Dermatology

• Physical examination


  1. More accurate differential diagnosis

  2. Consider privacy in a consultation room

  3. Clearly explain the procedure you want to perform

  4. Gain the patient's consent

  5. Demonstrate empathy

  6. Gain experience when recognising skin problems by seeing multiple similar cases
• History taking


  1. History of presenting complaint (onset, duration, periodicity, site of onset, spread/arrangement, distribution, feel of lesion, aggravating or relieving factors)

  2. Previous history and family history

  3. Medications (oral or topical, prescribed or OTC)

  4. Medical conditions e.g. diabetes, SLE

  5. Allergies (to drugs, food, clothing, footwear, jewellery, toiletries, or cosmetics)

  6. Occupational (past and current)

  7. Sports and hobbies

  8. Animal contacts

  9. Human contacts

  10. Foreign travel

  11. Recent stress

  12. Dietary history e.g. sugar, fats, caffeine, alcohol

  13. How patient feels about their skin problem and what they expect from treatment
• Lesion


  A single area of altered skin

  
• Rash


  Widespread eruption of lesions
• Dermatitis


  Eczema = inflammation of the skin (not a diagnosis)

  
• Tinea


  Name of group of diseases caused by fungus
• Pruritis


  Itchy skin
• Erythema/erythematous


  Redness due to dilated blood vessels that blanch when pressed
• Pigmentation


  Any shade of brown, black, grey or blue resulting from the presence of melanin at different depths in the skin
• Hyperpigmentation


  Excessive colour in the skin that causes it to be darker than the normal background skin
• Hypopigmentation


  Loss of melanin causing the skin to be paler than normal surrounding skin but not completely white
• Macule


  A flat lesion < 1cm in diameter
• Patch


  A flat lesion > 1cm in diameter
• Papule


  A raised solid lesion < 1cm in diameter
• Nodule


  A raised solid lesion > 1cm in diameter
• Vesicle


  A clear, fluid-filled lesion, < 1 cm in diameter
• Bulla


  A clear, fluid filled lesion, > 1cm in diameter
• Texture/morphology of skin lesions and rashes


  • Macule
  • Papule
  • Nodule
  • Vesicle
  • Bulla

  
• Cyst


  Sac or cavity containing fluid or semi-solid material or air
• Pustule


  < 1 cm in diameter, filled with pus (=purulent material composed of inflammatory cells i.e. neutrophils). May be yellow or white, does not always imply infection
• Abscess


  A pus-filled cyst, usually infected, red and painful
• Texture/morphology of skin lesions and rashes


  • Cyst
  • Pustule
  • Abscess

  
• Scale


  Increased dead cells stuck together on the skin surface (also called hyperkeratosis)

  
• Plaque


  A solid, raised, plateau-like (flat-topped) lesion greater than 1cm in diameter
• Texture/morphology of skin lesions and rashes


  • Scale
  • Plaque

  
• Lichenification


  Thickening and accentuation of the skin as a result of the chronic rubbing or scratching
• Crusting


  Arises as a result of plasma exudating through an eroded epidermis. Crust is usually yellow or brown and may ooze. Epidermal crusts may contain blood, making them look red, purple or black.
• Excoriation


  Scratching which removes epidermis or localised damage to the skin which causes bleeding or oozing. They are often linear.

  
• Texture/morphology of skin lesions and rashes


  • Lichenification
  • Crusting
  • Excoriation

  
• Annular


  In circle or ring
• Discoid/nummular


  Disc or coin shaped circular lesion
• Wheal/weal


  Superficial skin-coloured or pale skin swelling, usually surrounded by erythema and the skin surface is smooth

  
• Shape or configuration of lesions


  • Annular
  • Discoid/nummular
  • Wheal/weal
• Dermatitis


  • Nonspecific inflammatory response of the skin
  • Affects 1 in 5 people during their lifetime
  • Isolated short episodes vs chronic
  • Causes: Endogenous (e.g. atopic, seborrheic, discoid, asteatotic, venous and hand or foot, lichen simplex), Exogenous (e.g. contact dermatitis), Environmental (e.g. irritants, allergens, stress)

  
• Treatment for atopic dermatitis


  1. Avoid aggravating factors e.g. soap, shampoo, bubble bath, wool, grass, chlorinated pools

  2. Moisturise with emollients

  3. Topical corticosteroids as main treatment for all age groups (Face: hydrocortisone 1% ointment once daily until clear OR [severe] methylprednisolone aceponate 0.1% ointment/FO once daily for 7/7, Trunk/limb: triamcinolone acetonide 0.02% ointment once daily until clear OR [severe] methylprednisolone aceponate 0.1% oint/FO once daily OR [severe] mometasone furoate 0.1% ointment once daily)
• Atopic dermatitis


  Also known as atopic eczema
• Avoid aggravating factors


  Soap, shampoo, bubble bath, wool, grass, chlorinated pools
• Topical corticosteroids


  Main treatment for all age groups
• Topical corticosteroid treatment


  1. Face: hydrocortisone 1% ointment once daily until clear OR [severe] methylprednisolone aceponate 0.1% ointment/FO once daily for 7/7

  2. Trunk/limb: triamcinolone acetonide 0.02% ointment once daily until clear OR [severe] methylprednisolone aceponate 0.1% oint/FO once daily OR [severe] mometasone furoate 0.1% ointment once daily
• Pimecrolimus 1% cream


  Topical treatment for patients unable to tolerate topical corticosteroids or unsuitable