Basic Dermatology Flashcards
What factors should you establish when taking a history or the presenting complaint?
- Initial appearance and evolution
- Symptoms (particularly itch and pain)
- Aggravating and relieving factors (triggers)
- Previous and current treatments (and whether effective of not)
What past medical history should you establish if taking a dermatological history?
- Any systemic disease?
- History of atopy?
- History of skin cancer or pre-cancer?
- History of sunburn/ sunbathing/ sun-bed use?
- Skin type
Describe the Fitzpatrick Skin Types
What family history should you establish when taking a dermatological history?
- FH of skin disease
- FH of atopy
- FH of autoimmune disease
What social history should you establish when taking a dermatological history?
- Occupation
- sun exposure?
- contactants?
- Is there an improvement when away from work?
What 4 things should you do when examining skin?
- Inspect
- Palpate
- Describe
- Systemic check: whole skin, hair, nails, mucous membranes
How should you describe skin conditions?
SCAM
Site: distribution (rash) or size and shape
Colour (and configuration)
Associated changes e.g. surface features
Morphology
What is the ABCD for pigmented skin lesions?
Asymmetry
Border (irregular or blurred)
Colour
Diameter
What are the different sites and distribution descriptions for dermatology issues?
What are the 4 different ways to decribe configuration of skin issues?
What are the 4 different ways to describe the colour of dermatological issues?
What are the 4 different surface features of dermatology issues?
What is a macule?
Totally flat, different colour to skin
What is a papule?
Small and raised - like a spot
What is ‘patchy’ morphology?
e.g. vitiligo / hypopigmentation
What is a plaque in dermatology?
Lots of papules can cause a plaque - raised with lots of inflammation
What is a nodule?
What is a vesicle?
A fluid filled skin lesion
What is a pustule?
A skin lesion filled with pus
What are bulla?
Large, fluid filled vesicles
What is an annular skin lesion?
A ring shaped lesion
What are skin wheals?
Urticaria
Usually transient and linked to allergy
What are discoid/ nummular skin lesions?
Round lesions- red all the way through
(vs annular which are ring shaped and redder around the edges)
What are comedones?
Either open (blackheads) or closed (white heads)
What hair findings may you see in dermatology?
What nail findings may you see in dermatology?
How do you manage atopic eczema?
- Avoid irritants e.g. soap, fragrance, wool, animal fur
- Use emollients (moisturiser) to restore skin barrier
- Use topical corticosteroids daily until inflammation clear
- mild/ moderate for face
- moderate or potent for body limbs
What are some major and minor features of suspected melanoma?
Major:
- Change in size
- Irregular shape
- Irregular colour
Minor:
- Diameter >7mm
- Inflammation
- Oozing
- Change in sensation
What is molluscum contagiousum?
- A pox virus infection
- 2-6 week incubation period
- Usually resolves in 6-9 months without treatment
What is tinea fungal infection?
A fungal infection caused by dermatophyte funghi
Causes a mildly pruritic rash on skin and scalp- associated with hair loss
What kind of rash is this? Associated with a burning sensation?
Shingles (Herpes Zoster infection)
- Reactivation of virus that has remained dormant in the sensory root ganglion from previous chicken pox infection
- Elderly and immunocompromised are at higher risk
- Associated with burning pain
- Duration 2-3 weeks
- Treat with anti-virals
What are some of the functions of skin?
- Protective barrier against environmental insult
- Temperature regulation
- Sensation
- Vitamin D synthesis
- Immunosurveillance
- Cosmesis
What is erythroderma?
Intense and usually widespread reddening of the skin due to inflammatory skin disease
- >90% of skin affected
- Causes: psoriasis, eczema, drugs, cutaneous T cell lymphoma
What are some of the complications of erythroderma?
- Total skin failure
- Hypothermia
- Infection (loss of protective barrier)
- Renal failure
- High output cardiac failure (due to dilated skin vessels)
- Protein malnutrition (high turnover of skin)
What are the signs and symptoms of erythroderma?
Signs:
- Erythematous
- Thickened
- Inflamed
- Scaly
- No sparing
Symptoms:
- Pruritus
- Fatigue
- Anorexia
- Feeling cold
What are the 4 major cell types found in the epidermis?
- Keratinocytes - protective barrier
- Langerhan cells - antigen presenting cells
- Melanocytes - produce melanin
- Merkel cells - contain specialised nerve endings for sensation
What are the layers of the epidermis?
What is the average epidermal turnover time?
30 days
Where is the stratum lucidum found?
Found in areas of thicker skin e.g. palms and soles of feet
What are the components of the dermis?
- Collagen
- Elastin
- Glycosaminglycans
- Provides stregnth and elasticity
What are sebaceous glands?
Glands that produce sebum through hair follicles to lubricate skin
- Active after puberty
- Stimulated by conversion of androgen to dihydrotestosterone
What is the function of eccrine and apocrine glands?
Regulate body temperature
- Innervated by sympathetic system
- Eccrine are widespread
- Apocrine are active following puberty- found in axillae, areolae, genitalia and anus
What are the 3 types of hair?
- Lanugo (fetal hair)
- Vellum (short hair all over body)
- Terminal hair (coarse hair)
What are the 3 main phases of the hair follicle cycle?
- Anagen
- Catagen
- Telogen
Label the features of the nail
