Integumentary System Flashcards
IntegSys: Current cond x 5, duration x 3, & location x 5
Current condition:
- when did it start?
- course of disease; steady or intermittent
- main symptoms
- which areas are affected?
- what makes it better or worse?
Duration:
- Onset - sudden Vs gradual
- Prev Episodes - photo-dermatoses tend to recur every spring w the onset of warmer weather
- Change - fluctuation Vs persistent; consider variation in severity eg; occupational contact allergies will improve when Pt on Hols
Location:
- not just skin, ? mucous membranes
- site of lesion is important
- eczema tends to be on flexural surfaces; whilst psoriasis tends to be on extensor parts
- distribution; genitals, sweaty areas, sun exposed skin
- isolated or spreading?
IntegSys: factors x 2, assoc* symptoms x 4, & Rx response
Provoking/relieving factors:
- heat & cold may either provoke or relieve, esp; urticaria
- certain meds do the same
Associated symptoms:
- Itch
- Tenderness - inflammation is often tender
- bleeding/discharge - bleeding, ? malignancy; discharge, ? Infected lesion
- systemic symptoms - pyrexia, malaise, joint pain/swelling, weight loss (remember some skin lesions are markers for malignancy)
Response to Rx:
- prescribed, OTC medications & Rx’s & their effectiveness
IntegSys: PMHx x 3 & FHx x 4
PMHx:
- details of prev skin infections
- common skin Dx; eczema, psoriasis, acne
- systemic Dx; diabetes, TB, immunosuppression
FHx:
- ?familial trend for Dx
- genetic predisposition is important in many; eczema & psoriasis
- concurrent/recurrent infection of other fam member; ? Contagious or environmental aetiology; scabies
- familial atypical mole & melanoma (FAMM) syndrome; multiple melanocytic lesions across fam members w at least 1 x melanoma
IntegSys: drug & allergy Hx x 6, social Hx x 7
Drug & allergy Hx:
- current topical & systemic drugs
- other topical & systemic drugs used in the past for skin & their effect
- Hx suggesting contact allergy; perfume
- Hx drug allergies
- Hx immediate allergies
- recreational drug use may have dermatological manifestations; acne & anabolic steroids
Social Hx:
- current impact of skin Dx on life & work
- impact of work on skin Dx
- alcohol can worsen psoriasis
- smoking is associated w palmoplantar pustulosis (lil’ pustules on palms/feet) & hidrandenitia suppurativa (acne in joints, underarms, butt crack)
- Hx high sun exposure/sun bed use
- travel may increase risk of some exotic skin Dx
- occupational/recreational activities may provide insight
IntegSys: psych/social seq* x 3 & DLQI
Psychological or social sequelae:
- anxiety/depression/social isolation due to skin cond
- psychological probs can cause some skin cond
- consider dermatology life quality index (DLQI)
DLQI
- questions relate to last week of life & scored out of 30
- >10 equals sig* effect on QoL
IntegSys: Phys* Ass; optimal cond x 6 & Gen* points x 5
Optimal conditions:
- maintain privacy
- chaperone or colleague present PRN
- provide gown
- ensure good lighting
- always explain process & gain prior consent
- equip: ruler, magnifying glass or dermatoscope!
General points All areas:
- hair growth pattern?
- hair pigmentation?
- skin pigmentation?
- is condition symmetrical?
- sun damage patterns; differences between covered & uncovered areas?
IntegSys: phys* Ass; areas to assess x 8
Scalp:
- feel scalp, pull hair appart, check edges of hair/scalp line
- note any baldness, scaring, or unusual thickness/twistiness
Ears:
- signs of sun damage at edges
- scaliness suggest seborrheic dermatitis
- discrete tender area on prominent ridge suggests chondrodermatitis
- psoriasis/eczema
Face:
- exam in areas of max sun exposure; forehead, cheeks, nose for skin CAs
- hair growth; eye lashes & eyebrows
- Eyes - mucosal surfaces; changes, dryness, excessive tearing, discolouration
- Lips - mouth, check tongue, gums, & buccal mucosal surfaces (white net like patter of lichen planus)
Neck, Axillae & Arms:
- Flexures
- Axillae; erythrasma, hidradenitis, suppurativa, fungal inf, psoriasis, seborrhoeic dermatitis
- antecubital fossa; atopic eczema
- Extensors
- elbows - psoriasis
- Hands
- wrists - scabies
- finger webs - irritants, contact derm, scabies
- nails - fungal inf*, psoriasis
Trunk: Back, Chest, Adbo & Buttocks:
- upper trunk - acne
- flexures - intertrigo (fungal looking rash in skin folds)
- nipples - atopic eczema, contact derm*, Paget’s Dx
- umbilicus - psoriasis
Genitalia, Perineum, Groin, & Peri-anal skin:
- contact Derm, fungal inf, intertrigo, genital warts or discharge
Legs:
- flexures - atopic eczema
- knees - psoriasis
- lower legs - varicose veins
- ankles - venous eczema
Feet:
- soles - pustular psoriasis
- toe webs - fungal infections
- toe nails - fungal infections
IntegSys: documentation
Documentation:
- note position
- distribution; symmetrical or asymmetrical
- note flexor or extensor surfaces involved
- area of friction or pressure
- sweaty or exposed regions?
- sexual contact factor?
- single/multiple lesions?
- measure size
- note; shape, colour, regularity or irregularity
- areas on inflammation
- consider if edges are clearly defined, or not
IntegSys: rash morphology egs
Macular - small patch of skin altered in colour, but not elevated
Papular - elevated, solid, palpable lesion </= 1cm diameter
Vesicular - small blisters, circumscribed lesion </= 1cm & contains liquid
Crusty - plasma exuding thru eroded epidermis
Urticarial - red & raised like hives
IntegSys: lesion morphology focus
Lesion morphology:
- look for tenderness
- warmth
- site within layers of skin; superficial/deep
- thickness
- consistency; chard, firm, soft, fluctuant
- blanching/non-blanching
- friable (crumbly) or bleeds easily
- any scaling
- look for evidence of infestation; scabies burrows
IntegSys: diagnosis & further tests
Check charts & diagnostic tables where needed
Other tests:
- swabs
- skin scrapings
Refer for
- Wood’s light
- skin biopsy
- patch & prick tests
Assess, Document & Refer!! (Unless in urgent care)
