Post on 30-Oct-2014
G a i l D . N e w t o n , P h . D . , R . P h .
ASSESSMENT OF COMMON SKIN, HAIR, AND NAIL DISORDERS
LECTURE OBJECTIVES
• Recognize the signs and symptoms of common dermatological disorders.
• Identify the causes of common dermatological problems.
• Recognize dermatological signs and symptoms that warrant referral to a primary care provider.
• Given a case, determine the most likely cause of the patient’s dermatological problem.
• Given a case, determine whether or not a patient’s dermatological condition warrants referral to a primary care provider.
WHAT IS THIS?
Which of the following is a picture of poison ivy dermatitis?
A B C
CONTACT DERMATITIS
• Defined as skin eruptions that develop as a result of a substance coming into contact with the skin
• Irritant contact dermatitis (ICD) is secondary to exposure to soaps, detergents and organic compounds.
• Allergic contact dermatitis (ACD) is secondary to exposure to any substance that triggers an allergic response such as plant resins, latex and certain metals
IRRITANT CONTACT DERMATITIS
Acute ICD
Chronic ICD
IRRITANT CONTACT DERMATITIS
“New Shirt” ICD
“Lip Lickers” ICD
ALLERGIC CONTACT DERMATITIS
ACD: Nickel
CONTACT DERMATITIS
• Treatment
• Avoidance
• Antihistamines
• Topical Steroids
• Oral Steroids
• Topical Astringents
• Topical Protectants
• Referral
• Signs of Infection
• Large Area of Involvement
• Interference With Activities of Daily Living
• Extensive Swelling
HOW DO I GET RID OF THIS?
Which of the following would not require medical referral?
A B C
ACNE
• androgenic hormones
• increased sebum production
• follicle growth
• Propionibacterium acnes
ACNE
ACNE
Type 1 Comedones only; <10 lesions on the face; no lesions on the trunk; no scarring
Self-treatment
Benzoyl peroxide Salicylic acid Sulfur/resorcinol Azelaic acid Tretinoin
Type 2 Papules; 10-25 lesions on face and trunk; mild scarring
Refer to physician
Topical antibiotics
Type 3 Pustules; >25 lesions; moderate scarring
Refer to physician
Oral antibiotics Topical therapy
Type 4 Nodules or cysts; extensive scarring
Refer to physician
Isotretinoin Systemic hormones
Treatment
ACNE
• Type 1: Open Comedones Only
• Type 1: Closed Comedones Only
ACNE
• Type 2 Acne • Type 3 Acne
ACNE
• Type 4 Acne • Type 4 Acne
FUNGAL SKIN INFECTIONS
• Dermatophytoses are the most common disorders of the skin.
• The most common causes are Epidermophyton, Microsporum and Trichophyton Species.
• These may be transmitted from fomites, animals and the soil.
• The three most common types of dermatophytosis are tinea pedis, tinea corporis, and tinea cruris.
FUNGAL SKIN INFECTIONS
• Require a warm moist environment and an avenue into the stratum corneum
• Presentation is different depending upon the dermatophye and infection site
FUNGAL SKIN INFECTIONS
FUNGAL SKIN INFECTIONS
• Risk Factors
• Immunosuppression
• History of atopic dermatitis
• Warm, humid climates
• Occlusive clothing and footwear
• Obesity
FUNGAL SKIN INFECTIONS
FUNGAL SKIN INFECTIONS
FUNGAL SKIN INFECTIONS
FUNGAL SKIN INFECTIONS
• Treatment
• Astringents
• Antifungals
• Clean, dry clothing
• Prevention
• Referral
• Signs of Infection
• Large Area of Involvement
• Interference With Activities of Daily Living
• Extensive Swelling
FUNGAL SKIN INFECTIONS
• Referral
• Scalp involvement
• Nail involvement
• Immune suppression
• Multiple diseases
• Diabetes
HOW DO I GET RID OF THIS?
Which of the following would not require medical referral?
A B C
PEDICULOSIS
• Pediculosis refers to louse-borne infestations.
• There are three types of lice that are common in the US.
• Head lice (pediculosis capitis)
• Body lice (pediculosis corporis)
• Pubic lice (pediculosis pubis)
• Pubic lice can also infest other hairy areas such as the eyelashes and axilla.
• Body lice infestations can be eradicated without drug therapy.
PEDICULOSIS
• Risk Factors
• Close physical contact
• Sharing infested combs, hats, clothing, bedding, etc.
• Multiple sexual partners
PEDICULOSIS
PEDICULOSIS
PEDICULOSIS
• Treatment
• Pediculocides
• Total nit removal
• Environmental Decontamination
• Prevention
PEDICULOSIS
• Referral
• Eyelash involvement
• > 2 treatment failures
• Evidence of secondary infection
• Systemic symptoms
WHAT ABOUT MY BABIES?
•Household pets with fur must also be treated with lice.
A. True
B. False
SKIN CANCER
• There are three types of skin cancer that are common in the US.
• Basal Cell Carcinoma (BCC)
• Squamous Cell Carcinoma (SCC)
• Melanoma
• The American Cancer Society estimates that 850,000 cases of BCC, 250,000 cases of SCC and 60,000 cases of melanoma are diagnosed annually.
SKIN CANCER
• Risk Factors• Fair skin
• History of sunburn
• Excessive UV exposure
• Presence of moles
• Family History
• Personal History
SKIN CANCER
• BCC may appear as a
• pearly or waxy bump
• flat, flesh-colored or brown scar-like lesion
• single ulceration with a rolled border
SKIN CANCER
BCC BCC
SKIN CANCER
• SCC may appear as a
• firm, red nodule.
• flat lesion with a scaly, crusted surface.
SKIN CANCER
SCC SCC
SKIN CANCER
• Melanoma signs include(a)
• large brownish spot with darker speckles
• mole that changes in color, size or feel or that bleeds.
• small lesion with an irregular border and portions that appear red, white, blue or blue-black.
• dark lesions on the palms, soles, fingertips or toes, or on mucous membranes lining the mouth, nose, vagina or anus.
“ABCDE” Rule for Skin Cancer