1. Approach in Clinical Dermatology (Notes)
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1. Approach to dermatology patient a. Careful history i. Before a full history is done, patient is often examine briefly ii. Prompt right questions b. Thorough physical examination c. Usage of laboratory tests i. Skin biopsy ii. Skin scrapping iii. Wood’s lamp iv. Patch test 2. Important history a. HOPI i. Duration of lesion ii. Pattern of spread / evolution iii. Associated symptoms 1. Itching 2. Pain 3. Fever iv. Aggravating factors v. Relieving factors 3. Physical examination a. Have 3 major skin signs i. Morphology ii. Distribution (Site) iii. Configuration / arrangement b. Morphology i. Primary lesions 1. Macule / patch a. Flat area of altered colour / texture b. Macule <0.5cm c. Patch >0.5cm 2. Papule / nodule a. Elevated solid lesion b. Papule <0.5cm c. Nodule >0.5cm 3. Plaque a. Elevated lesion with >2cm width 4. Vesicle / bullae
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Dermatology
Transcript of 1. Approach in Clinical Dermatology (Notes)
1. Approach to dermatology patienta. Careful historyi. Before a full history is done, patient is often examine brieflyii. Prompt right questionsb. Thorough physical examinationc. Usage of laboratory testsi. Skin biopsyii. Skin scrappingiii. Woods lampiv. Patch test2. Important historya. HOPIi. Duration of lesionii. Pattern of spread / evolutioniii. Associated symptoms 1. Itching2. Pain3. Feveriv. Aggravating factorsv. Relieving factors3. Physical examinationa. Have 3 major skin signsi. Morphologyii. Distribution (Site)iii. Configuration / arrangementb. Morphologyi. Primary lesions1. Macule / patcha. Flat area of altered colour / textureb. Macule 0.5cm2. Papule / nodulea. Elevated solid lesionb. Papule 0.5cm3. Plaquea. Elevated lesion with >2cm width4. Vesicle / bullae a. Fluid filled blisterb. Vesicle 0.5cm5. Pustule / abscess a. Pus filled blisterb. Pustule 0.5cm6. Petechiae / ecchymosesa. Extravasation of blood into skinb. Petechiae 0.5cm7. Wheal / angioedema a. Accumulation of dermal oedemab. Wheal = dermal oedema of any sizec. Angioedema = dermal + subcutaneous oedema8. Tumour9. Papilloma10. Burrow11. Comedone a. Plural for comedo b. Also known as blackheads12. Purpura, bruise 13. Telangiectasiaa. small, widened blood vessels on the skin14. Poikiloderma a. Extra pigmentation of the skin that demonstrates a variety of shadesb. Associated with widened capillaries (telangiectasia) in the affected areaii. Secondary lesions (evolve from primary lesions)1. Scale a. Flake arising from horny layerb. Seen in psoriasis2. Crusta. Dried blood / tissue fluid b. May look like scalec. Seen in impetigo3. Keratosisa. growth of keratin on the skin or on mucous membranesb. horn like thickening of skin4. fissurea. slit in the skin5. Erosiona. Complete or partial loss of epidermis6. Ulcera. Loss of whole epidermis and part of dermis7. Excoriationa. Ulcer / erosion produced by scratchingb. Common in skin picking disorder8. Lichenification a. Thickened, leathery skin with increased skin markingsb. Usually the result of constant scratching and rubbingc. Seen in actoopic eczema9. Scar, atrophy10. Sinus11. Pigmentation 12. Striaec. Description of primary / secondary lesionsi. Colour1. Brown (Melasma)2. Yellow (Xanthelasma)3. Blue, grey (Naevus of Ota)ii. Shape1. Oval a. Seen in Pityriasis rosea2. Round a. Seen in Pityriasis versicolor3. Polygonala. Seen in Lichen Planus4. Polycyclic a. 2 or more rings or coilsb. Seen in subacute cutaneous lupus5. Domea. Seen in Molluscum Contagiosum6. Annulara. Ring likeb. Seen in Tinea corporisiii. Margin1. Well defineda. Seen in psoriasis2. Ill defineda. Seen in eczema3. Rolling margina. Has raised bordersb. Can be traced with tip of pencilc. Seen in basal cell carcinomaiv. Surface1. Dome shaped2. Pedunculated3. Verrucous4. Umbilicated5. Flat topped6. Acuminate (spire like)4. Distributiona. Isolated (Single)i. Seen in Keratocanthomab. Flexurali. Seen in atopic eczemac. Regionali. Seen in psoriasisd. Generalisedi. More than 90% of body surface area (BSA) affected by erythrodermaii. Seen in cutaneous lymphomae. Symmetrical i. Seen in vitiligof. Sun exposed areasi. Usually by photodermatitis (SLE, drug induced) g. Intertriginousi. Occurred in web spaces such as armpitii. Seen in Tinea crurish. Folliculari. Seen in folliculitisi. *** Diferential diagnosis of Erythrodermai. *Erythroderma is not a diagnosis but a presentationii. Psoriasisiii. Etopic eczemaiv. Seborrhic eczemav. Cutaneous lymphomavi. Drug allergy5. Configuration / arrangementa. Reticulate / retiformi. Net like appearanceii. Seen in Lichen planus, Livedo reticularisb. Zosterismi. Seen in Herpes Zosterc. Groupedi. Seen in herpes labialisd. Lineari. Seen in contact dermatitise. Serpiginousi. Seen in cutaneous larva migransf. Arcuatei. Curved likeg. Nummulari. Rounded / coin likeii. Seen in discoid eczemah. Annulari. Ring like6. Other examinationsa. Hair and nailsi. Psoriasis patients nail can present with1. Leukonychia2. Onycholysis3. Separation of nail from the bedb. Mucous membranesi. Steven Johnson can affect mucosal membranesc. General physical examinationi. Check the lymph nodes in lymphomaii. Check the joints in SLE
