Session 4 Flashcards
DERMATOLOGICAL HISTORY
• Presenting complaint - • Nature (e.g. rash vs lesion)
• Site
• Duration
• History of presenting complaint - • 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
• Past medical history -• 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*
• Family history - • Family history of skin disease*
• Family history of atopy
• Family history of autoimmune disease
• Social history - • Occupation
• Sun exposure*
• Contactants
• Improvement in PC when away from work
• Drug history and allergies - • Regular and recent
• Systemic and topical
• Get specific with topical treatments!
• Where?
• How much?
• How long for?
- Impact on quality of life / ICE• Impact of skin complaint on life
- Ideas
- Concerns
- Expectations- • Impact of skin complaint on life
- Ideas
- Concerns
- Expectations
What are the different skin types?
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EXAMINING THE SKIN and description of physical findings
Inspect
describe
palpate
systemic check - whole skin, hair, nails, mucous membranes
How to describe a skin condition?
SCAM • S - Site, distribution (rash) • or 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
How to describe Site & Distribution of a skin condition
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How to describe Configuration of a skin condtion
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How to describe the colour of a skin condition
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How to describe the Surface Features of a skin condition
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How to describe the hair findings in a skin condition
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How to describe nail findings?
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Case presentation
• A 42 year old man with a background of chronic plaque psoriasis has presented to Accident Emergency feeling unwell.
• Describe the rash?
• Describe which functions of the skin are impaired in this patient?
• What is the name of this clinical presentation?
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panopto
Functions of the skin
- Protective barrier against environmental insults
- Temperature regulation
- Sensation
- Vitamin D synthesis
- Immunosurveillance
- Cosmesis
Erythroderma and its complications
- > 90% of body surface area affected, erythematous and exfoliatitive
- Causes: psoriasis, eczema, drugs, cutaneous T cell lymphoma
- Symptoms: pruritus, fatigue, anorexia, feeling cold
- Signs: erythematous, thickened, inflamed, scaly, no sparing
- ‘Total skin failure’
- Hypothermia (loss of thermoregulation)
- Infection (loss of protective barrier)
- Renal failure (insensible losses)
- High output cardiac failure (dilated skin vessels)
- Protein malnutrition (high turnover of skin)
Cells of the Epidermis
- 4 major cell types each with individual function
- Keratinocytes - protective barrier
- Langerhan cells- antigen presenting cells
- Melanocytes- produce melanin which provides pigment to the skin and protects cell nuclei from UV DNA damage
- Merkel Cells - contain specialised nerve endings for sensation
Layers of the epidermis
- 4 layers of the epidermis
- Each layer represents a different stage of maturation of the keratinocyte
- Average epidermal turnover time is about 30 days
- The 4 layers of the epidermis include: stratum basale (basal layer), stratum spinosum, stratum granulosum, stratum corneum (horny layer- most superficial)
- Stratum lucidum found in areas of thicker skin such as palms and soles