FNP: Skin Review

7/25/2019 FNP: Skin Review

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Skin

1. Tinea versicolor is a common superfcial ungal inection o the skin,causing hypo or hyperpigmented (versicolor), slightly scaly maculeson the trunk, neck, and upper arms (short-sleeved shirt distriution).They are easier to see in darker skin and may e more ovious atertanning. !n lighter skin, macules may look reddish or tan instead o

pale.". Tinea corporis has annular lesions #ith central clearing and papules onthe orders. This is usually seen in children.

$. %itiligo may e&hiit depigmented macules appear on the ace, hands,eet, e&tensor suraces, and other regions' and may coalesce intoe&tensive areas that lack melanin.

- ereditary

. !chthyosis vulgaris is a skin disorder that causes thin *akes o deade&oliated epidermis.

+. elanoma-- dark, raised, asymmetric lesion #ith irregular orders maye a melanoma.

. s/uamous cell carcinoma has a raised, crusted order #ith centralulceration on the lesion. 0iopsy confrms the diagnosis.

- /uamous cell carcinoma appear on sun e&posed skin o airskinned adults over si&ty and look like scaly red patches, opensores, elevated gro#ths #ith a central depression, or #arts' theymay crust or leed.

2. 0asal call carcinoma can present as a red raised nodule #ith a lustroussurace and telangiectatic vessels #ith or #ithout ulceration. !t occursmore re/uently in air -skinned people #ho have een e&posed tolarge amounts o sun.

- asal call carcinoma o the eyelid is uncommon, it does occurmost oten on the lo#er lid and medial canthus. !t looks like apapule #ith an ulcerated center. etastasis is rare utshould e reerred or removal.

- 0asal cell carcinoma typically presents #ith an initial translucentnodule that spreads, leaving a depressed center, a frm elevatedorder, and visile telangiectatic vessels. They usually appear in

adults over orty and seldom metastasi3e.4. 5aposi6s sarcoma is seen in patients #ith !7 and appears in many

orms and on any part o the ody. The anormal cells orm purple, red,or ro#n lotches or tumors on the skin and can ecome liethreatening #hen the lesions are in the lungs, liver, or digestive tract.

8. cutaneous cyst is a enign, closed sac that lies in the dermis,orming a dome shaped lump.


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19. Tophi are identifed as deposits o uric acid crystals secondary togout and appear as hard nodules in the heli& or antiheli&.

11. :hondrodermatitis ;odularis elicus is a condition #ith painulnodules that develop on the rim o the heli& (#here there is no

sucutaneous tissue). This develops a result o repetitive mechanicalpressure or environmental trauma (sunlight). They are small,indurated, dull red, poorly defned, and painul.

1". !mpetigo usually appears as red crusty lesions on the ace,especially around a child6s nose and mouth. The lesions urst anddevelop honey-colored crusts.

1$. %aricella is characteristic o papules, vesicles, and crusted lesionsoccurring simultaneously.

1. erpes simple& on the lips and mouth appear as small vesicles orlisters and are termed


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kin

patches come rom lood that has leaked through poorly supportedcapillaries and spread #ithin the dermis.

"". >ichenifcation is thickening and roughening o the skin #ithincreased visiility o normal skin urro#s. !t can e seen in patients

#ith atopic dermatitis.

"$. nnular lesions are descried as circular lesions that egin in thecenter and spreads to the periphery as #ith tinea and ring#ormlesions.

". :on*uent lesions appear as i the lesions run together and arecharacteristic o hives.

"+. 7iscrete lesions appear as distinct, individual lesions that remainseparate as in acne.

". Target lesions resemle the iris o the eye and appear #ithconcentric rings o color in the lesions. These are seen in erythemamultiorme.

"2. 5oplik spots are seen #ith measles. They are small, #hite spots(oten on a reddened ackground) that occur on the inside o thecheeks early in the course o red measles, rueola.

"4. ?astia6s spots are pink or red lines that are ormed o con*uentpetechiae ound in skin creases and are seen in patients #ho have

scarlet ever.

"8. phthous ulcers are recurrent small, round, or ovoid ulcers #ithcircumscried margins, erythematous haloes, and yello# or gray *oorsoccurring in the mouth.

$9. kin that appears very dry, rough and cool to touch can eassociated #ith hypothyroidism.

$1. hyperthyroidism, the skin has a velvety appearance and isusually #arm to touch.

$". ?soriasis can present as silvery, scaly papules or pla/ues, mainly

on the e&tensor suraces o the skin.$$. cleroderma appears as skin that is thickened, taut, and shiny in

appearance.$. ddison6s 7isease-yperpigmentation o skin and mucous

memranes

$+. !7--airy leukoplakia

$


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kin

$. :ushing6s disease skin conditions@ striae, skin atrophy, purpura,ecchymosis, telangiectasias, acne, moon acies, uAalo hump, orhypertrichosis.

$2. ?allor, &erosis, pruritus, hyperpigmentation, uremic rost,calciphyla&is (calciphyla&is occurs #hen calcium accumulates in the

skin and small vessels o the skin and at tissue), hal and hal nails,are skin conditions #hich may e ound in patients #ith chronic renaldisease.


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kin

$4. 7iaetes may produce any o these skin conditions@ necroiosislipoidica diaeticorum, diaetic ullae, diaetic dermopathy,granuloma annulare, acanthosis nigricans, candidiasis,neuropathic ulcers, eruptive &anthomas, and peripheral vasculardisease.

$8. 9. =hiteheads are closed comedones1. 0lackheads are open comedones". ?ustules are skin lesions #ith pus$. :ysts are *uid-flled skin lesions. 0oils BurunclesC- are painul inections that develop #ithin hair

ollicles. They usually egin as papules on the skin, then develop a#hite or sot center.

+. 0listers BvesiclesC-- small lesions flled #ith clear *uid.. ole (nevusDnevi) is a pigmented area on the epidermis.2. Elcer@ occurs on the skin or a mucous memrane accompanied

y the disintegration o tissue.

4. ?soriasis is scaly, commonly erythematous, and presents #ithsilvery scales, n alternative presentation o psoriasis is plagues.

8.+9. n allergic reaction to something usually presents #ith a

generali3ed rash that resemles hives' erythematous and symmetricrash.

+1. :ontact dermatitis is associated #ith a reaction in the area thatthe oFect touched. Grythema ecomes evident initially, ollo#ed y

s#elling, #heals (or urticaria), or maculopapular vesicles, scales. Thisis oten accompanied y intense pruritus.

+".+$. topic dermatitis presents #ith erythematous papules and

vesicles, #ith #eeping, oo3ing, and crusts. >esions usually appear incharacteristic areas@ the scalp, orehead, cheeks, orearms and #rists,elo#s, and acks o knees. ?aro&ysmal and severe pruritus can epresent. There is usually a amily andDor personal history o allergies.- ?ritority intervention or child #ith atropic dermatitis is relive itching.0y relieving pruritus, itching is eased and this helps decreasescratching ehaviors #hich can increase risk o inection. This is the

maFor intervention. The others are helpul ut not priority. The key isto keep the lesions moist as dryness #ill lead to itching and scratchingand the potential or inection, especially in the case o impetigo.

+


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+. 0eau6s lines are deep grooved lines that run rom side to side onthe fngernail. They appear as transverse depressions o the nailplates, usually ilateral, resulting rom temporary disruption opro&imal nail gro#th rom systemic illness, such as severe illness, coldstress in the presence o Heynaud6s disease, and trauma.

++. Terry6s nails, the nail plate turns #hite #ith a ground-glassappearance, a distal and o reddish ro#n, and oliteration o thelunula.

+. ees6 lines present as curving transverse #hite ands that crossthe nail parallel to the lunula. They arise rom the disrupted matri& othe pro&imal nail, vary in #idth, and move distally as the nail gro#sout. These lines are seen in arsenic poisoning, heart ailure, odgkinIsdisease, chemotherapy, caron mono&ide poisoning, and leprosy.

+2. ?itting nails present as punctate depressions o the nail platecaused y deective layering o the superfcial nail plate y thepro&imal nail matri&. They may e associated #ith psoriasis, ut also

seen in HeiterIs syndrome, sarcoidosis, alopecia areata, and locali3edatopic or chemical dermatitis.+4. ?aronychia is red, s#ollen, tender in*ammation o the nail olds.

cute paronychia is usually secondary to a acterial inection. :hronicparonychia is oten secondary to a ungal inection rom a reak in thecuticle in those #ho perorm #et #ork.

+8. Jnychomycosis is a slo#, persistent ungal inection ofngernails and toenails causing change in color, te&ture, andthickness. Jnycholysis- separation o the nail plate rom the nail ed Kthe nail may crumle or reak #ith loosening o the nail plate, usuallyeginning at the distal edge and progressing pro&imally.

9. >eukonychia is a #hite discoloration appearing on nails. The mostcommon cause is inFury to the ase o the nail (the matri&) #here thenail is ormed. ?soriasis o the nails may appear as small pits in thenails.


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1. ?HGEHG E>:GH@- tage !@ !ntact skin #ith non-lanchale redness o a locali3ed

area usually over a ony prominence. The area may e painul,frm, sot, #armer or cooler as compared to adFacent tissue.

- tage !!@ ?artial thickness loss o dermis presenting as a shallo#

open ulcer #ith a red pink #ound ed, #ithout slough. ay alsopresent as an intact or openDruptured serum-flled lister.- tage !!!@ Lull thickness tissue loss and sucutaneous at may e

visile ut one, tendon or muscle are not e&posed. lough maye present ut does not oscure the depth o tissue loss and thedepth varies y anatomical location.

- tage !%@ Lull thickness tissue loss #ith e&posed one, tendon ormuscle. lough or eschar may e present on some parts o the#ound ed. The depth varies y anatomical location.

". 7acryocystitis is an inection and lockage o the lacrimal sacand duct.

$. ordeolum is oten secondary to locali3ed staphylococcalinection o the hair ollicles at the lid margin.

. :hala3ion is a eady nodule protruding on the lid.

+. ?hysiologic changes o aging include loss o elastic turgor, and#rinkling.

- kin that appears dry, *aky, rough, and itchy is termed

asteatosis. un e&posure can cause damage to the skinresemling an appearance as #eather eaten, thickened,yello#ed, and deeply urro#ed.

- eorrheic keratoses appear as raised, yello#ish lesions that eelgreasy, velvety, or #arty.

- ?ainul vesicular lesions in a dermatomal distriution maysuggest herpes 3oster.

. The ;ational elanomaDkin :ancer creening ?rogram o themerican cademy o 7ermatology validates the H model ordesignating risk actors or melanoma. - history, - age, H - regular

dermatologist asent, -mole changing, and - male gender.- 0:7G nomenclature is the method used in recogni3ing

characteristics o possile melanomas. - asymmetry, 0 -orders, : - color, 7 - diameter, and G - evolution.

- 0:HT is the 0reast :ancer Hisk ssessment Tool.- The ;ational ealth and ;utrition G&amination urvey (;;G)

is used to predict diaetes prevalence.


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kin

2. chancre is defned as a painless ulceration ormed during theprimary stages o syphilis.

- group o scattered small vesicles is associated #ith genitalherpes.

- ?apules appearing in many shapes that can e raised, *at, or

cauli*o#er-like are characteristic o genital #arts (condylomataacuminata).- ;on-tender indurated nodules are associated #ith carcinoma o

the penis.4. Gcchymoses in the elderly is not a sign o aging and should e

evaluated or inFury or ause.- 0ro#n macular spots, age spots, on the hands are related to sun

e&posure.- eorrheic keratoses are thickened lesions on the skin that range

rom tan to ro#n to lack #ith a clear order and develop onthe trunk ut can also occur on the hands, eet, ace, and scalp

and are not considered harmul.- :herry angiomas are a common type o skin lesion that frstoccurs in early adulthood and continues #ith age. These roundlesions typically develop on the trunk, hands, and eet. Theyrange rom right to dark red and are asymptomatic #ith noreported clinical conse/uences.

8. 0EH;@- Types o urn inFuries are chemical, electric, radiation, or thermal

and are classifed y the depth o damaged skin.- uperfcial thickness urns appear erythematous #ithout listers

and usually have local pain. superfcial thickness urn involvesthe epidermis only.

- uperfcial partial thickness urns include@ moist areas that arered to ivory #hite in color, listers orming almost immediately,and painul to touch. ince the pain receptors are intact, pain isperceived. superfcial partial thickness urn involves theepidermis and the dermis.

- 7eep partial thickness urns have a dry #a&y, #hitishappearance and resemle ull thickness urns. ometimes gratsare needed. deep thickness urn involves the entire layer odermis, and is more severe than a superfcial partial thickness

urn.- Lull thickness urns involve the destruction o all skin elements

#ith coagulation o sudermal ple&us, muscle, and or tendons. ull-thickness urn involves all skin layers, including theepidermis, dermis, and the sucutaneous tissue and at. usclesand tendons may e involved.

- The


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percentages are as ollo#s@ head and neck M 14N, anterior andposterior chest M 14N each, arms (anterior and posterior) M.+N each, legs (anterior and posterior) M .2N each, andperineum M 1N. Lor this e&ample, 14N or posterior trunk plus8N or arms M "2N.

29. 7ark-colored adherent crust o dead tissue ound on some ulcersis reerred to as eschar.

- Grythroderma occurs #hen a skin condition aAects the #holeody or nearly the #hole ody, resulting in a red appearance allover.

- n e&coriation is a scratch mark or surace inFury penetrating thedermis.

- G&oliation reers to peeling skin.21. kin that is edematous, erythematous, tender, and #arm to

touch is consistent #ith cellulitis.

- Grythema multiorm may appear as a nodule, papule, or maculeor may look like hives. They may have listers or vesicles andhave a central sore surrounded y pale red rings, also called a


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red or purplish patch covering the scalp or ace, re/uently along thedistriution o cranial nerve % and intensifes #ith crying, e&ertion, ore&posure to heat or cold. stra#erry mark is a type o hemangiomathat has a raised right red area #ith #ell-defned orders aout " to$ cm in diameter. !t does not lanch #ith pressure. Telangiectasia are

caused y vascular dilation and are permanently dilated lood vesselsthat are visile on the skin surace.2+. Gcchymosis is purple or luish purple area that ades to green,

yello#, and ro#n #ith time. !t is generally larger than petechia andcan e round, oval or take on an irregular shape. !t does not lanch#ith pressure and does not pulsate. These lesions are termed ruisesand occur secondary to trauma. ?etechia and purpura are deep red orreddish purple and ade #ith time. spider vein is luish in color and ismostly seen on the legs near veins.

2. spider angioma is fery red, slightly raised and surrounded yerythema and radiating legs that lanch #ith pressure. These are

usually seen in patients #ith liver disease, pregnancy, vitamin 0defciency, and sometimes patients #ith no disease. The spider vein islue. :herry angiomas are right or ruy red and increase in si3e andnumer as one ages. ?etechiae are deep red or reddish purple and areseen #hen lood is outside the vessels. This suggests a leedingdisorder or inFury to the skin.

22. Huor is a term used to descrie the response o the skin toin*ammation. kin that appears dusky red is ruor.

24. dysplastic nevus is a type o mole that looks diAerent rom acommon mole. !t may e igger than a common mole, and its color,surace, and order may e diAerent. !t is usually more than +

millimeters #ide and can have a mi&ture o several colors, rom pink todark ro#n. Esually, it is *at #ith a smooth, slightly scaly, or pelysurace, and it has an irregular edge that may ade into thesurrounding skin.

- 0asal cell carcinoma usually arises in sun-e&posed areas andclassically appears as pearly, erythematous, translucent papules,ut may also e sutle red macules or e&hiit othermorphologies.

- /uamous cell carcinoma are crusted hyperkeratotic lesions #itha rough surace or *at, reddish patches #ith an in*amed orulcerated appearance.

- elanomas arise rom the pigment-producing melanocytes in theepidermis. These melanocytes give skin its color and appear asdark, raised, asymmetric lesions #ith irregular orders.

28. Jnychomycosis is a slo#, persistent ungal inection ofngernails and toenails causing change in color, te&ture, andthickness. The nail may crumle or reak #ith loosening o the nailplate, usually eginning at the distal edge and progressing pro&imally.>eukonychia is a #hite discoloration appearing on nails. The most


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common cause is inFury to the ase o the nail (the matri&) #here thenail is ormed. ?soriasis o the nails may appear as small pits in thenail. ?aronychia is red, s#ollen, tender in*ammation o the nail olds.

49. pediculosis puis (lice or cras)-- G&coriations or itchy, small,red maculopapular.

41. circumscried superfcial elevation o the skin ormed y ree*uid in a cavity #ithin the skin layers are classifed as three diAerentlesions@ a vesicle, flled #ith serous *uid and up to 1 cm.' a ulla, flled#ith serous *uid and measures greater than 1 cm.' and a pustule, flled#ith pus. %aricella and herpes simple& are e&amples o vesicles.econd degree urns are e&amples o a ulla. cne and impetigo aree&amples o pustules. ?soriasis and athlete6s oot are e&amples o ascale type lesion.

4". >ichenifcation is defned as the thickening and roughening o theskin #ith increased visiility o the normal skin urro#s (numerousgrooves o variale depth on the surace o the epidermis). trophy is

thinning o the skin #ith loss o normal skin urro#s. G&coriation o theskin is an arasion or scratch mark. The urro# o a scaies lesionincludes small papules, pustules, lichenifed areas and e&coriations.

FNP: Skin Review

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