ICA Derm Flashcards
Learn the key components of a dermatological history
Presenting complaint - nature, site, duration
History of presenting complaint - Initial appearance, Location (inc. hair and nails)
- Associated symptoms
- Aggravating and relieving symptoms
- Previous episodes
- Treatments
- Contact history
Past Medical History
- Systemic disease
- History of atopy (eg hayfever + asthma)
- History of skin cancer
- History of sun burn
History part 2
Family History
- Skin disease
- Atopy
- Autoimmune disease
Social History
- Home situation (inc. pets) - Smoking
- DrugsandAlcohol
- Occupation
- Diet
- Cleaning products
Drug History
- Prescribed
- Over the counter (OTC)
Allergies
Idea, concerns and expectation
- Learn the terminology to describe cutaneous physical signs
- Use a systematic approach in describing pigmented lesions (ABCDE mnemonic)
ABCDE (for pigmented lesions)
- A:Asymmetry - B: Border
- C: Colour
- D: Diameter - E:Evolution
- Use a systematic approach to describe a skin complaint (SCAM mnemonic)
Inspection and palpation
SCAM
- S: Site and Distribution (rash) - Size and Shape (lesion)
- C: Colour and Configuration
- A: Associated changes
- M: Morphology
• Appreciate how skin conditions are linked to other diagnoses.
Atopic eczema
A clinical diagnosis - can diagnose just on history
- Treatment
- Education and support
- Avoidance of triggers
Topical - Emollients - Soap substitutes - Steroids and or calcineurin inhibitors - Phototherapy - Systemic therapy
- History
- Begins in childhood, but can occur later
- Atopy
- Topical
- Family
Clinical features
- Pruritus (itchy)
- Typically occurs in skin creases – ‘flexural’
- Can occur in response to a specific trigger (e.g. contact dermatitis)
Acne Vulgaris
- A clinical diagnosis
History
- Adolescents and young adults
- Chronic skin disease – due to blockage of hair follicles in the skin
Multifactorial cause
- Increased sebum production (androgen influence)
- Excessive deposition of keratin in pores
- Overgrowth of Cutibacterium acnes (skin commensal)
- Pro-inflammatory chemicals released in the skin
Treatment
- Topical - Non-antibiotic or Antibiotic
- Systemic - Antibiotics - OCP - Isotretinoin
- Psychological impact
Psoriasis
- A clinical diagnosis
- Treatment
- Topical
- Phototherapy - exposing skin to UV light
- Systemic - oral or injectable
- History
- Chronic skin condition.
- Occurs equally in men and women and can appear at any age but often between 20-30 years and 50-60 years
- Strong genetic predisposition.
- Has a relapsing and remitting course
- Important to identify triggers or iatrogenic causes (mainly medication eg NSAIDS, lithium, anti-malarial etc)
- Multi-factorial autoimmune cause
- T cell cytokine production is stimulated, this in turn causes keratinocyte proliferation.
Urticaria
- A clinical diagnosis
- History
- Acute <6 weeks or chronic >6 weeks
- Triggers - viral infections, NSAIDS etc
- Pathophysiology:
- mast cell degranulation and histamine release leading to increased capillary permeability and leakage of fluid into surround tissue
Treatment
- General education
- Systemic
- H1 anti-histamine - H2 anti-histamine - Other: steroids, ciclosporin, montelukast,
omaluzimab
Describe several functions of skin.
• Describe the key components in the structure of normal skin.
• Be aware of the potential psychological and social impact on patients with skin conditions.
Viral infections
Infections: Viral
- Molluscum contagiosum
- Pox virus - very contagious
- Common infection in children and occurs when a child comes into direct contact with a skin lesion or an object that has the virus on it.
- Appear anywhere
- Small firm spots that have a dimple in the middle.
- Can be itchy -
Usually, self-limiting
- Shingles
- Herpes Zoster virus
- Painful rash
- Tingling feeling in the skin (prior to rash)
- Vesicles, dermatomal,
- Treatment
- Antivirals esp for vulnerable patients and if on face but usually better over time
- Avoiding particular patient groups - can catch chicken pox not shingles
Bacterial infections
Impetigo
- Highly contagious
- Common in children
- Staph or Strep
- Seen in areas of broken skin e.g. eczema and psoriasis
- Treated with topical antibiotics or hydrogen peroxide
In fections: Fungal
- Dermatophytosis infection
- Superficial fungal infection
- Dermatophytes are fungal organisms that need keratin to grow
- Spread by direct contact from other people, animals, soil, and from
fomites - eg people who share showers, gyms and sweating. - Often classified by the area impacted e.g. scalp: tinea capitis, feet:
tina pedis, groin: tinea cruris etc - A clinical diagnosis but can be supported with microscopy and
fungal cultures - Responds well to topic antifungals
- Patient advice - not sharing towels, hygiene
Skin cancers
Malignant melanoma
- Cancer from melanocytes
- Main cause: UV light exposure which can come from the sun and sunbeds
- New mole or a change in appearance of an existing mole
- Can appear anywhere but most common on in areas exposed to the sun
- Risk factors - pale skin, freckles, family history (dark skin happens on palms or soles).
- Usually treated with surgery
- If spread may require radiotherapy
Squamous cell carcinoma
- Characterised by abnormal and accelerated growth of squamous cells (found in the epidermis)
Asymmetry, irregular border, different colours, flaky texture, develops rapidly.
- They develop mostly in areas of skin exposed to the sun, including parts of the face such as the nose, forehead and cheeks. Also, on back or lower legs. -
They are most often diagnosed in people who are middle aged
or older
- Usually treated with surgery to remove affected area of skin
- Basal cell carcinoma
- Commonest type of skin cancer
Shiny, tiny blood vessels, spontaneously bleed, jelly-like contents, translucent bump. - Slow growing – rarely spread
- Older adults
- Occurs when one of the skin’s basal cells develops a mutation in its DNA - Much of the damage to DNA in basal cells is thought to result from (UV) radiation
- Surgery
