Patient Education for Protection Against Sun Damage

The key to preventing a skin cancer is to stay out of the sun and not to use a sunlamp. If you are going to be in the sun, you should wear clothes made from tightly woven cloth so the sun’s rays can’t get to your skin. You should also stay in the shade when you can. Wear a wide-brimmed hat to protect your face, neck, and ears.

Remember that clouds and water won’t protect you from the sun’s rays. The sun’s rays can also reflect off water, snow, and white sand.

If you can’t stay out of the sun or wear the right kind of clothing, you should use sunscreen to protect your skin. But don’t think that you are completely safe from the sun just because you are wearing sunscreen.

Use sunscreen with a sun protection factor (SPF) of 15 or more. Put the sunscreen everywhere the sun’s rays might touch you, including your ears, the back of your neck, and bald areas on your scalp. Put more on every two to three hours and after sweating or swimming.

Patient Education on Skin Examination

What’s the best way to do a skin self-examination?

The best way is to use a full-length mirror and a hand-held mirror to check every inch of your skin.

First, you need to learn where your birthmarks, moles and blemishes are and what they usually look like. Check for anything new, such as a change in the size, texture or color of a mole, or a sore that doesn’t heal.

Look at the front and back of your body in the mirror, then raise your arms and look at the left and right sides.

Bend your elbows and look carefully at your palms and forearms, including the undersides, and your upper arms. Check the back and front of your legs.

Look between your buttocks and around your genital area.

Sit and closely examine your feet, including the bottoms of your feet and the spaces between your toes.

Look at your face, neck and scalp. You may want to use a comb or a blow dryer to move hair so that you can see better.

By checking yourself regularly, you’ll get familiar with what’s normal for you. If you find anything unusual, see your doctor. The earlier skin cancer is found, the better.

Prostatitis Syndrome Symptoms

Prostatitis syndromes tend to occur in young and middle-aged males. The symptoms of prostatitis include pain (in the perineum, lower abdomen, testicles and penis, and with ejaculation), bladder irritation, bladder outlet obstruction, and sometimes blood in the semen.

Clinical Skills

Full Skin Exam

When performing a skin exam at annual visits and/or evaluating a patient presenting with a skin lesion — have the patient change into a gown so you can perform a full skin exam.

Skin Examination

Distribution

The distribution of the skin lesions is important in diagnosing skin diseases. Many conditions have typical patterns or affect specific regions of the body. For example, psoriasis commonly affects extensor surfaces of joints, and atopic eczema impacts flexor surface of joints. Involvement of the palms and soles is seen in erythema multiforme, secondary syphilis and eczema.

Shape

Descriptions like oval, round, linear etc. can be used to describe the shape of the lesions. Annular lesions are circular with normal skin in the center. Annular macules are observed in drug eruptions, secondary syphilis and lupus erythematosus. Iris lesions are a special type of annular lesion in which an erythematous annular macule or papule develops a second ring or a purplish papule or vesicle in the center (target or bull’s eye lesion).

Arrangement

A linear arrangement of lesions may indicate a contact reaction to an exogenous substance brushing across the skin. Zosterform refers to lesions arranged along the cutaneous distribution of a spinal nerve.

Size

It is important to measure some lesions, especially nevi and skin malignancies like squamous cell carcinoma. Squamous cell carcinoma of the skin greater than 2 cm in diameter is regarded to be high risk for recurrence and metastasis. Nevi larger than 6 mm in diameter are more likely to be malignant than smaller nevi.

Associated symptoms

Associated symptoms, like itching, pain, or burning sensation are helpful to make a diagnosis of certain skin diseases. Eczema tends to be itchy compared to fungal skin infections. Pain is usually associated with herpes simplex or herpes zoster.

Management

Eczema Treatment

Eczema treatment: Medium-strength corticosteroid cream to decrease inflammatory process. In addition, regular use of emollient to soften the lesion and prevent exacerbations. If the lesion is dry, ointment may be a better vehicle for the corticosteroid.

Topical Corticosteroids

Accurate diagnosis

An accurate diagnosis is essential in selecting a topical corticosteroid. Topical corticosteroids are effective for conditions that are characterized by hyperproliferation, inflammation, and immunologic involvement. They can also provide symptomatic relief for burning and pruritic lesions.

Vehicle

The vehicle, or base, is the substance in which the active ingredient is dispersed. The base determines the rate at which the active ingredient is absorbed through the skin. There are several types of vehicles:

Creams: The cream base is a mixture of several different organic chemicals (oils) and water, and usually contains a preservative. It can be used in nearly any area and therefore most often prescribed. It is cosmetically most acceptable. It has a drying effect with continuous use, therefore best for acute exudative inflammation.

Ointments: The ointment base contains a limited number of organic compounds consisting primarily of grease such as petroleum jelly, with little or no water. Ointment is desirable for drier skin and has a greater penetration of medicine than a cream and therefore has enhanced potency.

Lotions and gels: Lotions contain alcohol, which has drying effect on an oozing lesion. Lotions are most useful in the scalp area because they penetrate easily and leave little residue. Gels have a jelly-like consistency and are beneficial for exudative inflammation, such as poison ivy.

Potency

The anti-inflammatory properties of topical corticosteroids result in part from their ability to induce vasoconstriction to the small blood vessels in the upper dermis. The potency of corticosteroids are tabulated in seven groups, with group I the strongest and group VII the weakest.

Potency

Examples

Use to treat

Group I

Augmented betamethasone dipropionate 0.05%, Halobetasol propionate

0.05%

Psoriasis, lichen planus, severe hand eczema, and alopecia areata.

Group II

Desoximetasone, Fluocinonide 0.05%

Psoriasis, lichen planus, severe hand eczema, and alopecia areata.

Group III

Betamethasone dipropionate 0.05%, Triamcinolone acetonide 0.5% (ointment or cream)

Atopic dermatitis, nummular eczema, stasis dermatitis, and seborrheic dermatitis.

Group IV

Floucinolone acetonide 0.025% (ointment), Triamcinolone acetonide

0.1% (ointment)

Atopic dermatitis, nummular eczema, stasis dermatitis, and seborrheic dermatitis.

Group V

Floucinolone acetonide 0.025% (cream), Triamcinolone acetonide 0.1%

(lotion) or Triamcinolone acetonide 0.025% (ointment)

Atopic dermatitis, nummular eczema, stasis dermatitis, and seborrheic dermatitis.

Group VI

Alclometasone dipropionate 0.05%, Desonide 0.05%

Dermatitis in eyelids and diaper area, mild dermatitis on face, and mild intertrigo.

Group

VII

Hydrocortisone 1%, 2.5%

Dermatitis in eyelids and diaper area, mild dermatitis on face, and mild intertrigo.

Administration

Once or twice daily application is recommended for most preparations. More frequent administration does not provide better results.

Side effects

The most common side effect of topical corticosteroid is skin atrophy. It also can cause hypopigmentation. This is more apparent with darker skin tones. Topically applied high and ultra high potency corticosteroids can be absorbed well enough to cause systemic side effects. Hypothalamic-pituitary-adrenal suppression, glaucoma, septic necrosis of the femoral head, hyperglycemia, hypertension and other systemic side effects have been reported.

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