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Examination of Skin andExamination of Skin andDermatologic TherapyDermatologic Therapy
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Module InstructionsModule Instructions
The following module contains hyperlinkedThe following module contains hyperlinked
information which serves to offer moreinformation which serves to offer moreinformation on topics you may or may not beinformation on topics you may or may not be
familiar with. We encourage that you read allfamiliar with. We encourage that you read all
the hyperlinked information.the hyperlinked information.
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Examination of SkinExamination of Skin
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Components of Dermatological EvaluationComponents of Dermatological Evaluation
History (Subjective)History (Subjective)
Physical Examination (Objective)Physical Examination (Objective)
Diagnosis (Assessment)Diagnosis (Assessment)
PlanPlan
SOAPSOAP notenote
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History ComponentsHistory Components
A dermatologic history is similar to other fields of medicine anA dermatologic history is similar to other fields of medicine anddincludes:includes:
Chief ComplaintChief Complaint
History of Present Illness: Onset and evolution, SymptomHistory of Present Illness: Onset and evolution, Symptom(itch, pain), Current Treatments(itch, pain), Current Treatments
Past Medical History (PMH)Past Medical History (PMH)
AllergiesAllergies
MedicationsMedications
Family History (especially psoriasis, atopic dermatitis, allergiFamily History (especially psoriasis, atopic dermatitis, allergiccrhinitis, asthma, and skin cancer, particularly melanoma)rhinitis, asthma, and skin cancer, particularly melanoma)
Social History: Occupation, living state (may becomeSocial History: Occupation, living state (may become
important in the case of allergic skin reactions)important in the case of allergic skin reactions) Review of SystemsReview of Systems
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Physical ExaminationPhysical Examination
Be complete, examining both places that the patientBe complete, examining both places that the patient
indicates there may be a lesion as well as places theindicates there may be a lesion as well as places thepatient may not be obvious to the patientpatient may not be obvious to the patient
For example, it is important to examine the cleft ofFor example, it is important to examine the cleft of
the buttock in a patient with psoriasisthe buttock in a patient with psoriasis
For skin cancer patients, a complete examination of allFor skin cancer patients, a complete examination of all
sun exposed areas is essential (full body skin exam)sun exposed areas is essential (full body skin exam)
Adequate illumination is essential for seeing skin lesionsAdequate illumination is essential for seeing skin lesions
Magnification may help in identifying lesionsMagnification may help in identifying lesions
Palpate lesions (with gloves)Palpate lesions (with gloves)
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Describing Skin LesionsDescribing Skin Lesions
Carefully describe ALL skin lesionsCarefully describe ALL skin lesions
Indicate the distribution of lesions (where theyIndicate the distribution of lesions (where theyare on the body)are on the body)
Indicate configuration of lesions (shape andIndicate configuration of lesions (shape andgrouping)grouping)
Indicate the color of lesionsIndicate the color of lesions
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Types of Skin LesionsTypes of Skin Lesions
Primary Lesions: these lesions represent thePrimary Lesions: these lesions represent the
early stage of the lesion, how they look whenearly stage of the lesion, how they look whenthey start, prior to evolvingthey start, prior to evolving
Secondary Lesions: these lesions represent aSecondary Lesions: these lesions represent a
later stage after the lesion has evolved or beenlater stage after the lesion has evolved or beenalteredaltered
This may help you to determine where in theThis may help you to determine where in theskin the process is occurring (epidermis, dermis,skin the process is occurring (epidermis, dermis,fat)fat)
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Types of Primary Skin LesionsTypes of Primary Skin Lesions
MaculeMacule:: 1 cm flat non--palpable lesionpalpable lesion
These lesions only represent a change in colorThese lesions only represent a change in color
The color displayed helps localize the pathologyThe color displayed helps localize the pathology
Red: from blood vessels in the dermisRed: from blood vessels in the dermis
White: from loss of melanin in the epidermisWhite: from loss of melanin in the epidermis
Brown: from melanin in the epidermis or dermisBrown: from melanin in the epidermis or dermis
http://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/macule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/macule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/macule.html7/23/2019 Lecture 1 - Exam of Skin-Derm Therapy FINAL MEDPEDS
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More Primary Skin LesionsMore Primary Skin Lesions
PapulePapule: elevated: elevated bumpbump
< 0.5 cm< 0.5 cm
NoduleNodule: elevated: elevated bumpbump
> 0.5 cm, frequently in> 0.5 cm, frequently inthe dermis or fat and deeper than a plaquethe dermis or fat and deeper than a plaque
Large nodules, >2cm are often referred to asLarge nodules, >2cm are often referred to as
tumorstumors
PlaquePlaque: Plateau: Plateau--like lesion > 0.5 cmlike lesion > 0.5 cm
WhealWheal: Special plaque composed only of fluid (a: Special plaque composed only of fluid (ahive)hive)
Cyst: Papule or nodule filled fluid or semisolidCyst: Papule or nodule filled fluid or semisolid
materialmaterial
http://missinglink.ucsf.edu/lm/DermatologyGlossary/nodule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/papule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/papule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/nodule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/nodule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/wheal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/plaque.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/plaque.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/wheal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/wheal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/wheal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/plaque.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/nodule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/papule.html7/23/2019 Lecture 1 - Exam of Skin-Derm Therapy FINAL MEDPEDS
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More Primary Skin LesionsMore Primary Skin Lesions
VesicleVesicle: Fluid filled: Fluid filled blisterblister
0.5 cm
PustulePustule:: Cloudy fluid filled lesion containingCloudy fluid filled lesion containing
many inflammatory cells (pus in it!!!)many inflammatory cells (pus in it!!!)
TelangiectasiaTelangiectasia::
Dilated superficial vessels (notDilated superficial vessels (not
brokenbroken
blood vessels)blood vessels)
http://missinglink.ucsf.edu/lm/DermatologyGlossary/bulla.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/vesicle.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/vesicle.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/pustule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/bulla.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/bulla.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/pustule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/pustule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/telangectasias.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/telangectasias.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/telangectasias.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/pustule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/bulla.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/vesicle.html7/23/2019 Lecture 1 - Exam of Skin-Derm Therapy FINAL MEDPEDS
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Secondary LesionsSecondary Lesions
CrustCrust: Dried fluid and: Dried fluid and keratinocyteskeratinocytes
arisingarising
from broken vesicles andfrom broken vesicles and bullaebullae
ScaleScale::
thickened stratumthickened stratum corneumcorneum
(scale occurs(scale occurs
in the epidermis)in the epidermis)
IndurationInduration:: Increased firmness and thickeningIncreased firmness and thickeningof the dermis (need to feel to determine this)of the dermis (need to feel to determine this)
http://missinglink.ucsf.edu/lm/DermatologyGlossary/crusting.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/crusting.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/scaling.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/scaling.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/induration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/induration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/induration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/scaling.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/crusting.html7/23/2019 Lecture 1 - Exam of Skin-Derm Therapy FINAL MEDPEDS
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Secondary LesionsSecondary Lesions
ErosionErosion: Loss of the epidermis: Loss of the epidermis
Ulcer(ation):Ulcer(ation): Loss of the epidermis and someLoss of the epidermis and someor all of the dermis and sometimes subcutaneousor all of the dermis and sometimes subcutaneous
tissuetissue
AtrophyAtrophy::
Loss of dermis or fat (sunken in) orLoss of dermis or fat (sunken in) or
thinning of the epidermis (finely wrinkledthinning of the epidermis (finely wrinkledtranslucent skin)translucent skin)
http://missinglink.ucsf.edu/lm/DermatologyGlossary/ulceration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/erosion.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/erosion.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/ulceration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/ulceration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/atrophy.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/atrophy.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/atrophy.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/ulceration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/erosion.html7/23/2019 Lecture 1 - Exam of Skin-Derm Therapy FINAL MEDPEDS
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Shapes and ConfigurationsShapes and Configurations
AnnularAnnular: Making a circle, clear in the center: Making a circle, clear in the center
Round or ovalRound or oval
GroupedGrouped ((herpetiformherpetiform): occurring in crops): occurring in crops
LinearLinear: Making a line: Making a line
DermatomalDermatomal: Going along the nerves: Going along the nerves
http://missinglink.ucsf.edu/lm/DermatologyGlossary/annular.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/annular.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/grouped.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/linear.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/grouped.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/grouped.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/dermatomal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/linear.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/linear.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/dermatomal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/dermatomal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/dermatomal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/linear.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/grouped.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/annular.html7/23/2019 Lecture 1 - Exam of Skin-Derm Therapy FINAL MEDPEDS
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DirectionsDirections
A series of pictures displaying variousA series of pictures displaying various
morphologies and patterns will follow, try tomorphologies and patterns will follow, try tothink about how you should describe thesethink about how you should describe these
lesions to your residents andlesions to your residents and attendingsattendings
andandthen see how these lesions are appropriatelythen see how these lesions are appropriately
described.described.
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How would you describe this lesion?How would you describe this lesion?
Which morphologies areWhich morphologies are
present?present?
a.a. maculemacule
i. bullai. bulla
b. patchb. patch
j. pustulej. pustule
c. papulec. papule
k.k. telangiectasiatelangiectasia
d. noduled. nodule
l. crustl. crust
e. plaquee. plaque m. scalem. scale
f. whealf. wheal
n.n. indurationindurationg. cystg. cyst
o. erosiono. erosion
h. vesicleh. vesicle
p. ulcerp. ulcer
q. atrophyq. atrophy
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How would you describe this lesion?How would you describe this lesion?
On exam, the patient has large
white patches of depigmentationwith some surroundingdepigmented
macules
withoutoverlying scale
MACULE
PATCH
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How would you describe this lesion?How would you describe this lesion?
Which morphologies areWhich morphologies are
present?present?
a.a. maculemacule
i. bullai. bulla
b. patchb. patch
j. pustulej. pustule
c. papulec. papule
k.k. telangiectasiatelangiectasia
d. noduled. nodule
l. crustl. crust
e. plaquee. plaque m. scalem. scale
f. whealf. wheal
n.n. indurationindurationg. cystg. cyst
o. erosiono. erosion
h. vesicleh. vesicle
p. ulcerp. ulcer
q. atrophyq. atrophy
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How would you describe this lesion?How would you describe this lesion?
Papule
Plaque
Exam: 10-20 scatteredflesh colored papulesintermixed with 5-10blue plaques
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How would you describe this lesion?How would you describe this lesion?
Which morphologies areWhich morphologies are
present?present?
a.a. maculemacule
i. bullai. bulla
b. patchb. patch
j. pustulej. pustule
c. papulec. papule
k.k. telangiectasiatelangiectasia
d. noduled. nodule
l. crustl. crust
e. plaquee. plaque m. scalem. scale
f. whealf. wheal
n.n. indurationindurationg. cystg. cyst
o. erosiono. erosion
h. vesicleh. vesicle
p. ulcerp. ulcer
q. atrophyq. atrophy
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Wheal
How would you describe this lesion?How would you describe this lesion?
Exam: large circumscribedplaque with flesh coloredcenter and erythematous
border (wheal and flare)
Flare
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How would you describe this lesion?How would you describe this lesion?
Which morphologies areWhich morphologies are
present?present?
a.a. maculemacule
i. bullai. bulla
b. patchb. patch
j. pustulej. pustule
c. papulec. papule
k.k. telangiectasiatelangiectasia
d. noduled. nodule
l. crustl. crust
e. plaquee. plaque m. scalem. scale
f. whealf. wheal
n.n. indurationindurationg. cystg. cyst
o. erosiono. erosion
h. vesicleh. vesicle
p. ulcerp. ulcer
q. atrophyq. atrophy
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How would you describe this lesion?How would you describe this lesion?
Bulla
Crust
Erosion
Exam: numerous scattered
bullae
with some rupturedbullae
with overlying crustas well as some erosions atsites of ruptured bullae
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How would you describe this lesion?How would you describe this lesion?
Which morphologies areWhich morphologies are
present?present?
a.a. maculemacule
i. bullai. bulla
b. patchb. patch
j. pustulej. pustule
c. papulec. papule
k.k. telangiectasiatelangiectasia
d. noduled. nodule
l. crustl. crust
e. plaquee. plaque m. scalem. scale
f. whealf. wheal
n.n. indurationindurationg. cystg. cyst
o. erosiono. erosion
h. vesicleh. vesicle
p. ulcerp. ulcer
q. atrophyq. atrophy
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How would you describe this lesion?How would you describe this lesion?
Pustule
Papule
Exam: grouped pustules
and inflammatorypapules on theabdomen, thighs, and
genital region
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How would you describe this lesion?How would you describe this lesion?
Which morphologies areWhich morphologies are
present?present?
a.a. maculemacule
i. bullai. bulla
b. patchb. patch
j. pustulej. pustule
c. papulec. papule
k.k. telangiectasiatelangiectasia
d. noduled. nodule
l. crustl. crust
e. plaquee. plaque m. scalem. scale
f. whealf. wheal
n.n. indurationindurationg. cystg. cyst
o. erosiono. erosion
h. vesicleh. vesicle
p. ulcerp. ulcer
q. atrophyq. atrophy
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Telangiectasia
Nodule
Exam: diffuse telangiectasiaon the cheek as well as a
large well circumscribedtan/brown plaque at the jaw
How would you describe this lesion?How would you describe this lesion?
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How would you describe this lesion?How would you describe this lesion?
Which morphologies areWhich morphologies are
present?present?
a.a. maculemacule
i. bullai. bulla
b. patchb. patch
j. pustulej. pustule
c. papulec. papule
k.k. telangiectasiatelangiectasiad. noduled. nodule
l. crustl. crust
e. plaquee. plaque m. scalem. scale
f. whealf. wheal
n.n. indurationindurationg. cystg. cyst
o. erosiono. erosion
h. vesicleh. vesicle
p. ulcerp. ulcer
q. atrophyq. atrophy
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Exam: Large
ulceration withdefined borders onthe medial ankle
Ulceration
How would you describe this lesion?How would you describe this lesion?
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How would you describe this lesion?How would you describe this lesion?
Which morphologies areWhich morphologies are
present?present?
a.a. maculemacule
i. bullai. bulla
b. patchb. patch
j. pustulej. pustule
c. papulec. papule
k.k. telangiectasiatelangiectasiad. noduled. nodule
l. crustl. crust
e. plaquee. plaque m. scalem. scale
f. whealf. wheal
n.n. indurationindurationg. cystg. cyst
o. erosiono. erosion
h. vesicleh. vesicle
p. ulcerp. ulcer
q. atrophyq. atrophy
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How would you describe this lesion?How would you describe this lesion?
Epidermal Atrophy
-looks like cigarette paper
Exam: large atrophichypopigmented
patchwith interspersedtan/brown macules
anda tan/brown border
Macule
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How would you describe this lesion?How would you describe this lesion?
Which morphologies areWhich morphologies are
present?present?
a.a. maculemacule
i. bullai. bulla
b. patchb. patch
j. pustulej. pustule
c. papulec. papule
k.k. telangiectasiatelangiectasiad. noduled. nodule
l. crustl. crust
e. plaquee. plaque m. scalem. scale
f. whealf. wheal
n.n. indurationindurationg. cystg. cyst
o. erosiono. erosion
h. vesicleh. vesicle
p. ulcerp. ulcer
q. atrophyq. atrophy
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Exam: well defined annular
plaque with erythematous
border and flesh coloredcenter
How would you describe this lesion?How would you describe this lesion?
PlaqueAnnular border
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How would you describe this lesion?How would you describe this lesion?
Which morphologies areWhich morphologies are
present?present?
a.a. maculemacule
i. bullai. bulla
b. patchb. patch
j. pustulej. pustule
c. papulec. papule
k.k. telangiectasiatelangiectasiad. noduled. nodule
l. crustl. crust
e. plaquee. plaque m. scalem. scale
f. whealf. wheal
n.n. indurationindurationg. cystg. cyst
o. erosiono. erosion
h. vesicleh. vesicle
p. ulcerp. ulcer
q. atrophyq. atrophy
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Vesicle
Exam: region ofgrouped vesicles that
coalesce into bullaeat the periphery ofthe lesion
How would you describe this lesion?How would you describe this lesion?
Bulla
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DematologicDematologic
TherapyTherapy
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Principles of Dermatologic TherapyPrinciples of Dermatologic Therapy
The efficacy of any topical medication isThe efficacy of any topical medication is
related to:related to:
1. The concentration of the medication1. The concentration of the medication
2. The vehicle (the mode in which it is2. The vehicle (the mode in which it istransported)transported)
3. The active ingredient (inherent strength)3. The active ingredient (inherent strength)
4. Anatomic location4. Anatomic location
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Drug CostsDrug Costs
Topical Medications can be very expensiveTopical Medications can be very expensive
They are not all covered by insuranceThey are not all covered by insurance
Over the counter (Over the counter (OTC)OTC)ss
are generally cheaperare generally cheaper
than name brandsthan name brands
Know the costs of the medications youKnow the costs of the medications you
prescribe and tell the patient in advance whatprescribe and tell the patient in advance what
they should expect to paythey should expect to pay
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VehiclesVehicles
Ointment (like Vaseline): Greasy, moisturizing,Ointment (like Vaseline): Greasy, moisturizing,
messy,messy, most effective in penetrating the skinmost effective in penetrating the skin..
Creams (vanish when rubbed in): Less greasy,Creams (vanish when rubbed in): Less greasy,
can sting, more likely to cause allergycan sting, more likely to cause allergy(preservatives/fragrances).(preservatives/fragrances).
Lotions (liquid): Cooling, liquids that pourLotions (liquid): Cooling, liquids that pour
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VehiclesVehicles
Solutions (liquids that are greasy or alcoholic):Solutions (liquids that are greasy or alcoholic):
Can sting, good for hairy areasCan sting, good for hairy areas
Gels (semi solid alcoholGels (semi solid alcohol--based): Can sting, goodbased): Can sting, good
for hairy areas or wet lesionsfor hairy areas or wet lesions
Foams (cosmetically elegant): Good for hairyFoams (cosmetically elegant): Good for hairy
areasareas
Sprays: Aerosols (rarely used)Sprays: Aerosols (rarely used)
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Amount of Medication to PrescribeAmount of Medication to Prescribe
Rule of 9Rule of 9ss: Each whole leg is 18% of the Body Surface: Each whole leg is 18% of the Body Surface
Area.Area.
It takes 30 grams of medication to covers the wholeIt takes 30 grams of medication to covers the whole
body. A large tube of topical medication is 60 grams.body. A large tube of topical medication is 60 grams.
Whole body x percentage needing medication =Whole body x percentage needing medication =
amount necessary per applicationamount necessary per application
Ex. For one legEx. For one leg30g x 0.18 = 5.4g30g x 0.18 = 5.4g
The sole is 1% of body surface area (BSA), requiringThe sole is 1% of body surface area (BSA), requiring
0.3 grams (30g x 0.01) per treatment.0.3 grams (30g x 0.01) per treatment.
http://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdf7/23/2019 Lecture 1 - Exam of Skin-Derm Therapy FINAL MEDPEDS
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A patient comes in with a large rash on her leftA patient comes in with a large rash on her left
calf. If she must apply her topical medicationcalf. If she must apply her topical medicationBID how much should you prescribe for theBID how much should you prescribe for the
month?month?Refer to BSA diagramRefer to BSA diagramfor assistance.for assistance.
ANSWER: 30 days/month x 2 times/day xANSWER: 30 days/month x 2 times/day x
30g/body x 0.065 = 120 grams (4 oz)30g/body x 0.065 = 120 grams (4 oz)
Amount of Medication to PrescribeAmount of Medication to Prescribe
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Amount of Medication to PrescribeAmount of Medication to Prescribe
How much would you prescribe for the monthHow much would you prescribe for the month
if someone needed to medicate both soles onceif someone needed to medicate both soles oncea day?a day?Refer to BSA diagramRefer to BSA diagramforfor assisanceassisance..
a. 1.8ga. 1.8gb. 18gb. 18g
c. 180gc. 180g
d. 1800gd. 1800g
http://burns%20for%20erythroderma.pdf/http://burns%20for%20erythroderma.pdf/http://burns%20for%20erythroderma.pdf/http://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://burns%20for%20erythroderma.pdf/http://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://burns%20for%20erythroderma.pdf/http://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdf7/23/2019 Lecture 1 - Exam of Skin-Derm Therapy FINAL MEDPEDS
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Amount of Medication to PrescribeAmount of Medication to Prescribe
Answer: bAnswer: b
How much would you prescribe for the month ifHow much would you prescribe for the month ifsomeone needed to medicate both soles once a day?someone needed to medicate both soles once a day?
a. 1.8ga. 1.8g
b. 18gb. 18g
c. 180gc. 180g
d. 1800gd. 1800gExplanation: 30 days/month x 1 time/day x 30g xExplanation: 30 days/month x 1 time/day x 30g x
0.01/sole x 2 soles = 18g (1/2 oz)0.01/sole x 2 soles = 18g (1/2 oz)
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Topical CorticosteroidsTopical Corticosteroids
Topical steroids are classified based on potency.Topical steroids are classified based on potency.
Potency is inherent to the molecule, not thePotency is inherent to the molecule, not theconcentrationconcentration
The CLASS of the steroid is the strength.The CLASS of the steroid is the strength.
Steroids within any class are equivalent inSteroids within any class are equivalent in
strengthstrength
In practice, it is important to know one steroidIn practice, it is important to know one steroid
from each classfrom each class
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Topical CorticosteroidsTopical Corticosteroids
SuperSuper--High Potency:High Potency: ClobetasolClobetasol
((TemovateTemovate) 0.05% cream,) 0.05% cream,ointment, solution, foamointment, solution, foam
High Potency:High Potency: FluocinonideFluocinonide
((LidexLidex) 0.05% cream, gel,) 0.05% cream, gel,ointment, solutionointment, solution
Medium Potency:Medium Potency:TriamcinoloneTriamcinolone
(TAC) 0.1% cream,(TAC) 0.1% cream,
ointment, solutionointment, solution
MidMid--Low:Low:Aclometasone(AclovateAclometasone(Aclovate) 0.05% cream or) 0.05% cream orointment,ointment, DesonideDesonide
0.05% cream or ointment0.05% cream or ointment
Lowest Potency: Hydrocortisone 1% or 2.5% cream orLowest Potency: Hydrocortisone 1% or 2.5% cream orointmentointment
NOTE:NOTE: ClobetasolClobetasol
0.05% is STRONGER than0.05% is STRONGER than
hydrocortisone 1%. Look at class not percentage.hydrocortisone 1%. Look at class not percentage.
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Applying CorticosteroidsApplying Corticosteroids
There are many ways that corticosteroids are applied.There are many ways that corticosteroids are applied.
The topical steroid can also be applied to spot lesionsThe topical steroid can also be applied to spot lesions
Soak and smearSoak and smear: this involves the patient soaking in a: this involves the patient soaking in atub for 15 min (to open pores) and thentub for 15 min (to open pores) and then smearingsmearing
thethe
topical steroid on the skintopical steroid on the skin
Sometimes, occlusion is used which is the placing ofSometimes, occlusion is used which is the placing ofsaran wrap or vinyl suit over the topical steroid tosaran wrap or vinyl suit over the topical steroid to
increase penetrationincrease penetration
Typically midTypically mid--low/lowest potency topical steroids arelow/lowest potency topical steroids areused on the face with a stronger one for the body as aused on the face with a stronger one for the body as a
stronger steroid on the face may cause atrophy as astronger steroid on the face may cause atrophy as aresult of thin skin and strong steroid!result of thin skin and strong steroid!
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Side Effects of Topical Steroid TreatmentSide Effects of Topical Steroid Treatment
Acne (Acne (perioralperioral
dermatitis/dermatitis/rosacearosacea) can result when a) can result when agreater than low potency steroid is applied to the facegreater than low potency steroid is applied to the face
Atrophy andAtrophy and striaestriae
(stretch marks) can result when steroid(stretch marks) can result when steroidis used in the groin or arm pitsis used in the groin or arm pits
PetechiaePetechiae
andand telangiectasiatelangiectasia
is possible from skin atrophyis possible from skin atrophy
Increased Fungal infections: For example,Increased Fungal infections: For example, LotrisoneLotrisoness
((betamethasonebetamethasone
andand clotrimazoleclotrimazole) does not kill fungus as) does not kill fungus asthethe betamethasonebetamethasone
is too strong and suppresses theis too strong and suppresses theimmune response from killing the fungus.immune response from killing the fungus.
Systemic side effects are rare due to low absorption,Systemic side effects are rare due to low absorption,however with full body high potency steroid it is possiblehowever with full body high potency steroid it is possible
NOTE: THE HIGHER THE POTENCY THENOTE: THE HIGHER THE POTENCY THEMORE LIKELY SIDE EFFECTS ARE TOMORE LIKELY SIDE EFFECTS ARE TOOCCUR!OCCUR!
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TopicalTopicalAntifungalsAntifungals
There are several classes of topical antifungalThere are several classes of topical antifungal
medicationsmedications
Some classes areSome classes are FungistaticFungistatic
(stop fungi from(stop fungi fromgrowing), others are Fungicidal (they kill thegrowing), others are Fungicidal (they kill the
fungi)fungi)
Not all conditions are treatable with topical antiNot all conditions are treatable with topical anti--
fungalsfungals
(hair infections and nail infections do(hair infections and nail infections donot respond to topical treatment and requirenot respond to topical treatment and requiresystemic treatment)systemic treatment)
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TopicalTopicalAntifungalsAntifungals
The following are some examples of topicalThe following are some examples of topical antifungalsantifungals::
ImidazolesImidazoles
((fungistaticfungistatic):): KetoconazoleKetoconazole,, EconazoleEconazole,,
OxiconazoleOxiconazole,, SulconazoleSulconazole,, ClotrimazoleClotrimazole
(OTC),(OTC),
MiconazoleMiconazole
(OTC)(OTC)
AllylaminesAllylamines
(fungicidal):(fungicidal): NaftifineNaftifine,,TerbinafineTerbinafine
(OTC),(OTC),
ButenifineButenifine
CiclopiroxCiclopirox
(may have both(may have both fungistaticfungistatic
and fungicidaland fungicidalproperties)properties)
KetoconazoleKetoconazole
((NizoralNizoral) shampoo is often used in) shampoo is often used inseborrheicseborrheic
dermatitisdermatitis
NOTE: most frequently prescribed antiNOTE: most frequently prescribed anti--fungalsfungals
are inare inyellowyellow
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Review InstructionsReview Instructions
This module contains key morphology and descriptionsThis module contains key morphology and descriptions
used in dermatology. Please review this information asused in dermatology. Please review this information asit is fundamental to dermatologic diseases. Theit is fundamental to dermatologic diseases. The
following links will help you.following links will help you.
DistributionDistribution
Primary LesionsPrimary Lesions
Secondary LesionsSecondary Lesions
Shape and arrangement of lesionsShape and arrangement of lesions
Dermatology lexiconDermatology lexicon
http://missinglink.ucsf.edu/lm/DermatologyGlossary/primarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution1.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution1.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/secondarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/primarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/primarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/secondarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/secondarylesions1a.htmlhttp://www.dermatologylexicon.org/http://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution.htmlhttp://www.dermatologylexicon.org/http://www.dermatologylexicon.org/http://www.dermatologylexicon.org/http://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/secondarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/primarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution1.html7/23/2019 Lecture 1 - Exam of Skin-Derm Therapy FINAL MEDPEDS
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END OF MODULEEND OF MODULE