Lecture 7- Basic dermatology skills Flashcards
taking a dermatological history
ASK QUESTIONS FIRST THEN LOOK AT COMPLAINT
1) Presenting complaint
- Usually a single symptom
- Nature (e.g. rash vs lesion)
- Site
- Duration
2) History of presenting complaint
- Initial appearance and evolution
- Time line
- E.g. has it just appeared or have you just noticed it
- Has it changed?
- Symptoms (particularly itch and pain)
- Blanching? etc
- Aggravating and relieving factors
- Previous and current treatments (effective or not)
3) Past medical history
- Systemic disease
- History of atopy (asthma, hay fever, eczema)
- History of skin cancer or pre-cancer
- History of sunburn/sunbathing/sun-bed use
- Skin type
4) Family history
- Fx of skin disease
- Fx of atopy
- Fx of autoimmune disease
5) Social history
- Occupation
- Sun exposure
- Contactants
- E.g. latex glove allergic- dermatitis
- Improvements in PC when away from work
6) Drug history and allergies
- Regular and recent
- Systemic and topical
- Get specific with topical treatments
- Where??
- How much?
- How long for?
7) Impact on quality of life / ICE
What is used to TYPE skin
Filzpatrick skin types
physical exam
describe acronymn
-
S
- Site, distribution (rash)
- Size and shape (lesion)
-
C
- Colour and configuration
-
A
- Associated changes e.g. surface features
-
M
- Morphology
ABCD for pigmented lesions
- Asymmetry
- Border (irregular or blurred)
- Colour
- Diameter
terms used for describing site and distribution
- generalised
- flexural
- extensor
- photosensitive
generalised
lesions distributed randomly over most of the body surface area (widespread) or within an anatomical region.
flexural
related to flexion, or skin folds, such as the backs of knees, the armpits, the elbow creases and the groin.
extensor
involving extensor surfaces of limbs. Contrast with flexor surfaces.
e.g. elbows
photosensitive
increase in the reactivity of the skin to sunlight.
terms used for describing colour
- erythematous
- pupurpic
- brown or black
- hypopigmented
erythematous
red and blanching
Blanching of the skin is defined by the paling or whitening of skin
pupuric
bleeding into the skin, either as petechiae (small red, purple or brown spots) or ecchymoses (bruises); purpura does not blanch with pressure (diascopy).
brown or black
Hyperpigmentation — darkened skin compared to normal; it can be localised or generalised.
hypopigmented
skin colour that is paler than normal.
terms used for describing configuration
discrete
confluent
linear
target
discrete
Separate, distinct lesions that are not joined to one another.
confluent
Joining or running together.
linear
a linear shape to a lesion often occurs for some external reason, such as scratching; also known as striate.
target
concentric rings like a dartboard; also known as iris lesion.
terms used for describing morphology
macule
papule
patch
plaque
nodule
vesicle
pustule
bulla
annular
wheal
discoid/nummular
comedone
macule
flat lesion less than 1cm, without elevation or depression
papule
elevated, solid lesion less than 1cm
patch
flat lesion greater than 1cm, without elevation or depression
plaque
flat, elevated lesion, usually greater than 1cm
Flat lesion=
macule (smaller <1cm) and patch (bigger>1cm)
Raised lesion=
papule (<1cm) and plaque (>1cm)
nodule
elevated, solid lesion greater than 1cm
vesicle
elevated, fluid-filled lesion less than 1cm
pustule
elevated, pus- filled lesion usually less than 1cm
bulla
elevated, fluid filled lesion, usually greater than 1cm
annular
ring/circle shaped
wheal
urticaria (hives)
also spelt ‘wheal’, is a transient elevation of the skin due to dermal oedema, often pale centrally with an erythematous rim and without surface change. Wealing indicates urticaria or an urticaria-like condition.
discoid/nummular
Nummular lesion — round (coin-shaped) lesions; also known as discoid.
comedown
open or closed
skin-coloured, small bumps (papules) frequently found on the forehead and chin of those with acne. A single lesion is a comedo.
terms for descriving surface features
scale
crust
excoriation
erosion/ulceration
scale
Scaling or hyperkeratosis — an increase in the dead cells on the surface of the skin (stratum corneum). Descriptive terms for scale include:
- Desquamation (skin coming off in scales)
- Psoriasiform (large white or silver flakes)
- Pityriasiform (branny powdery scale)
- Lichenoid (apparent scale is tightly adherent to the skin surface)
- Keratotic (horny scale)
- Exfoliation (peeling skin)
- Maceration (moist peeling skin)
- Verrucous (warty).
crust
Crusting — the result of plasma exuding through an eroded epidermis. It is rough on the surface and is yellow or brown in colour. Bloody crust appears red, purple or black.
excoriation
a loss of the epidermis and a portion of the dermis due to scratching or an exogenous injury. It may be linear or punctate.
erosion/ulceration
partial or full thickness loss
a sore due to the superficial or partial destruction of surface tissue such as the skin.
alopecia (patchy)
Alopecia areata is a condition that causes hair to fall out in small patches, which can be unnoticeable
alopecia (diffuse)
hypetrichosis
is excessive hair growth over and above the normal for the age, sex and race of an individual, in contrast to hirsutism, which is excess hair growth in women following a male distribution pattern.
hirsuitism
women that results in excessive growth of dark or coarse hair in a male-like pattern — face, chest and back.
koilonychia
known as spoon nails, is a nail disease that can be a sign of hypochromic anemia, especially iron-deficiency anemia. It refers to abnormally thin nails (usually of the hand) which have lost their convexity, becoming flat or even concave in shape.
putting nails
Nail pitting is when you have tiny dents in your fingernails or toenails. It can be a sign of psoriasis, eczema, or joint inflammation. You might also get them if they run in your family
Onycholysis
is a common medical condition characterized by the painless detachment of the nail from the nail bed, usually starting at the tip and/or sides.
clubbing
Clubbed fingers is a symptom of disease, often of the heart or lungs which cause chronically low blood levels of oxygen. Diseases which cause malabsorption, such as cystic fibrosis or celiac disease can also cause clubbing. Clubbing may result from chronic low blood-oxygen levels.
