phrm 826 lecture _ skin hair nails part i (1)
TRANSCRIPT
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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
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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.
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WHAT IS THIS?
Which of the following is a picture of poison ivy dermatitis?
A B C
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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
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IRRITANT CONTACT DERMATITIS
Acute ICD
Chronic ICD
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IRRITANT CONTACT DERMATITIS
“New Shirt” ICD
“Lip Lickers” ICD
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ALLERGIC CONTACT DERMATITIS
ACD: Nickel
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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
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HOW DO I GET RID OF THIS?
Which of the following would not require medical referral?
A B C
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ACNE
• androgenic hormones
• increased sebum production
• follicle growth
• Propionibacterium acnes
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ACNE
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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
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ACNE
• Type 1: Open Comedones Only
• Type 1: Closed Comedones Only
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ACNE
• Type 2 Acne • Type 3 Acne
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ACNE
• Type 4 Acne • Type 4 Acne
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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.
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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
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FUNGAL SKIN INFECTIONS
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FUNGAL SKIN INFECTIONS
• Risk Factors
• Immunosuppression
• History of atopic dermatitis
• Warm, humid climates
• Occlusive clothing and footwear
• Obesity
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FUNGAL SKIN INFECTIONS
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FUNGAL SKIN INFECTIONS
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FUNGAL SKIN INFECTIONS
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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
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FUNGAL SKIN INFECTIONS
• Referral
• Scalp involvement
• Nail involvement
• Immune suppression
• Multiple diseases
• Diabetes
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HOW DO I GET RID OF THIS?
Which of the following would not require medical referral?
A B C
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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.
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PEDICULOSIS
• Risk Factors
• Close physical contact
• Sharing infested combs, hats, clothing, bedding, etc.
• Multiple sexual partners
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PEDICULOSIS
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PEDICULOSIS
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PEDICULOSIS
• Treatment
• Pediculocides
• Total nit removal
• Environmental Decontamination
• Prevention
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PEDICULOSIS
• Referral
• Eyelash involvement
• > 2 treatment failures
• Evidence of secondary infection
• Systemic symptoms
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WHAT ABOUT MY BABIES?
•Household pets with fur must also be treated with lice.
A. True
B. False
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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.
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SKIN CANCER
• Risk Factors• Fair skin
• History of sunburn
• Excessive UV exposure
• Presence of moles
• Family History
• Personal History
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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
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SKIN CANCER
BCC BCC
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SKIN CANCER
• SCC may appear as a
• firm, red nodule.
• flat lesion with a scaly, crusted surface.
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SKIN CANCER
SCC SCC
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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.
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“ABCDE” Rule for Skin Cancer