NR511 Midterm Study Guide
Dermatology
1. Actinic keratosis most common precancerous skin lesion in light
skinned patients, more common in patients 50 years or older (most
common in Celtic, Irish, and Scottish descent)
Found in sun exposed areas
Caused by skin cells that accumulate from repeated sun exposure
Pathophys: continued sun damage from UV radiation damages the
DNA in epithelial cells
Primary lesions: macules or plaques, poorly circumscribed
Secondary lesion: erythematous and scaly
(May feel like sandpaper when touched)
Not an aggressive form of cancer if/when it changes to squamous
cell unless on the lip
Patient complaints subjective: irritated, rough or scaly rash, pruritus,
tenderness or stinging sensation
Objective findings: reddened, scaly, rough, or uneven surfaces. Hard or
spiny lesion. Sandpaper like texture.
Diagnostic tests: fluorescence using photosensitizing drug (methyl ester
of 5-aminolevulinic acid) over area of concern will have a pink
fluorescence with the wood’s lamp
Treatment: no evidence to support removal of lesion as most will not
turn cancerous however it is standard to REMOVE the lesion(s)
,Topical Therapy:
5-fluorouracil (5-FU) cream (Efudex, Carac) applied in a thin layer
over the lesion BID for 3 weeks, avoid eyelids, lips, and folds of
the nose. This treatment causes red, raw, and painful skin in the
areas applied which may lead to noncompliance. Exposure to
sunlight makes this worse
Imiquimod 5% cream used for face and scalp lesions.
Applied 3x weekly for 8 weeks.
Diclofenac 3% in 2.5% hyaluranon gell (Solaraza) applied
BIF for 60 to 90 days
Adapalene 0.1%to 0.3% (topical retinoid)applied daily for 4
weeks and then increased to BID
Side effects of these treatments include redness, itching, rash,
and dry skin
Topical chemotherapy combined with phototherapy with blue or
red wavelength have better cosmetic results than cryosurgery. 2
day course
Cryosurgery tissue is destroyed by freezing using liquid nitrogen.
Hypopigmentation may occur at site of previous lesion
Surgical curettage or shave excision are not considered first line
treatments for actinic keratosis
Surgical biopsy is the only way to obtain an intact sample to be analyzed
as a way to confirm diagnosis
If treatment does not work no matter the choice always refer to
dermatologist
,Education is centered around prevention, avoidance of excessive sun
exposure, use of protective clothing, and use of sunscreen.
Should teach patients ABCDE mnemonic
A= asymmetry
B= border irregularity
C= color change
D= Diameter larger than a pencil eraser
E= elevation from a flat lesion to a raised or evolving lesion
2. Dermatitis
DERMATITIS
ATOPIC DERMATITIS
• Atopic dermatitis (eczema) is not considered a distinct disease
entity but is a descriptive term for a group of skin disorders
characterized by pruritus and inflammation, whose distinct cause is
unknown. • Eczemais a more general term that is often used
collectively to describe skin of an erythematous and inflamed
appearance, reflective of a superficial pathological process. Currently,
the terms eczema and dermatitisare often used synonymously in the
clinical arena in a nonspecific sense.
• The use of the term eczematous rash, although also indistinct, may
be helpful both diagnostically and therapeutically, because eczematous
dermatitis may be classified into two major etiological categories—
contact dermatitis and atopic dermatitis.
• Early in its presentation, atopic dermatitis is erythematous in
appearance, with papulovesicular lesions that ooze and crust. At its later
stages, the rash becomes a red-purple color, dries, and develops scaling
and lichenification, which is exacerbated by itching resulting from its
highly pruritic nature.
Epidemiology and Causes
, • Atopic dermatitis is a constitutional and inherited reaction, which
usually begins in infancy. • Children born to older women are more
likely to develop eczema than children born to younger women.
• Prevalence of atopic disease is now estimated at 1 in 18 or 5.5%,
which amounts to 15 million people in the United States. About 10% of
the U.S. population will have atopic dermatitis at some point in their
lifetime.
• Atopic dermatitis presents more severely in childhood. Onset
during the first year of life occurs in up to 50% of all patients; in 85%,
onset is before age 5 years. Up to 5% of all children are affected by
atopic dermatitis. Most cases (40%) resolve by adulthood, however. The
remainder of patients with atopic dermatitis are affected with a chronic
course of the disease that is characterized by acute exacerbation
(often during times of stress) and intermittent remissions.
• No ethnic predisposition has been found for atopic dermatitis, and
it occurs equally in both sexes. • The cause of atopic dermatitis is
unknown.
• Family history is positive for atopy in two-thirds of all cases.
Genetic predisposition may be the most important etiological factor in
all-atopic conditions. A personal or family history of all or part of the
“atopic triad”—asthma, allergic rhinitis, and eczema—is often
present.
• It has been proposed that individuals with any of these three
conditions have preferential production of allergen-specific
immunoglobulin E (IgE) and that the presence of such antibodies should
be a mandatory criterion for the diagnosis of atopic dermatitis. Such a
diagnostic test, however, only establishes the diagnosis of atopic
syndrome, not atopic dermatitis. Any patient with a history of hives
(urticaria), hay fever, or rashes should be considered to have an
atopic history.
Dermatology
1. Actinic keratosis most common precancerous skin lesion in light
skinned patients, more common in patients 50 years or older (most
common in Celtic, Irish, and Scottish descent)
Found in sun exposed areas
Caused by skin cells that accumulate from repeated sun exposure
Pathophys: continued sun damage from UV radiation damages the
DNA in epithelial cells
Primary lesions: macules or plaques, poorly circumscribed
Secondary lesion: erythematous and scaly
(May feel like sandpaper when touched)
Not an aggressive form of cancer if/when it changes to squamous
cell unless on the lip
Patient complaints subjective: irritated, rough or scaly rash, pruritus,
tenderness or stinging sensation
Objective findings: reddened, scaly, rough, or uneven surfaces. Hard or
spiny lesion. Sandpaper like texture.
Diagnostic tests: fluorescence using photosensitizing drug (methyl ester
of 5-aminolevulinic acid) over area of concern will have a pink
fluorescence with the wood’s lamp
Treatment: no evidence to support removal of lesion as most will not
turn cancerous however it is standard to REMOVE the lesion(s)
,Topical Therapy:
5-fluorouracil (5-FU) cream (Efudex, Carac) applied in a thin layer
over the lesion BID for 3 weeks, avoid eyelids, lips, and folds of
the nose. This treatment causes red, raw, and painful skin in the
areas applied which may lead to noncompliance. Exposure to
sunlight makes this worse
Imiquimod 5% cream used for face and scalp lesions.
Applied 3x weekly for 8 weeks.
Diclofenac 3% in 2.5% hyaluranon gell (Solaraza) applied
BIF for 60 to 90 days
Adapalene 0.1%to 0.3% (topical retinoid)applied daily for 4
weeks and then increased to BID
Side effects of these treatments include redness, itching, rash,
and dry skin
Topical chemotherapy combined with phototherapy with blue or
red wavelength have better cosmetic results than cryosurgery. 2
day course
Cryosurgery tissue is destroyed by freezing using liquid nitrogen.
Hypopigmentation may occur at site of previous lesion
Surgical curettage or shave excision are not considered first line
treatments for actinic keratosis
Surgical biopsy is the only way to obtain an intact sample to be analyzed
as a way to confirm diagnosis
If treatment does not work no matter the choice always refer to
dermatologist
,Education is centered around prevention, avoidance of excessive sun
exposure, use of protective clothing, and use of sunscreen.
Should teach patients ABCDE mnemonic
A= asymmetry
B= border irregularity
C= color change
D= Diameter larger than a pencil eraser
E= elevation from a flat lesion to a raised or evolving lesion
2. Dermatitis
DERMATITIS
ATOPIC DERMATITIS
• Atopic dermatitis (eczema) is not considered a distinct disease
entity but is a descriptive term for a group of skin disorders
characterized by pruritus and inflammation, whose distinct cause is
unknown. • Eczemais a more general term that is often used
collectively to describe skin of an erythematous and inflamed
appearance, reflective of a superficial pathological process. Currently,
the terms eczema and dermatitisare often used synonymously in the
clinical arena in a nonspecific sense.
• The use of the term eczematous rash, although also indistinct, may
be helpful both diagnostically and therapeutically, because eczematous
dermatitis may be classified into two major etiological categories—
contact dermatitis and atopic dermatitis.
• Early in its presentation, atopic dermatitis is erythematous in
appearance, with papulovesicular lesions that ooze and crust. At its later
stages, the rash becomes a red-purple color, dries, and develops scaling
and lichenification, which is exacerbated by itching resulting from its
highly pruritic nature.
Epidemiology and Causes
, • Atopic dermatitis is a constitutional and inherited reaction, which
usually begins in infancy. • Children born to older women are more
likely to develop eczema than children born to younger women.
• Prevalence of atopic disease is now estimated at 1 in 18 or 5.5%,
which amounts to 15 million people in the United States. About 10% of
the U.S. population will have atopic dermatitis at some point in their
lifetime.
• Atopic dermatitis presents more severely in childhood. Onset
during the first year of life occurs in up to 50% of all patients; in 85%,
onset is before age 5 years. Up to 5% of all children are affected by
atopic dermatitis. Most cases (40%) resolve by adulthood, however. The
remainder of patients with atopic dermatitis are affected with a chronic
course of the disease that is characterized by acute exacerbation
(often during times of stress) and intermittent remissions.
• No ethnic predisposition has been found for atopic dermatitis, and
it occurs equally in both sexes. • The cause of atopic dermatitis is
unknown.
• Family history is positive for atopy in two-thirds of all cases.
Genetic predisposition may be the most important etiological factor in
all-atopic conditions. A personal or family history of all or part of the
“atopic triad”—asthma, allergic rhinitis, and eczema—is often
present.
• It has been proposed that individuals with any of these three
conditions have preferential production of allergen-specific
immunoglobulin E (IgE) and that the presence of such antibodies should
be a mandatory criterion for the diagnosis of atopic dermatitis. Such a
diagnostic test, however, only establishes the diagnosis of atopic
syndrome, not atopic dermatitis. Any patient with a history of hives
(urticaria), hay fever, or rashes should be considered to have an
atopic history.
