EO 001.05 - Dermatological Examination Flashcards
What are six focused history questions that should be asked during a dermatological exam?
- Changes in moles or birthmarks;
- Itching, change in sweating, dry skin;
- Lesions that do not heal;
- General symptoms (eg, fever, arthralgia, weight loss, malaise);
- History of skin disease; and
- Family history of skin cancer, psoriasis, etc
What five qualities should be noted of a lesion?
(SCAMD)
- Size
- Color
- Arrangement / Arrangement (ex: 1 single patch, several small vesicles)
- Morphology
- Distribution
What are the eight steps of a dermatological exam?
Prior to exam, obtain vital signs
- Focused history: HPI, (CHLORIDE AAA PMA), Fam./Soc. Hx
- Perform 1st inspection of lesions and note (SCAMD):
- Palpate the lesion (O/E):
- Perform a 2nd inspection:
- Palpation of the scalp.
- Make a Note in CFHIS or on CF2138 (record relevant positive and negative findings)
Keratin
Keratin is a protein that helps strengthen and protect certain connective tissue cells.
Dermatophytes
Dermatophytes are fungi which propagate and survive solely on the cornified outer layers of skin.
Dermatophyte infections
Dermatophyte infections are yeast infections - infections of the skin caused by “keratinophilic” fungi (dermatophytes which eat keratin)
What are host and local factors that facilitate a dermatophyte infection?
Host Factors
- Atopy
- Glucocorticoid use
- Skin Disorders
Local Factors
- Sweating or Humid conditions
- Occlusion
- Exposure
Tinea Corporis (Ring Worm) Overall
Classification: Dermatophyte Fungal Infection
Transmission:
- Autoinoculation from other parts of the body
(from tinea pedis or tinea capitis.)
- Skin to skin contact with people or animals
Prevalence:
- (Geographic) More common in tropical and
subtropical regions
- All ages. All genders
Incubation period:
- Days to months since contact with vector
Hx Findings:
- Other family members who have similar lesions
- Contact with animals.
- Previous use of topical steroids
What is Tinea Corporis classified as?
Dermatophyte Fungal Infection
How is Tinea Corporis transmitted?
- Autoinoculation from other parts of the body
(from tinea pedis or tinea capitis.) - Skin to skin contact with people or animals
What is the prevalence of Tinea Corporis?
- (Geographic) More common in tropical and
subtropical regions - All ages. All genders
How long is the incubation period of Tinea Corporis?
Days to months since contact with vector
What HX findings would be consistent with Tinea Corporis?
- Other family members who have similar lesions
- Contact with animals.
- Previous use of topical steroids
If Tinea Corporis was present, what would be found on exam?
- Small well circumscribed plaques with or without
scaling, pustules, or vesicles, - Peripheral enlargement and central clearing, - Annular configuration with concentric rings. - Light to bright red, sharply marginated and occur
alone or in groups of 3-4 - Hyperpigmentation (occasionally)
- Mildly pruritic to intense itching.
- No associated findings.
Where is Tinea Corporis generally found on the body?
Exposed areas. Trunk, limbs, face, neck (excluding the feet, hands, and groin)
In addition to Tinea Corporis, what Deferential Diagnosis should be considered?
- Psoriasis
- Seborrheic dermatitis
- Nummular eczema
- Contact dermatitis
- Lyme disease
- Pityriasis rosea
What are common management strategies for Tinea Corporis?
- Refer to MO
- Rx (Prescription) : Clotrimazole (OTC) 1%
cream/Ketoconazole (Rx) 2% topical BID X 1-3
weeks. - Pt education: Hygiene, avoid skin to skin contact,
loose breathable clothes to allow skin to dry. - Tests: Fungal Scraping, Woods Lamp (most cases
do not fluoresce)
What is the common name for Tinea Corporis?
Ring Worm
Tinea Cruris (Jock Itch) Overall
Classification: Dermatophyte Fungal Infection
Transmission: Autoinoculation from other parts of the body, usually Tinea Pedis
Prevalence:
- Any age, but rare in children
- Males > Females
Onset: Sub acute/Chronic
Hx Findings:
- Warm, humid environment
- Tight clothing worn by men
- Possible Obesity
- Chronic topical glucocorticoid application
- Past or current Hx of Tinea Pedis/Cruris
- Quite pruritic
What is Tinea Cruris classified as?
Dermatophyte Fungal Infection
How is Tinea Cruris transmitted?
Autoinoculation from other parts of the body, usually Tinea Pedis
What is the prevalence of Tinea Cruris?
- Any age, but rare in children
- Males > Females
What is the onset of Tinea Cruris?
Sub acute/Chronic
What HX findings would be consistent with Tinea Cruris?
- Warm, humid environment
- Tight clothing worn by men
- Possible Obesity
- Chronic topical glucocorticoid application
- Past or current Hx of Tinea Pedis/Cruris
- Quite pruritic.
If Tinea Cruris was present, what would be found on exam?
- Usually bilateral
- Well demarcated erythematous plaques
- Large, scaling, central clearing
- Vesicles may be present at margins
- Clearly defined, raised borders
- *Pruritus is common (often what has made Pt
seek care)
Where is Tinea Cruris generally found on the body?
- Often begins on the proximal medial thigh then
spreads to groin and pubic regions - Unlike yeast infections, the scrotum and penis
are usually spared - Occasionally the gluteal cleft is affected too
In addition to Tinea Cruris, what Deferential Diagnosis should be considered?
- Candida
- Psoriasis
- Pityriasis versicolor
What are common management strategies for Tinea Cruris?
- Rx (Prescription): Clotrimazole 1%
cream/Ketoconazole 2% Topical BID X 1-3 weeks,
including at least 1 week after lesions have
cleared. - Tmt co-existing locations of fungal infections
(Ring worm & athletes foot) - Pt education:
- Hygiene, avoid skin to skin contact,
- Loose breathable cloth to allow skin to dry.
- Dry off before putting on clothes.
- Put on your socks before you put on your
underwear.
- Refer to MO (Medical Officer) /PA (Physician
Assistant) for long term Tx (tmt). - Suggest Dermatologist referral in worst cases.
What is the common name for Tinea Cruris?
Jock Itch
Tinea Pedis (Athlete’s Foot) Overall
Classification: Dermatophyte Fungal Infection
Transmission: Barefoot walking on floors
Prevalence:
- Males more prominent than females
- Approx. 4% of population
- Rare in children/can be common in teens
Incubation period: May be from4 to 10 days
Hx Findings:
- Present from months to years
- Often prior history of tinea pedis, tinea unguium
of toenails
- May flare in hot climate
- Sweaty feet or Hx of Excessive sweating
- Occlusive Tightfitting footwear (boots)
- Immunosuppression
- Prolonged application of topical steroids
What is Tinea Pedis classified as?
Dermatophyte Fungal Infection
How is Tinea Pedis transmitted?
Barefoot walking on floors
What is the prevalence of Tinea Pedis?
- Males more prominent than females
- Approx. 4% of population
- Rare in children/can be common in teens
How long is the incubation period of Tinea Pedis?
May be from4 to 10 days
What HX findings would be consistent with Tinea Pedis?
- Present from months to years
- Often prior history of tinea pedis, tinea unguium
of toenails - May flare in hot climate
- Sweaty feet or Hx of Excessive sweating
- Occlusive Tightfitting footwear (boots)
- Immunosuppression
- Prolonged application of topical steroids
If Tinea Pedis was present, what would be found on exam?
- Erythema, Scaling, Maceration, Burning, Possible
bulla formation - Frequently Asymptomatic. Pruritus
- 4 Types of Skin Lesions: interdigital, moccasin,
inflammatory/bullous, and ulcerative.
Where is Tinea Pedis generally found on the body?
Feet (usually bilateral)
In addition to Tinea Pedis, what Deferential Diagnosis should be considered?
- Interdigital type: erythrasma (bacterial), impetigo
(bacterial) - Moccasin type: Psoriasis vulgaris, eczematous
dermatitis (eczema), dyshidrotic oedema - Inflammatory/bullous type: Bullous impetigo,
allergic contact dermatitis.
What are common management strategies for Tinea Pedis?
- Rx: Clotrimazole 1% cream/Ketoconazole Topical
BID X 1-3 weeks - Pt education
- Refer to MO/PA for long term Tx (treatment)
- Suggest Dermatologist referral in worst cases
What is the common name for Tinea Pedis?
Athlete’s Foot
Malasezzia SPP (Tinea Versicolor) Overall
Classification: Superficial fungal infection
Transmission: Skin-to-skin contact, contact with contaminated objects
Prevalence:
- Predominantly adolescents and young adults
- Up to 50% in tropical climates
Hx Findings:
- Immunosuppression (glucocorticoids)
- Use of topical skin oils
- NOT related to personal hygiene
- FHx in 21%!
What is Malasezzia SPP classified as?
Superficial fungal infection
How is Malasezzia SPP transmitted?
Skin-to-skin contact, contact with contaminated objects
What is the prevalence of Malasezzia SPP?
What HX findings would be consistent with Malasezzia SPP?
- Immunosuppression (glucocorticoids)
- Use of topical skin oils
- NOT related to personal hygiene
- FHx in 21%!
If Malasezzia SPP was present, what would be found on exam?
- Small hyper/hypopigmented macules, patches
and plaques that coalesce into larger patches - Variance in pigmentation with skin colour
- May be mildly pruritic.
Where is Malasezzia SPP generally found on the body?
Most commonly on the upper trunk and proximal upper extremities
In addition to Malasezzia SPP, what Deferential Diagnosis should be considered?
Seborrheic dermatitis, pityriasis rosea, vitiligo
What are common management strategies for Malasezzia SPP?
- Rx: Clotrimazole 1%
cream/Ketoconazole/Terbinafine 1% Topical BID
X 1-4 weeks - Pt Edu.: Changes in pigmentation often persist after treatment. Restoration may take months!
- Ref. to MO/PA for long term Tx (tmt)
- Suggest Dermatologist referral in worst cases
What is the common name for Malasezzia SPP?
Tinea Versicolor
Candidiasis (Yeast Infection) Overall
Pathophysiology: Fungal infection caused by a yeast. Candida belongs to your normal flora.
Symptomatic reactions are due to a variety of host factors: Eg.: Diabetes, antibiotics, stress, nutrient deficiencies, immunocompromised, oral contraceptives, etc.
Candidiasis generally occurs on moist, occluded skin.
What is Candidiasis classified as?
Fungal Infection
If Candidiasis was present, what would be found on exam?
- May have erosions of the skin, - White plaques, - Pruritus
Where is Candidiasis generally found on the body?
Oropharyngeal or vulvovaginal
What HX findings would be consistent with Candidiasis?
- Diabetes
- Antibiotics
- Stress
- Nutrient Deficiencies
- Immunocompromised
- Oral contraceptives
What are common management strategies for Candidiasis?
- Topical antifungal treatment (Clotrimazole 1%
a.k.a. Canesten) - Oral antifungals (Fluconazole, Nystatin)
- Pt Edu. Prevention (smoking cessation, personal
hygiene, nutrition) - Refer to higher medical authority (MO/PA)
What is the common name for Candidiasis?
Yeast Infection
Pediculosis (Lice) Overall
Transmission: Most commonly by direct contact with infected individuals. May also occur indirectly (sharing of combs, etc.).
Prevalence: Predominantly in younger children. More common in females than males.
How is Pediculosis transmitted?
Most commonly by direct contact with infected individuals. May also occur indirectly (sharing of combs, etc.).
What is the prevalence of Pediculosis?
Predominantly in younger children. More common in females than males.
If Pediculosis was present, what would be found on exam?
- Pruritus (itchiness ++)
- Lesions due to burrowing and biting of lice
- Lice or scabs may be seen
- Excoriation may cause secondary changes and infection!
What are common management strategies for Pediculosis?
- Prevention/Education/Reassurance
- Topical insecticides (permethrin/ivermectin)
- Systemic Therapy (oral ivermectin)
- Refer to higher medical authority
What is the common name for Pediculosis?
Lice
How is Scabies transmitted?
Scabies burrow into skin, then breed/lay eggs.
If Scabies were present, what would be found on exam?
- Burrow lines: gray/skin colored ridges. Either
linear or wavy - Inflammatory papule or nodule
- Well-demarcated plaques covered by a very thick crust or scale
Define Scabies
An infestation of the skin by mites
In addition to Scabies, what Deferential Diagnosis should be considered?
Bedbugs can be easily confused with Scabies
What are common management strategies for Scabies?
- PT education (wash all clothing/bedding at a high temperature)
- Scabicides (Permethrin or Ivermectin)
- Antihistamines
- Refer to higher medical authority
List the differences between Scabies VS Bedbugs
Scabies:
- Microscopic
- Burrow marks into skin
- Intense itching
- Prefer moist folds of skin
Bedbugs:
- Bugs can be seen with naked eye
- Bites and moves on in a pattern
- Bites any exposed skin
Define Urticaria
Vascular reaction of the skin that release from the release of histamines and other vasoactive substances
If Urticaria was present, what would be found on exam?
- Pruritus
- Sharply defined wheals may remained small or
enlarged - Erythema
- Edema
True or False, Urticaria can be chronic
True
What are common management strategies for Urticaria?
- Prevention (Mitigating or eliminating the cause, it
etiology is known) - Antihistamines
- Oral glucocorticoids
- Refer to higher medical authority
Define cellulitis
Bacterial infection characterized by an acute reaction spreading to the dermis or subcutaneous tissues and originating at the site of bacterial entry
If Cellulitis was present, what would be found on exam?
- Erythema, Hot and Edema
- Shiny plaque with tender area originating at the
site - Borders usually sharply defined, irregular and
slightly elevated - Vesicles, bullae, erosions, abscesses, hemorrhage
and necrosis may form in the area
What are common management strategies for Cellulitis?
- Meds : Oral or IV antibiotics (Abx) + Analgesics
- Dressings (sterile saline dressings for local pain)
- Supportive Measures (rest, immobilization,
elevation) - Refer to higher medical authority
Define Ingrown Toenail
Incurvation of nail border into adjacent nail fold, causing pain
What causes an Ingrown Toenail?
- Tight shoes
- Trauma/abnormal gait
- Toe shape/genetics
- Excess nail trimming
If an Ingrown Toenail was present, what would be found on exam?
- Painful nail folds with various degrees of
erythema and swelling - Abscess may form secondary to it and produce
discharge
What are common management strategies for Ingrown Toenail?
- Conservative approach for mild cases:
- Soak in warm water & Epsom salts
- Cotton wedge between nail and painful fold
- Change footwear
- Antimicrobial therapy
- Potential surgical removal of nail (Nail resection) - Refer to higher medical authority
Define Blisters (Bullae/Vesicles)
A collection of fluid below or within the epidermis
What causes blisters?
Rounded, elevated lesion containing serous fluid (plasma), due to burns, bites, friction, contact dermatitis, and drug reactions. Also present in skin frailty disorders
What are common management strategies for Blisters?
- Area cleaned/dried and protective dressing
applied (2nd skin, moleskin, etc.) - Unless blister is painful or interferes with
function due to its size, it should not be
punctured - Activity as tolerated
- Pt Edu: Consider proper precaution against
future blisters (Double socks, foot powder,
better boots)
Define Warts (Verrucae)
Warts are small benign growths on the skin caused by Human Papillomavirus (HPV)
If Warts were present, what would be found on exam?
- Rough, flat or raised papules, sometimes
blanched - Ranging from 1-10 mm in diameter
- Commonly asymptomatic
- Common on hands, knees and elbows
- Can be single or clustered
- Patient may request removal due to cosmetic
disfigurement
What are common management strategies for Warts?
- Wart Parade: freezing = cryotherapy, liquid
nitrogen - Topical salicylic acid
- Refer to higher medical authority
Define Contact Dermatitis
Generic term applied to acute or chronic inflammatory reactions caused by substances that were in contact with the skin.
Cell-mediated (delayed) hypersensitive reaction in normal skin due to contact with a strong allergen
If Contact Dermatitis was present, what would be found on exam?
- May create rashes or dry skin,
- Acute Irritation: burning, erythema, swelling, blisters,
- Chronic Irritation: erythema, itching, tinging/pain if fissures develop, dryness, scaling and crusting
What are common management strategies for Contact Dermatitis?
- Avoidance/remove irritant/wash area,
- Clean secondary sources like hair and nail,
- Use barrier cream, moisturizers, and topical
corticosteroids (betamethasone), - Antihistamines,
- Refer to higher medical authority
