Derm History, Eczema or Psoriasis diagnosis

Question 1

You are the GP

A 7 - 10 year old boy comes in with his mum complaining of an itchy rash

Take a structured HxPC

Answer 1

TOPSCERA or SCAM

• T) How long
• O) Sudden vs gradual
• P) Worse vs better vs same
• S) Where
• C) Character SSSBCST
• E/A)
• R)
• A) itch + weep + raised + crust + bleed + blister

Question 2

You are the GP

A 7 - 10 year old boy comes in with his mum complaining of an itchy rash

You have taken a structured history using TOPSCERA
and discovered an itchy red rash on the flexures. Main differential for an itchy red rash?

Answer 2

Eczema

Question 3

You are the GP

A 7 - 10 year old boy comes in with his mum complaining of an itchy rash

You suspect a diagnosis of Eczema after taking HxPC what do you need to ask in

PMHx,
FHx,
Dhx
SHx

to confirm the diagnosis?

Answer 3

PMHx

• previous episodes
• hay fever
• asthma
• eczema

FHx - Allergies
DHx - Allergies
SHx -

Question 4

You are the GP

Mr Smith comes in complaining of skin problems.

On examination he has lesions symmetrically distributed over his elbows, knees and sacrum;

they are:
well demarcated, 
oval and erythematous, 
silver scales on the surface nail changes 
lesions on scalp 

What is the main differential?

Answer 4

Psoriasis

Question 5

You are the GP

Mr Smith comes in complaining of skin problems

At what point in the consultation should you give Mr Smith a working diagnosis?

Answer 5

After history and examination

Question 6

You are the GP

Mr Smith comes in complaining of skin problems.

After history and examination you diagnose him with psoriasis of the scalp

Which would be the most appropriate treatment to start with?

Answer 6

Tar Based Shampoo