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Approach to Dermatology in the Emergency Department

Approach to Dermatology in the Emergency Department. Tintinalli Chapter 245. History Discomfort Duration Progression Location Exposures to medication Immunizations Food / pet / pests exposure. History Morphology Evolutionary nature Rate of progression Distribution

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Approach to Dermatology in the Emergency Department

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  1. Approach to Dermatology in the Emergency Department Tintinalli Chapter 245

  2. History Discomfort Duration Progression Location Exposures to medication Immunizations Food / pet / pests exposure History Morphology Evolutionary nature Rate of progression Distribution Associated systemic complaints Mucosal system review Sexual history Approach

  3. Patient in gown! Good light Inspect all skin and mucosal surfaces Hair, nails, scalp Determine Distribution Pattern Lesion arrangement Configuration Exam

  4. Distribution • Distribution: the location of the skin findings

  5. Pattern • Pattern: the anatomic, functional, and physiologic arrangements of the skin lesions.

  6. Lesion arrangement • Lesion arrangement: refers to the symmetry and configuration. • Bilateral suggests internal event or systemic exposure.

  7. Configuration • Configuration • Internal configuration: applies to relation its individual features • External configuration: applies to relations to one another

  8. Derm Terms • Macule:circumscribed flat discoloration Lentigo

  9. Derm Terms • Papule: elevated solid lesion up to 0.5 cm in diameter. Color varies. • Accumulated material may be metabolic byproduct or inflammatory product. Lesions my coalesce to form plaque.

  10. Derm Terms • Plaque: circumscbibed, superficial, solid lesion more than 0.5 cm in diameter, often formed by confluence of papules. Psoriasis

  11. Derm Terms • Nodule: a circumscribed, elevated, solid lesion more than 0.5 to 1 cm in diameter. (larger is referred to as a tumor) Keratoacanthoma

  12. Derm Terms • Pustule: a circumscribed collection of leukocytes and free fluid that varies in size. Folliculitis

  13. Derm Terms • Vesicle: circumscribed collection of free fluid up to 0.5 cm in diameter. • Bulla: circumscribed collection of free fluid larger than 0.5cm. Chicken pox

  14. Derm Terms • Wheal: firm, edematous plaque resulting from infiltration of the dermis with fluid.

  15. Derm Terms • Scales: excess dead epidermal cells that are produced by abnormal kertinization and shedding. Pityriasis rosea Pitr

  16. Derm Terms • Crust: a collection of dried serum and cellular debris.

  17. If it’s dry, wet it If it’s wet, dry it Caution with steroids in DM Ulcers Immunodeficiency Psychiatric disease Topical steroids Low to high strength Use ONLY low for face Do Not use fluorinated steroids in pregnancy Treatment Pearls

  18. Use antihistamines when appropriate Consider topical antibiotics /antifungals Consider acyclovir for herpes infection Lice / scabies CNS toxicity in infants with lindane use. Use permethrin or pyrethrin Treatment Pearls

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