image bank dermatology

DERMATOLOGY FOR THE

ADVANCEDPRACTICE NURSE

FAYE LYONS & LISA OUSLEY

IMAGE BANK

Education: Nurses and

Primary Care Providers

Patient and familycharacteristics, values,

and preferences

Practitioner expertiseand experience

Best Available Research

FigurE 1.1 Evidence-based practice.

Copyright Springer Publishing Company

5 Treatment basedon EVIDENCED-

BASED PRACTICEguidelines

Diagnosis based onliterature review

and clinicalexpertese

4

Patient presentswith a rash

1

3Systematic

assessment ofpatient and

evaluation of rash

Obtain a historyand subjective

symptoms

2

FigurE 1.2 Conceptual framework for diagnosing and treating dermatologic skin rashes.


Yes Yes Yes Yes Yes

ChickenPox

No No No

BIOPSY

BiopsyFurther testing

No

No No No No

No No No NoBilateralAcneRosaceaPerioral dermatitis

Unilateral(KOH+)Tinea barbaeBiopsy

Shingles

Yes Yes Yes

Yes Yes Yes

Yes

Cellulitis

Contact Dermatitis Biopsy

Biopsy

No No No

Vesicular?

Papular?

Macular?

Scaly?

FEVER?

FEVER?

CrossesMidline of

body

Yes Yes Yes Yes Yes

Painful?

FEVER?Crosses

Midline ofbody

Impetigo (honey-colored crusting) Contact Dermatitis (poison oak)Molluscum

ShinglesHerpes Simplex Virus

BilateralAtopic Dermatitis

UnilateralEczema

BilateralRosacea

Lupus (Butterfly rash?)→referral

UnilateralBiopsy (Discoid lupus?)

BilateralSeborrhea Dermatitis

Tinea Capitus (KOH + -scalp)

EczemaUnilateralActinic Keratosis/Biopsy

→Referral to Dermatology

Itch?

Itch? Painful?

Itch? Painful?

Itch? Painful?

Face.


Yes Yes Yes (Fever may be present)

NoNoNo

No

No NoNo No

NoNo

BilateralBiopsy (Bullous disease?)

BilateralAcne

Viral ExanthemErythema Multiforme (Target lesions)

Scarlett Fever (Erythematous and sandpaper texture)

UnilateralImpetigo

UnilateralBiopsy

Yes Yes Yes

Yes Yes Yes

Yes

Contact Dermatitis Biopsy

Biopsy

No No No

Vesicular?

Papular?

Macular?

Scaly?

FEVER?

Yes Yes Yes

Contact Dermatitis (Localized)Molluscum

Unilateral—Shingles

Bilateral—Chicken Pox/Viral etiology

BilateralAllergic Dermatitis (Drug reaction)

Urticaria

UnilateralContact Dermatitis

BilateralPityriasis Rosea (Salmon-colored patches)Tinea Corporis (Erythematous sharp edges)

UnilateralBiopsy

(Discoid lupus?)

BilateralSeborrheic Dermatitis/Seborrhic Keratosis

Psoriasis (Thick-scaled plaques)

EczemaLichen PlanusTinea Versicolor (KOH +, hypopigmented, mild scaled patches)Tinea Corporis (KOH +, hypopigmented patches,sharp erythematous borders)

UnilateralBiopsy

Unilateral—Shingles

Bilateral—Biopsy

UnilateralCellulitis

BilateralReferral/Biopsy/Further testing

Itch? Painful?

Itch? Painful?

Itch? Painful?

Itch? Painful?

Torso.


Yes Yes

NoNoNo

Targetoid? Erythema Multiforme

Biopsy (Lupus?)

No No

Contact Dermatitis/Allergic DermatitisHives (Urticaria)

No No

BilateralBiopsy (Bullous disease?)

Keratosis Pilaris (white papules—upper triceps, legs)Folliculitis (erythematous papules/pustules)Biopsy (solitary papule/patch—skin cancer?)

UnilateralBiopsy (Skin cancer?)

Yes Yes Yes

Yes Yes Yes

Yes

Erythrasma(Axillea, between toes—KOH-)

No No

Vesicular?

Papular?

Macular?

Scaly?

FEVER?

Yes Yes Yes

Contact Dermatitis (Localized)Dyshidrotic Eczema (Hands/feet)Herpetic (Vesicular clusters onfingers—Herpetic whitlow)

BilateralContact DermatitisAllergic Dermatitis

UnilateralBiopsy

UnilateralBiopsy (Skin cancer?)

Lichen Planus (Individual papules)

BilateralPsoriasis

KOH +Tinea

KOH –Eczema—Generalized Dryness/ Actinic Keratosis

Unilateral—BIOPSY

Bilateral—ChickenPox/Viral etiology

Biopsy/Referral

Unilateral(Targetoid—Lymedisease) Cellulitis

BilateralReferral/Biopsy/Further testing

(Rocky Mountain spotted fever—wrists/ankles)

Yes Yes

FEVER?Itch? Painful?

Itch? Painful?

Itch? Painful?

Itch? Painful?

Extremities.


No

Molluscum

Yes Yes

No

Molluscum

No

Psoriasis

No

Contact Dermititis/Allergic Dermititis

NoUnilateral?

Biopsy

Bilateral?

Folliculitis

No

Yes Yes Yes

Yes Yes Yes

BiopsyTo exclude malignancy

Cellulitis

NoNo

Lichen Planus

Vesicular?

Papular?

Macular?

Scaly?

Yes Yes

Yes

Candidiasis

KOH +Tinea Cruris/Candidal Intertrigo

KOH –Seborrheic dermititis/Psoriasis

Herpetic

Herpetic—HSV I(Culture)

Yes Yes

FEVER?

Itch? Painful?

Itch? Painful?

Itch? Painful?

Itch? Painful?

genitals.


Basics of Dermatology

Epidermis

Dermis

Squamous cells

Basal cells

Melanocyte

Derm

isE

pidermis

FigurE 2.1 Skin anatomy.

Published by Springer Publishing Company

Trigeminal

Supraclavicular

Ventral Cutaneous Branches

Superior lateral

Lateral Cutaneous Branches

Medial brachial

Intercostobrachial

Medialantebrachial

Lateralantebrachial

Iliohypogastric

Ilioinguinal

UlnarMedian

Lateral cutaneous

Posterior cutaneous

Intermediate cutaneous

Medial cutaneous

Obturator

Patellar plexus

Superficial fibular

Sural

L5, S1,2

L4,5

L3,4

L2,3

L1,2

S2,3

L1

T12

T11

T10

T9

T1T8

T7

T6C5,6

C3,4

T5T4T3T2

C8, T1

C8,

T1

C5,

6

C6,7,8

L5, S1,2

Genitofemoral

C2,3

C2,3

FigurE 2.2 Dermatomes.


Skin Assessment

FigurE 4.1 Auspitz sign is the appearance of bleeding points when scale from the rash is removed from psoriatic lesions.


FigurE 4.2 Viral exanthem of the leg.


Diagnostics

FigurE 5.1 (a) A jellyfish sting and (b) fire ant stings. Marine and insect stings are examples of wounds that may become infected. A wound culture may be

beneficial in these instances.


(a) (b)

Treatment Approaches

FigurE 6.1 An ingrown toenail.


Clinical Management

FigurE 7.1 Age spots are among the benign lesions caused by sun exposure.


FigurE 7.2 Acanthosis nigricans is a dark, velvety, hyperpigmentation of the skin, often found at the skin folds.


FigurE 7.3 Nummular eczema.


Figure 7.4 Bullous impetigo.


Abrasions and Skin Tears

Figure iii.1 An abrasion on the medial knee.


Acne

FigurE iii.2 inflammatory acne.


Alopecia

FigurE iii.3 Alopecia or hair loss.


FigurE iii.4 Alopecia areata.


FigurE iii.5 Alopecia caused by tinea capitis or ringworm.


Aphthous Stomatitis

FigurE iii.6 An ulcer caused by rAS.


Burns

FigurE iii.7 Sunburn of the neck.


Candidiasis

FigurE iii.8 Angular cheilitis.


FigurE iii.9 Diaper dermatitis.


Cellulitis/Erysipelas

FigurE iii.10 (a) An example of cellulitis. (b) Cellulitis resulting from a vaccination for varicella.


(a) (b)

FigurE iii.11 An example of erysipelas.


Cysts

FigurE iii.12 Sebaceous cyst.


FigurE iii.13 Hidradenitis suppurativa on the axilla.


FigurE iii.14 Keratosis pilaris on the arm.


Dermatitis

FigurE iii.15 (a-c) Examples of contact dermatitis.


(a) (b)

(c)

FigurE iii.16 Facial contact dermatitis.


FigurE iii.17 Eczema of the hand.


FigurE iii.18 Examples of AD on the (a) face and (b) arms/trunk.


(a) (b)

FigurE iii.19 An example of LSC/ND.


FigurE iii.20 Seborrheic dermatitis.


FigurE iii.21 Example of stasis dermatitis.


FigurE iii.22 Erythema multiforme.


Erythema Multiforme

FigurE iii.23 Example of erythema multiforme.


Erythema Nodosum

FigurE iii.24 Erythema nodosum.


granuloma Annulare

FigurE iii.25 granuloma annulare.


FigurE iii.26 A herpes simplex virus type 1 infection, commonly known as a cold sore.


Herpes Simplex Virus

FigurE iii.27 An example of herpetic whitlow.


FigurE iii.28 Example of herpes zoster infection.


FigurE iii.29 Although the introduction of the varicella vaccine in 1995 has greatly reduced the incidence of the disease, some individuals do have

skin reactions to the vaccine.


impetigo

FigurE iii.30 Examples of impetigo on a child’s (a) arm and (b) ear.


FigurE iii.31 Bullous impetigo.


insect Bites

FigurE iii.32 Scabies.


FigurE iii.33 (a and b) Scabies are often found on the arm. (c) Scabies in the axilla.


(a) (b)

(c)

(a) (b)

(c) (d)

(e)

FigurE iii.34 Examples of insect bites: (a–c) bedbug bites (d) a spider bite, and (e) chigger bites.


Lentigo/Nevi

FigurE iii.35 Example of nevus, also called a mole.


FigurE iii.36 A congenital nevus on the scalp.


FigurE iii.37 Examples of normal nevi.


Lichen Planus

(a)

(b)

FigurE iii.38 Examples of (a) genital (b) buccal lichen planus.


Molluscum Contagiosum

FigurE iii.39 Molluscum contagiosum virus infection.


Nail Conditions

(a) (b)

FigurE iii.40 Examples of (a) mild to moderate and (b) moderate to severe ingrown toenails.


FigurE iii.41 Onychomycosis infection.


FigurE iii.42 Paronychia infection.


Pemphigus

FigurE iii.43 Examples of pemphigus vulgaris, the most common type of pemphigus.


Perioral Dermatitis

FigurE iii.44 Perioral dermatitis.


Pityriasis rosea

FigurE iii.45 Pityriasis rosea.


Psoriasis

FigurE iii.46 Psoriasis lesions.


rosacea

FigurE iii.47 rosacea.


Skin Cancer

FigurE iii.48 Example of actinic keratosis.


FigurE iii.49 Example of basal cell carcinoma.


FigurE iii.50 Example of malignant melanoma.


FigurE iii.51 Squamous cell carcinoma.


FigurE iii.52 Verrucous carcinoma.


Tinea infections

FigurE iii.53 Tinea corporis.


FigurE iii.54 Example of tinea pedis.


(a) (b)

(c) (d)

(e)

FigurE iii.55 (a–e) Examples of tinea versicolor.


urticaria

FigurE iii.56 urticaria.


Vasculitis

FigurE iii.57 Leukocytoclastic vasculitis.


FigurE iii.58 Varicose veins.


Verruca Vulgaris

FigurE iii.59 Examples of verruca vulgaris (warts) on the hand and knee.


FigurE iii.60 A plantar wart.


FigurE iii.61 genital warts.


FigurE iii.62 Doughnut wart.


Vitiligo

FigurE iii.63 Vitiligo.


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