoma?
- Most deadly cancer
- Highly metastatic
- Grows deep, not wide
- 1/2 rise from pre-existing nevi
- High risk (fair skin, sun exposure)
- Use the ABCD for characteristics
What are the danger signs (abnormal characteristics of lesions ABCDE's)?
- Asymmetry: not regularly round or oval, ragged edges or poorly defined margins
- Border: irregularity (notching, scalloping, ragged edges or poorly defined margins)
- Color: variations (areas of brown, tan, black, blue, red, white or combination)
- Diameter: greater than 6mm (the size of pencil eraser)
- Elevation and Enlargement
What is basal cell cancer?
- Also called BCC
- Most common skin cancer
- grows slowly, seldom metastasizes
- usually appears on face (most common in fair skin older than 40 yrs
- Usually starts as skin colored papule/nodule with overlying telangicetasia(small dilated blood vessels)
- May develop a depressed center
What is squamous cell cancer?
- Also known as SCC
- Grows rapidly
- Usually appears on hands or head (sun exposed areas, usually older than 60 yrs
- Erythematous scaly patch 1cm or more
- Develops central ulcer
What is actinc keratosis?
- Also called AK
- pink, scaly papules- may be precursor to SCC
What is an open comedone?
blackheads, very common in adolescents
What is are closed comedones?
White heads, common in adolescents
What are seborrheic keratosis?
- Raised, crusty, irregular lesions. Look "stuck on" sometimes waxy, non cancerous located on trunk, face, hands (genetic)
- Common in the aging adult
What is a leukonychia striata?
White hairline markings from trauma or picking at cuticle (normally found)
What is the normal nail angle?
160 or less
What is clubbing?
- Nail straighten out to greater than 180 and nail bed becomes spongy
- Related to chronic hypoxia- COPD, Lung CA, CHD
What is splinter hemorrhages?
- 4-5 reddish-brown streaks in nail
- Indicates bacterial endo carditis, trauma
What is Koilonychia?
- Spoon nails/ concave
- Iron deficiency anemia
What is Paronychia?
Inflammation/infection of skin around nail bed
What is Onycholysis?
Loosening of nail plate (fungal infection)
If you see pitting in the nails this could be a sign of what?
What is a subungual hematoma of the nail?
- bleeding under the nail plate, painful, may need to be drained by drilling a hole to release pressure
- ex car door slam
How does one get an ingrown nail?
- Cuts the nail at an angle
- Diabetes patients are at risk for infection
What is Habit-tic deformity?
Picking at nail with index finger
What is a normal capillary refill?
- less that 2 sec
- If more than 2 sec this could mean altered peripheral circulation
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