Dermatology – history taking, examinations and explanations

1. Dermatology – history taking, examinations and explanations Andriana Harris, Chieun Han

2. History • Site • Localised or diffuse • Symmetrical or asymmetrical • Which body parts • Appearance • Size • Shape • Edge – well or poorly demarcated • Colour – erythematous, pigmented, loss of pigment

3. Describing the lesion • Associated symptoms • Crusting, scaling, lichenification, excoriation, surrounding skin • Pain, blistering, bleeding

4. History of presenting complaint • Previous episodes • Exposure • Sun or sunbeds • Xrays • Arsenic (UV radatiation)

5. Rest of the history • Systemic symptoms • Anorexia, weight loss, fever, malaise • Past medical history • Keratoses or scabs in past which were frozen or removed • Drug history • UV drug therapy • Family history • Social history

6. Examination • Say you would like to expose to underwear • Maintain dignity with a blanket • Systematic approach • Top to bottom, arms and legs • SONG – scalp, oral cavity, nails, genitalia (only offer!) • If you find something  palpate  describe • Cover patient • Present fully to examiner • To complete… use dermatoscope, systemic examination

7. Rashes

9. Eczema • Skin is made up of a layer of water then a layer of immune cells below to protect itself • In eczema there is a reduction in water  dryness  allows more things into the skin  activates the immune cells  redness • Inflammation of skin that flares and relaxes • Usually starts in early childhood • Associated with asthma and hayfever • Emollients used to replenish the water layer • Steroid creams used to reduce inflammation

11. Psoriasis • Top layer of skin has a fixed period of time before it is renewed • In psoriasis, there is a faster than normal cell turnover  excess amount of new cells  plaques  activates the immune cells below  redness • Emollients used to soften plaques • Vitamin D based treatments and cold tar used to reduce cell turnover • Steroid creams to reduce inflammation

12. Rashes to the face

14. Acne vulgaris • Erythematous papules and pustules to the cheeks, measuring xmm, edges are poorly demarked and there is associated crusting and scaring • Surrounding skin is unaffected • During your teenage years you make more sebum (oil)  greasy appearance to skin • Whitehead or blackhead – pore that has become blocked • Papules – sebum collects under blocked pores, bacteria liver there and can cause inflammation  red skin

16. Acne rosacea • Erythematous papules and pustules to the cheeks and nose, measuring xmm, edges are poorly demarked and there is associated comedomes • Surrounding skin is erythematous

18. Impetigo • Erythematous papules and macules to the chin, measuring xmm, edges are poorly demarked and there is associated crusting

19. Moles – benign

20. Moles – malignant

22. Basal cell carcinoma • Solitary skin coloured papule, with a pearly edge and central telangectasia, it measures xmm, there are no associated features • Can be local tissue invasion and ulceration • Rarely metastases

24. Squamous cell carcinoma • Erythematous papule with well defined edges, measuring xmm, there is associated ulceration and crusting • More aggressive than basal cell carcinoma • Lesion changing in shape or size in a sun exposed area is SCC until proven otherwise

26. Melanoma • Irregular pigmented macule with irregular, well demarcated borders and it measures at xmm, there are no associated features • Can be found in immunocompromised patients • Strong family history • If diagnosed early the survival rate can be 100% • Shape and size changes so it can be superficial and then become nodular

27. Skin manifestations of systemic diseases

28. KAHOOT