introductory lecture on clinical dermatology covering what dermatology is, how to take a history in dermatology, how to examine the skin, descriptive terms, inflamatory dermatoses, skin tumours and cancers
An introduction to clinical dermatology
What is dermatology?
Broad speciality
Diseases of the skin
Study and research of the skin and disorders of the skin
Includes hair, skin, nails, and membranes
Why is it important?
Incredibly common
Many skin problems managed in general practice
Chronic skin diseases are very problematic
The quality-of-life deficit in acne
Acne scored highly relative to other problems
Can impact patients very negatively
Taking a dermatology history
Normal medical histories
Think of other aspects
Standard structure
Occupation
Access to UV light, animals
Various sites might be affected
Think about medical history especially atopy and history of skin cancer
Family histories
Medications
Impact on the quality of life
Drug allergies
Can be a problem in skin disease
Skin rashes
Steven-Johnson syndrome
Desquamation
Examining the skin
Need good light
Inspect closely
Describe
Palpate
Systemic checks
Can be diagnosed by seeing and recognising patterns
Inspection
Psoriasis in nails – can have discoloration, lifting, nail pitting
Koebnerisation
Tools to help inspection
Woods lamp – UVA pigmentary changes and fluorescent infections
Dermoscopy – pigmented lesions to diagnose melanomas
Examining the skin
Site, Colour, Associated secondary changes and the Morphology
Asymmetry
Irregular border
Two or more colours
, Diameter
Distribution and pattern
Generalise (everywhere), widespread (extensive), localised (one place), flexural (skin
folds)
Scoring systems
Think about distribution to think about what has caused it
Photosensitive
Dermatome – around a single nerve
Examining hair and nails
Lichen planus
o Nails
o Scalp
o Hair
o Mucous membranes
o Presents around ankles and wrists
Palpate the individual lesion
Surface
Consistency
Mobility
Tender
Temperature
Descriptive terms for signs and symptoms
Lesion – area of altered skin
Naevus – localised malformation
Pruritus – itching
Descriptive terms for colour
Erythema – redness with blanches on pressure
Can be on palms or other places
Vascular changes
Purpura – red or purple areas
Petechiae – small pinpoint
Ecchymoses – bruise like patches
Hyper pigmentation
Darker skin due to various causes
Increase in melanin
Can occur due to contraceptives, pregnancy, and inflammation
Often more noticeable in skin of colour
De-pigmentation
White skin due to absence of melanin
Vitiligo
Inflammatory dermatoses
Acne
o Affects many young adults
o Can affect face, back and chest
o 8th most prevalent disease worldwide
o Disease of sebogensis
o Can lead to scarring
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