Dermatology 101 with Sandra Oehlke, FNP

Enjoy the Dermatology 101 webinar with our wonderful nurse practitioner, Sandra Oehlke, who discusses a wide range of topics from how your skin changes across your life span, ways we can protect our skin when we’re out in the sun, different ways to identify moles that could be precancerous, and managing all different kinds of skin infections.

Skin Across Your Lifespan:

• Infant skin is thinner and has only 10-20 layers of the top layer called the stratum corneum and is more likely to absorb topical products

• Mature skin has 60 layers of stratum corneum and therefore is more protective than infant skin

• Aged skin has increased fragility, is thinner, has decreased fat, and a loss of elasticity

Your Skin Is a Window into Your Health:

• Hormonal imbalances

  • Insulin resistance (as seen in diabetes), can present as velvety brown skin in skin folds

  • Hypothyroidism can look like dry skin, less sweating, and coarse skin

  • Hyperthyroidism shows itself as warm moist skin with sweaty palms or hair loss

• Liver or kidney failure

  • Liver symptoms are noted when Jaundice is noticable in the skin

  • Kidney failure typically consists of dry itchy skin, with gray or yellow color

• Circulation

  • Symptoms are typically cool skin, swelling in the lower legs, and dark staining of the lower legs

Sun Protection:

• Options for Sun Protection

  • Avoidance: the most harmful rays are in the middle of the day from 10am-4pm

  • Sun protective clothing, such as specially made hats, sunglasses, dresses, pants, shirts, and swimsuits.

• Choosing the Appropriate Sunscreen

  • Chemical sunscreen absorbs the sun’s rays and may contain oxybenzone, avobenzone, octisalate, octocrylene, homosalate, and octinoxate.

  • Physical sunscreen shields the surface of your skin, deflect the sun’s rays, and contain zinc oxide and/or titanium dioxide. These types of sunscreens (often called “sunblock”) are ideal for young children and people with sensitive skin.

  • Sunscreen recommendations include using an SPF 30 that is broad-spectrum for UVA and UVB and water-resistant. Make sure to apply every day when you are headed outdoors, even on rainy or snowy days. It’s helpful to apply 15 minutes before sun exposure, reapply every 2 hours, and after swimming or sweating. Cover all sun-exposed areas and make sure to use sunscreen lip balm as well. 

Skin Changes You Can Experience from the Sun:

• Wrinkles, dark spots which typically show up as freckles, age spots (solar lentigines).

• Scaling, flaking, or developing visible blood vessels which can are also called actinic keratosis, telangiectasias

• Loss of elasticity, which presents itself through deep linear wrinkles on sun-exposed areas, such as the back of your neck.

Precancerous Growths:

• Actinic keratosis: which can be red, scaly, and appear like chapped lips

• A potential cause for this is due to sun, sun lamps, or tanning bed exposure

• These can be warning signs for them turning into squamous cell carcinoma

Skin Cancers:

• A basal cell has a pearly appearance on sun-exposed areas 

• Squamous cell has a scaly type of appearance such as red, brown, or even itchy

• Melanoma, which is the most lethal skin cancer, can be white, brown, black, red, or can be from a changing mole

Moles (Spot Check ABCDE):

• Asymmetry, Border (irregular edge)

• Color (irregular color in one spot, dark black, red, or white)

• Diameter and Elevation changes such as spots greater than 6 mm (size of a pencil eraser), getting bumpy, bleeding

• Management

  • Assess your skin and have someone check your back and see a dermatologist for any of your concerns

Sensitive Skin:

• Contact or allergic rash

  • Examples of this reaction could be where one is in contact with nickel or other metals, ingredients in skin products, plants, etc.

• Eczema

  • Typically presents as scaly, itchy, weeping skin, often associated with the “atopic triad” of eczema, seasonal allergies, and asthma

  • Treatment is ongoing with bleach baths, moisturizers, topical steroids, and newer medications available from a dermatologist.

• Hives

  • A rash that moves around can be caused by many things such as ice, heat, sweat, infection, or hormonal changes.

Bites:

• Hives from bites can be treated with over-the-counter antihistamines and topical hydrocortisone 

• Spider bites will present themselves as a pink, red, or black spot, depending on the type of spider.

• Tick bites can carry many diseases other than Lyme Disease, though this is the most common illness from tick bites. To avoid tick bites, make sure to apply DEET, tuck in your pants, and avoid tall grass when possible.

Plants/Juice/Sun:

• Poison ivy is not contagious if you have washed off the poison. Also, people will not react to their first exposure to poison ivy, though they will have a reaction to it on their second exposure.

• Stinging nettles are very itchy and can cause a quick reaction, though typically resolves in a few hours to days

• Lime juice and the sun

  • If lime juice is spilled on the skin in bright sunlight a rash can occur

Skin Infections:

• Bacterial infections include impetigo (infection on top of the skin), cellulitis (deep in the skin), folliculitis (found in the hair follicle)

  • Treatment is provided through topical or oral antibiotics 

• Viral infections include shingles, chicken pox, cold sores, and warts)

  • Treatment for viral infection includes immunizations for chicken pox and shingles and antiviral medications are also an option

• Fungal infections include ringworm or fungal nail infection

  • Treatment is provided through topical antifungal medications or oral medications for nails

Glands:

• Excessive sweating (such as underarm or your hands) 

  • You can an treat this topically with antiperspirants, or by a dermatologist for more advanced treatments 

• Acne

  • First, identify if this is normal vs abnormal acne

  • Different types of acne include whiteheads and blackheads, which can be treated with OTC prescriptions, retinoid, and a benzoyl peroxide.

• Rosacea

  • Presented as flushing prompted by certain triggers such as heat, stress, alcohol, and spicy foods. This can be treated topically and through avoiding triggers that cause this flushing.

Medication Reactions:

• Rashes can be caused by many medications and looks like a measles rash 

• Severe reaction requiring hospitalization in a burn unit called Toxic Epidermolysis Necrolysis (TEN) or Stevens-Johnson Syndrome (SJS)

  • Blistering emergency rashes can be caused by medications

• Fixed drug eruption or spot

  • A solitary red or purple spot can appear

Infestations:

• Lice are typically drawn to the back of the neck and can be treated with Permethrin. It is also contagious, so avoidance is key to not passing on the disease to others. 

• Bed Bugs typically present themselves as bites and itching in zig zag groupings. As soon as you are aware of bed bugs, make sure to bag any clothes and heat the items in the oven on low heat in order to prevent further spreading. 

• Scabies will live off the body for 72 hours and must be treated twice with a topical cream as more scabies eggs hatch in the skin.

If you have any questions about the topics discussed in this webinar, please reach out to your clinician through the Nice app.