IMAGE BANK DERMATOLOGY FOR THE ADVANCED PRACTICE NURSE
FAYE LYONS & LISA OUSLEY Education: Nurses and Primary Care Providers
Best Available Research
Patient and family characteristics, values, Practitioner expertise and preferences and experience
Figure 1.1 Evidence-based practice.
Copyright Springer Publishing Company 1 Patient presents with a rash
5 2 Treatment based Obtain a history on EVIDENCED- and subjective BASED PRACTICE symptoms guidelines
4 3 Diagnosis based on Systematic literature review assessment of and clinical patient and expertese evaluation of rash
Figure 1.2 Conceptual framework for diagnosing and treating dermatologic skin rashes.
Copyright Springer Publishing Company Yes Yes Yes Yes Yes Crosses Vesicular? Itch? Painful? FEVER? Midline of Chicken body Pox No No No Impetigo (honey-colored crusting) Contact Dermatitis (poison oak) Shingles Molluscum Herpes Simplex Virus BIOPSY
Yes Yes Yes Yes Yes Crosses Papular? Itch? Painful? FEVER? Midline of Biopsy body Further testing No No No No No Bilateral Unilateral Shingles Acne (KOH+)Tinea barbae Bilateral Unilateral Rosacea Biopsy Atopic Dermatitis Eczema Perioral dermatitis
Yes Yes Yes Yes Macular? Itch? Painful? FEVER? Cellulitis
No No No No Bilateral Unilateral Rosacea Biopsy (Discoid lupus?) Contact Dermatitis Biopsy Lupus (Butterfly rash?)→referral
Yes Yes Yes Scaly? Itch? Painful? Biopsy
No No No Bilateral Unilateral Eczema Seborrhea Dermatitis Actinic Keratosis/Biopsy Tinea Capitus (KOH + -scalp) →Referral to Dermatology
Face.
Copyright Springer Publishing Company Yes Yes Yes (Fever may be present) Unilateral—Shingles Vesicular? Itch? Painful? No Bilateral—Chicken Pox/ No No Viral etiology Bilateral Unilateral Contact Dermatitis (Localized) Biopsy (Bullous disease?) Impetigo Molluscum
Yes Yes Yes Unilateral—Shingles Papular? Itch? Painful? Bilateral—Biopsy No No No Bilateral Unilateral Acne Biopsy Viral Exanthem Bilateral Unilateral Erythema Multiforme (Target lesions) Allergic Dermatitis (Drug reaction) Contact Dermatitis Scarlett Fever (Erythematous and sandpaper texture) Urticaria
Yes Yes Yes Yes Unilateral Macular? Itch? Painful? FEVER? Cellulitis No Bilateral No Referral/Biopsy/Further testing No No Bilateral Unilateral Pityriasis Rosea (Salmon-colored patches) Biopsy Contact Dermatitis Biopsy Tinea Corporis (Erythematous sharp edges) (Discoid lupus?)
Yes Yes Yes Scaly? Itch? Painful? Biopsy
No No No Eczema Lichen Planus Bilateral Unilateral Tinea Versicolor (KOH +, hypopigmented, mild scaled patches) Seborrheic Dermatitis/Seborrhic Keratosis Biopsy Psoriasis (Thick-scaled plaques) Tinea Corporis (KOH +, hypopigmented patches, sharp erythematous borders)
Torso.
Copyright Springer Publishing Company Yes Yes Yes Yes Unilateral—BIOPSY Vesicular? Itch? Painful? FEVER? No Bilateral—Chicken No No Contact Dermatitis (Localized) Pox/Viral etiology Bilateral Unilateral Dyshidrotic Eczema (Hands/feet) Biopsy (Bullous disease?) Biopsy (Skin cancer?) Herpetic (Vesicular clusters on fingers—Herpetic whitlow)
Yes Yes Yes Papular? Itch? Painful? Biopsy/Referral
No No Keratosis Pilaris (white papules—upper triceps, legs) Folliculitis (erythematous papules/pustules) Bilateral Unilateral Biopsy (solitary papule/patch—skin cancer?) Contact Dermatitis Biopsy Allergic Dermatitis
Unilateral Yes Yes Yes Yes (Targetoid—Lyme Macular? Itch? Painful? FEVER? disease) Cellulitis Bilateral No Referral/Biopsy/Further testing No Targetoid? Erythema Multiforme (Rocky Mountain spotted fever— Contact Dermatitis/Allergic Dermatitis wrists/ankles) Hives (Urticaria) Biopsy (Lupus?)
Yes Yes Yes Scaly? Itch? Painful? Erythrasma (Axillea, between toes—KOH-)
No No Unilateral Bilateral KOH + KOH – Biopsy (Skin cancer?) Psoriasis Tinea Eczema—Generalized Dryness/ Actinic Keratosis Lichen Planus (Individual papules)
Extremities.
Copyright Springer Publishing Company Yes Yes Yes Vesicular? Itch? Painful? Herpetic—HSV I (Culture)
No No Molluscum Molluscum
Yes Yes Yes Yes Papular? Itch? Painful? FEVER? Herpetic
No No Unilateral? Bilateral? Candidiasis Biopsy Folliculitis
Yes Yes Yes Macular? Itch? Painful? Cellulitis
No No
Psoriasis Contact Dermititis/Allergic Dermititis
Yes Yes Yes Scaly? Itch? Painful? Biopsy To exclude malignancy No No KOH + KOH – Lichen Planus Tinea Cruris/Candidal Intertrigo Seborrheic dermititis/Psoriasis
Genitals.
Copyright Springer Publishing Company Basics of Dermatology
Epidermis
Dermis Epidermis Squamous cells
Basal cells Dermis
Melanocyte
Figure 2.1 Skin anatomy.
Published by Springer Publishing Company C2,3 Trigeminal
C2,3 Supraclavicular
Ventral Cutaneous Branches C3,4 Superior lateral T2 T3 Lateral Cutaneous Branches T4 Medial brachial C5,6 T5 T6 Intercostobrachial
T1 T7 Medial T8 antebrachial T9 Lateral T10 antebrachial C5,6 T11 T12 C8, T1 Iliohypogastric
L1 Genitofemoral
S2,3 Ilioinguinal
C8, T1 Ulnar L1,2 Median C6,7,8
Lateral cutaneous L2,3 Posterior cutaneous Intermediate cutaneous Medial cutaneous Obturator
Patellar plexus
L3,4
L5, S1,2 Superficial fibular
Sural L4,5
L5, S1,2
Figure 2.2 Dermatomes.
Copyright Springer Publishing Company Skin Assessment
Figure 4.1 Auspitz sign is the appearance of bleeding points when scale from the rash is removed from psoriatic lesions.
Copyright Springer Publishing Company Figure 4.2 Viral exanthem of the leg.
Copyright Springer Publishing Company Diagnostics
(a) (b)
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.
Published by Springer Publishing Company Treatment Approaches
Figure 6.1 An ingrown toenail.
Copyright Springer Publishing Company Clinical Management
Figure 7.1 Age spots are among the benign lesions caused by sun exposure.
Copyright Springer Publishing Company Figure 7.2 Acanthosis nigricans is a dark, velvety, hyperpigmentation of the skin, often found at the skin folds.
Copyright Springer Publishing Company Figure 7.3 Nummular eczema.
Copyright Springer Publishing Company Figure 7.4 Bullous impetigo.
Copyright Springer Publishing Company Abrasions and Skin Tears
Figure III.1 An abrasion on the medial knee.
Published by Springer Publishing Company Acne
Figure III.2 Inflammatory acne.
Copyright Springer Publishing Company Alopecia
Figure III.3 Alopecia or hair loss.
Copyright Springer Publishing Company Figure III.4 Alopecia areata.
Copyright Springer Publishing Company Figure III.5 Alopecia caused by tinea capitis or ringworm.
Published by Springer Publishing Company Aphthous Stomatitis
Figure III.6 An ulcer caused by RAS.
Copyright Springer Publishing Company Burns
Figure III.7 Sunburn of the neck.
Copyright Springer Publishing Company Candidiasis
Figure III.8 Angular cheilitis.
Published by Springer Publishing Company Figure III.9 Diaper dermatitis.
Copyright Springer Publishing Company Cellulitis/Erysipelas
(a) (b)
Figure III.10 (a) An example of cellulitis. (b) Cellulitis resulting from a vaccination for varicella.
Copyright Springer Publishing Company Figure III.11 An example of erysipelas.
Published by Springer Publishing Company Cysts
Figure III.12 Sebaceous cyst.
Copyright Springer Publishing Company Figure III.13 Hidradenitis suppurativa on the axilla.
Copyright Springer Publishing Company Figure III.14 Keratosis pilaris on the arm.
Copyright Springer Publishing Company Dermatitis
(a) (b)
(c)
Figure III.15 (a-c) Examples of contact dermatitis.
Copyright Springer Publishing Company Figure III.16 Facial contact dermatitis.
Copyright Springer Publishing Company Figure III.17 Eczema of the hand.
Copyright Springer Publishing Company (a) (b)
Figure III.18 Examples of AD on the (a) face and (b) arms/trunk.
Published by Springer Publishing Company Figure III.19 An example of LSC/ND.
Copyright Springer Publishing Company Figure III.20 Seborrheic dermatitis.
Copyright Springer Publishing Company Figure III.21 Example of stasis dermatitis.
Copyright Springer Publishing Company Erythema Multiforme
Figure III.22 Erythema multiforme.
Published by Springer Publishing Company Figure III.23 Example of erythema multiforme.
Published by Springer Publishing Company Erythema Nodosum
Figure III.24 Erythema nodosum.
Published by Springer Publishing Company Granuloma Annulare
Figure III.25 Granuloma annulare.
Copyright Springer Publishing Company Herpes Simplex Virus
Figure III.26 A herpes simplex virus type 1 infection, commonly known as a cold sore.
Copyright Springer Publishing Company Figure III.27 An example of herpetic whitlow.
Published by Springer Publishing Company Figure III.28 Example of herpes zoster infection.
Copyright Springer Publishing Company 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.
Published by Springer Publishing Company Impetigo
Figure III.30 Examples of impetigo on a child’s (a) arm and (b) ear.
Copyright Springer Publishing Company Figure III.31 Bullous impetigo.
Copyright Springer Publishing Company Insect Bites
Figure III.32 Scabies.
Published by Springer Publishing Company (a) (b)
(c)
Figure III.33 (a and b) Scabies are often found on the arm. (c) Scabies in the axilla.
Copyright Springer Publishing Company (a) (b)
(c) (d)
(e)
Figure III.34 Examples of insect bites: (a–c) bedbug bites (d) a spider bite, and (e) chigger bites.
Published by Springer Publishing Company Lentigo/Nevi
Figure III.35 Example of nevus, also called a mole.
Copyright Springer Publishing Company Figure III.36 A congenital nevus on the scalp.
Published by Springer Publishing Company Figure III.37 Examples of normal nevi.
Copyright Springer Publishing Company Lichen Planus
(a)
(b)
Figure III.38 Examples of (a) genital (b) buccal lichen planus.
Published by Springer Publishing Company Molluscum Contagiosum
Figure III.39 Molluscum contagiosum virus infection.
Copyright Springer Publishing Company Nail Conditions
(a) (b)
Figure III.40 Examples of (a) mild to moderate and (b) moderate to severe ingrown toenails.
Copyright Springer Publishing Company Figure III.41 Onychomycosis infection.
Copyright Springer Publishing Company Figure III.42 Paronychia infection.
Published by Springer Publishing Company Pemphigus
Figure III.43 Examples of pemphigus vulgaris, the most common type of pemphigus.
Published by Springer Publishing Company Perioral Dermatitis
Figure III.44 Perioral dermatitis.
Published by Springer Publishing Company Pityriasis Rosea
Figure III.45 Pityriasis rosea.
Published by Springer Publishing Company Psoriasis
Figure III.46 Psoriasis lesions.
Published by Springer Publishing Company Rosacea
Figure III.47 Rosacea.
Copyright Springer Publishing Company Skin Cancer
Figure III.48 Example of actinic keratosis.
Copyright Springer Publishing Company Figure III.49 Example of basal cell carcinoma.
Copyright Springer Publishing Company Figure III.50 Example of malignant melanoma.
Published by Springer Publishing Company Figure III.51 Squamous cell carcinoma.
Published by Springer Publishing Company Figure III.52 Verrucous carcinoma.
Copyright Springer Publishing Company Tinea Infections
Figure III.53 Tinea corporis.
Copyright Springer Publishing Company Figure III.54 Example of tinea pedis.
Copyright Springer Publishing Company (a) (b)
(c) (d)
(e)
Figure III.55 (a–e) Examples of tinea versicolor.
Copyright Springer Publishing Company Urticaria
Figure III.56 Urticaria.
Published by Springer Publishing Company Vasculitis
Figure III.57 Leukocytoclastic vasculitis.
Copyright Springer Publishing Company Figure III.58 Varicose veins.
Copyright Springer Publishing Company Verruca Vulgaris
Figure III.59 Examples of verruca vulgaris (warts) on the hand and knee.
Copyright Springer Publishing Company Figure III.60 A plantar wart.
Copyright Springer Publishing Company Figure III.61 Genital warts.
Published by Springer Publishing Company Figure III.62 Doughnut wart.
Copyright Springer Publishing Company Vitiligo
Figure III.63 Vitiligo.
Copyright Springer Publishing Company