An introduction to clinical dermatology

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