Tutorial 4 - Dermatology (A) - terminology Flashcards
How would you structure a dermatological history?
1. Explore history of presenting complaint.
2. Explore PMH
3. Explore FH
4. Explore social history
5. Current medication.
6. Explore how it affects their quality of life.
- History - Duration of lesion, associated symptoms (i.e. itching, bleeding, blistering, systemic symptoms), evoloution of rash / lesion, fluctuate or persistent lesion, relieving / exacerbating factors, past treatments tried.
- PMH - History of skin conditions, conditions which can present with skin changes.
- FH - Some skin conditions can run in the family i.e., psoriasis.
- Social history - Work / hobbies, exposure to sun, sun bed use, smoking / alcohol, sexual history, travel.
- Current medications - Prescribed, OTC and herbal current treatments.
- How is the dermatological concern affecting the patient’s life and mental health.
How would you examine a dermatological lesion ?
- INSPECT
- DESCRIBE
- PALPATE
- SYSTEMIC CHECK
What is involved in the INSPECTION ?
- General observation
- Comment if rash or lesion
- Establish pattern of distribution.
What is involved in the DESCRIPTION ?
- ABCD:
- Asymmetry (is it a mirror image?)
- Boarders (has it got regular boarders?)
- Colours (Is it one colour / mixture of colours)
- Diameter (size)
What is involved in the PALPATION?
- TEMPERATURE
- TENDERNESS
- MOBILITY
- CONSISTENCY
- SURFACE
What is involved in the SYSTEMIC CHECK?
Examine nailbeds, scalp, hair and mucous membranes.
What is meant by PRURITUS?
Itching
What is meant by LESION?
- Single area of altered skin.
What is meant by RASH?
- Multiple lesions
- Widespread eruptions
What is meant by NAVEUS?
- Another term for a mole.
What is meant by COMEDONE?
- Blockage of a sebaceous follicle by sebum, can present as whiteheads or blackheads.
What is meant by GENERALISED?
- All over the body.
What is meant by LOCALIZED?
- Restricted to one area of skin only.
What is meant by FLEXURAL?
- In body folds, i.e. groin, behind ears.
What is meant by EXTENSOR ?
- Knees, elbows, shins.
What is meant by DISCRETE?
- Individual lesions separated from each other.
What is meant by CONFLUENT
- Individual lesions merging together.
What is meant by LINEAR?
- In a line.
What is meant by TARGET?
- Concentric rings - like that of a target.
What is meant by ANULAR?
- Like a circle or ring.
What is meant by ERYTHEMA?
- Redness which is often due to inflammation / vasodilation - when pressure applied seems to disappear (blanching).
What is meant by PURPURA, PETECHIAE, ECCHYMOSES?
- PETECHIAE - small, pinpoint bleeding (red/purple/brown non blanching lesions)
- PURPURA and ECCHYMOSES are progressively larger red/purple/brown non blanching lesions.
What is meant by HYPOPIGMENTATION?
- Areas of paler skin.
What is meant by HYPERPIGMENTATION?
- Areas of darker skin.
What is meant by DE-PIGMENTATION?
- White skin due to absence of melanin.
What is meant by MACULE?
- Flat area of altered colour < 1 cm
What is meant by PATCH?
- Flat area of altered skin > 1 cm
What is meant by PAPULE?
- Solid raised lesion <0.5 cm
What is meant by NODULE?
- Solid raised lesion > 1 cm
What is meant by PLAQUE?
- Scaling, raised lesion >0.5 cm
What is meant by VESICE?
- Raise clear fluid lesion < 0.5 cm
What is meant by BULLA?
- Raised clear fluid lesion > 0.5cm
What is meant by PUSTULE?
- Raised, pus containing lesion < 0.5 cm
What is meant by ABSCESS?
- Localized accumulation of pus deep in dermis or hypodermis.
What is meant by EXCORIATION?
- Loss of epidermis following trauma.
What is meant by LICHENIFICATION?
- Thickening / leathery feel of skin.
What is meant by SCALE?
- Visable flakes of the stratum corneum.
What is meant by CRUST?
- Dried exudates (blood)
What is meant by SCAR?
- New fibrous tissue which occurs post wound healing.
What is meant by ULCER?
- Loss of epidermis and dermis.
What is meant by FISSURE?
- An epidermal crack often due to excessive dryness.
What is meant by STRIAE?
- Stretch marks which progress from purple to pink to white.
What is meant by ALOPECIA ?
- Loss of hair
What is meant by HIRSUTISM ?
- Growth of short, course hairs o face, neck, stomach, thighs of a women.
What is meant by CLUBBING ?
- Convex, like an upside-down spoon.
What is meant by KOILONYCHIA ?
- Concave, like a spoon.
What is meant by PITTING ?
- Shallow / deep depression in nail plate.
What are the functions of skin?
- Protection
- Temperature regulation
- Sensation
- Vitamin D synthesis
- First line defence - immunosurveillance.
What are the 3 layers of the skin?
- Epidermis
- Dermis
- Subcutaneous tissue / hypodermis.
What layers make up the epidermis?
- Stratum lucidum (only present on some parts of skin i.e., sole of fee).
- Stratum corneum
- Stratum Granulosum
- Stratum spinosum
- Stratum Basale (actively dividing cells)
What pathology might affect the epidermis?
- Changes in the epidermal turnover rate leading to psoriasis.
- Changes in the surface of the skin - scales / crusting / ulcer.
- Hyper / hypo pigmentation.
What does the dermis contain?
- The dermis is made up of collagen and elastin which give it its strength and elasticity. It also contains immune cells, blood cells, nerve cell, hair shaft / follicle, sebaceous glands, sweat glands.
What pathology might affect the dermis?
- Changes in the contour of the skin - atrophic scarring.
- Papules / nodules
- Changes related to the blood vessels i.e., erythema (vasodilation), urticaria (increased permeability of the blood vessels), purpura (capillary leakage).
What are the 3 types of hair?
- Lanugo hairs (fine long hairs in a foetus)
- Vellus hair (fine short hair found on all body surfaces)
- Terminal hair (coarse long hair on the scalp, eyebrows, eyelashes and pubic hair).
What is the structure of hair?
- Hair shaft
- Hair root
- Hair follicle
What are the 4 hair follicle stages?
- Anagen (growing phase)
- Catagen (transition phase)
- Telogen (resting phase)
- Exogen (shedding phase)
What pathology might affect the hair?
- Reduced / absent melanin production leading to grey / white hair.
- Changes in the duration of the growth cycles.
Briefily describe the structure of the nails.
- Nail plate - outer keratin cover
- Nail matrix - Where the nail plate starts to grow from
- Nail bed - Contains blood capillaries which give nails them their pink colour.
What pathology can affect the nails?
- Abnormalities of the nail bed i.e., splinter haemorrhage.
- Abnormalities of the nail plate i.e., discolouration
- Abnormalities of the nail matrix i.e., pits
What are sebaceous glands and what pathology can they cause?
- Produce sebum, which travels to skin via hair follicle (pilosebaceous unit). The sebum lubricates and waterproofs the skin.
- Sebaceous glands are stimulated by the conversion of androgens to DHT.
- When you have excess sebum production it can block up the hair follicles leading to acne.
