Dermatology Flashcards
When taking a dermatological history, what aspects should be explored?
Presenting complaint History of presenting complaint Past medical history Family history Social history Drug history Quality of life impact and ICE
What aspects of the presenting complaint should be explored?
Nature (rash/lesion) Site Duration and changes
What aspects of the history of the presenting complaint should be explored?
Initial appearance and evolution Symptoms (particularly itch/pain) Aggravating and relieving factors Previous and current treatments
What aspects of the past medical history should be explored?
Systemic diseases History of atopy Skin cancer Sunburn/sun-bed use Skin type
What are the atopic conditions?
Asthma Eczema Hay-fever
What system can be used to analyse skin type?
Fitzpatrick skin types
What aspects of family history should be explored?
Family history of skin disease (e.g. psoriasis) Family history of atopy Family history of autoimmune disease (e.g. alopecia, vitiligo)
What aspects of social history should be explored?
Occupation Sun exposure Exposure to chemicals Improvement of symptoms when away from work
What aspects of a drug history should be explored?
Regular and recent drugs Systemic and topical treatments used
How should the use of topical treatments be explored?
Where applied? How much? How long for?
How should quality of life impact and ICE be explored?
Impact of skin on life Ideas Concerns Expectations
When examining the skin what parts should be examined?
All sites, including: Nails Mucosa Hair
How should a dermatological examination be conducted?
Inspect Palpate Describe
When palpating the skin, what should be assessed?
Flat/raised Warmth
What mnemonic can be used to describe the skin?
S - site and distribution/size and shape C - colour A - associated changes M - morphology
How can colour be described?
Erythema (blanching redness) Purpura (red or purple non-blanching) Pigmented/hyperpigmented (brown/black) Hypopigmented
How can a lesion/rash’s morphology be described?
Macule Papule Patch Plaque Nodule Vesicle Pustule Bulla Annular Wheal Discoid Comedone
How does a macule feel on palpation?
Flat
How does a papule feel on palpation?
Raised but in a small area
How does a patch feel on palpation?
Flat but in a large area
How does a plaque feel on palpation?
Raised, but broader than it is high
How does a nodule feel?
Like a papule but >1cm
What is a vesicle?
A clear fluid filled lesion
What is a pustule?
A pus filled lesion
What is a bulla?
A large fluid filled lesion
What shape is an annualar lesion?
Ring shaped
What presents with a wheal?
Urticaria
What shape is a discoid lesion?
Coin shaped
What forms can a comedone come in?
Open (black head) Closed
How can pigmented lesions be assessed?
A - asymmetry B - border C - colour D - diameter E - evolution
What surface features can be described?
Scale Crust Excoriation Erosion/ulceration Fissures
What is scale?
Built up keratin
What is crust?
Dried exudate
What is excoriation?
Erosion from scratching
What is erosion/ulceration?
Partial/full thickness loss of skin
What are fissures?
Cracks
What hair findings can be found on examination?
Alopecia Hypertrichosis Hirsuitism
What is alopecia?
Alopecia describes hair loss, can be patchy or diffuse
What is hypertrichosis?
Excess of hair
What is hirsuitism?
Excess androgenic pattern of hair in women
What nail findings can be found on examination?
Koilonychia Pitting Onycholysis
What is koilonychia?
Spooning of the nails
What can koilonychia indicate?
Iron deficiency
What disease is pitting of the nails associated with?
Psoriasis
What is onycholysis?
Separation of the nail from the nail bed
What diseases is onycholysis associated with?
Psoriasis Thyroid disease
How common is acne?
Very common
When can acne occur?
Infantile (due to maternal hormones in breast milk) Adolescent Adult (12% of women and 5% of men, 5% of both genders will have it for life)
What are the risks associated with acne?
Painful Scarring Can have severe psychological affects
Where on the body is acne most common?
T-zone of the face Shoulders Chest
Describe the pathophysiology of acne
Follicular plugging occurs, causing increased sebum Then become infected by propionobacterium acnes
What can cause acne?
Hormones Cosmetics Medication (especially the POCP)
When should acne be referred early?
In patients with darker skin types who are more prone to scarring
What is another name for eczema?
Atopic dermatitis
What symptom is required for an eczema diagnosis?
Itchy
Where does eczema typically affect in children?
Face
Where does eczema typically affect in adults?
Flexures e.g. cubical fossa and popliteal fossa
What do eczema lesions most commonly become infected with?
Staph aureus
What can indicate a staph aureus infection in eczema?
One side looks different to the other
What is a serious complication of eczema?
Infections with herpes zoster/herpes simplex
What does eczema management consist of?
Education and advice Moisturiser Steroids Antibiotics to treat infection
What education and advice should be given to eczema patients?
Keep nails short Regular bath/shower (no soaps) Avoid aqueous creams
How should eczema patients use moisturisers?
Apply as often as possible, at least 3-4 times/day Use ointments or creams
What is another name for moisturisers?
Emollients
When are creams more suitable then ointments?
For use in the day as they are less oily
What should be done in the case of resistant eczema?
Investigate compliance Consider inadequate steroid treatment Consider infection Consider incorrect diagnosis
What is the most common form of psoriasis?
Plaque psoriasis
What is the average age of onset for psoriasis?
28
Describe the pathophysiology of plaque psoriasis
Increased rate of skin turnover leading to keratin excess
What is the normal turnover rate of skin?
23 days
What is the turnover rate of skin in plaque psoriasis?
5 days
Where does plaque psoriasis typically affect?
Elbows Knees Trunk
When can psoriasis look less scaly?
In flexural or genital psoriasis where the sweat makes it look more red and moist
What can flexural/genital psoriasis often be confused for?
Fungal infection
