Dermatology

Question 1

What is important to ask in a dermatology history

Answer 1

• Presenting complaint
• History of presenting complaint
• Past medical history
• Family history - Eg skin cancer - if present with pigmented lesion
• Social history - Newproducts, alcohol, smoking
• Drug history and allergies - Drg reaction - dermatological emergency y
• Impact on quality of life / ICE

Question 2

What could the presentic complaine be

Answer 2

• Nature (e.g. rash vs lesion) Rash - inflammatory eg eczema, psoriasis. Widespread Lesion = cancer? Something thats isolated
• Site
• Duration

Question 3

What to ask about the ph

Answer 3

• Initial appearance and evolution*
• Symptoms (particularly itch and pain)
• Aggravating and relieving factors (“triggers”)
• Previous and current treatments (effective or not)
* Indicates points more important with lesions as presenting complaint

Question 4

What should be asked about the pmh?

Answer 4

• Systemic diseases
• History of atopy (asthma, hay fever, eczema)
• History of skin cancer or pre-cancer*
• History of sunburn/sunbathing/sun-bed use*
• Skin type*

Question 5

What should be asked abou the fh

Answer 5

• Family history of skin disease*
• Family history of atopy
• Family history of autoimmune disease

Question 6

What should be asked about the social history

Answer 6

• Occupation
• Sun exposure* • Contactants
• Improvement in PC when away from work

Question 7

What should be asked about the drug history

Answer 7

• Regular and recent
• Systemic and topical
• Get specific with topical treatments!
• Where?
• How much?
• How long for?

Question 8

What should be asked abou ice

Answer 8

• Impact of skin complaint on life • Ideas
• Concerns
• Expectations

Question 9

Wat are the pricibles of examning skin

Answer 9

Inspect, palpate, describe, systemic check

Question 10

How can skin be describe

Answer 10

• S - Site, distribution (rash)
• or Size and Shape (lesion)
• C - Colour (and Configuration)
• A - Associated changes e.g. surface features
• M - Morphology

Question 11

What is abc for pigmented lesion

Answer 11

• Asymmetry
• Border (irregular or blurred) • Colour
• Diameter.- Over 6mm and growing

Question 12

How can site and distribution be described

Answer 12

Generalised, flexure, extensor, photosensitive

Question 13

How can cofiguration be described

Answer 13

Discrete, confluent, linear, target

Question 14

How can configuration be escirbes

Answer 14

Deseret, confluent, linear, target

Question 15

How can colour be described

Answer 15

Erythematous Red and blanching
Purpuric
Red or purple and non-blanching Brown or black
Pigmented or hyperpigmented Depigmented if total loss of colour
Hypopigmented

Question 16

How can surface features be described

Answer 16

Scale
Built up keratin

Crust Dried exudate

Excoriation Erosion from scratching = pruritus

Erosion/Ulceration
` Partial or full thickness loss

Question 17

How can morphology be described

Answer 17

Macula - flat <5,mm
Patch
Papuan
Plaque
Nodule
Vesicle
Pustule
Bulla
Annual
Wheal
Discoid
Comedone

Question 18

What are hair findings

Answer 18

Alopecia - patchy or diffuse, hypertrichosis, hirsuitism

Question 19

What are some nail findings

Answer 19

Koilonychia, pitting, oncholysis, clubbing