Dermatology

Question 1

How do you take a dermatological history?

Answer 1

• Presenting
• Hx of presenting complaint
• Past medical Hx
• Family Hx
• Social Hx
• Drug Hx and allergies
• Impact on quality of life/ ICE

Question 2

What is presenting complaint?

Answer 2

• Nature (e.g. Rash vs lesion)
• Site
• Duration

Question 3

What is history of presenting complaint?

Answer 3

• Initial appearance and evolution
• Symptoms (itch and pain)
• Aggravating and relieving factors (triggers)
• Previous and current treatments (effective or not)

Question 4

What to ask in past medical history?

Answer 4

• Systemic diseases
• History of atopy (asthma, hay fever, eczema)
• History of skin cancer or pre-cancer
• History of sunburn/sunbathing/sunbed use
• Skin type

Question 5

What are the Fitzpatrick skin types?

Answer 5

Type 1 White: always burns, never tan
Type 2 white: usually burns, difficult to tan
Type 3 white: sometimes burns, average tan
Type 4 moderate brown: rarely burns, tans with ease
Type 5 dark brown: very rarely burns, tans very easily
Type 6 black: does not burn, tans very easily

Question 6

What to ask in family history?

Answer 6

• Of skin disease
• of atopy (genetic tendency to develop allergic diseases)
• of autoimmune disease

Question 7

What to ask in social history

Answer 7

• Occupation: sun exposure and contactants
• improvement in PC when away from work

Question 8

What to ask in drug history?

Answer 8

• Regular and recent
• Systemic and topical
• Get specific with topical treatments: Where? How much? How long for?

Question 9

Questions to ask about the impact on life and ICE

Answer 9

• Impact of skin complaint on life
• Ideas
• Concerns
• Expectations

Question 10

What are the steps in skin examination?

Answer 10

• Inspect
• Palpate
• Describe
• Systemic check (whole skin, hair, nails, mucous membranes)

Question 11

Describe SCAM

Answer 11

S: site, distribution (rash) or Size and shape (lesion)
C: colour (and configuration)
A: Associated changes (e.g. surface features)
M: Morphology

Question 12

What to look for in pigmented lesions?

Answer 12

ABCD
Asymmetry
Border (irregular and blurred)
Colour
Diameter

Question 13

What are we looking for in site and distribution?

Answer 13

• Generalised
• Flexural
• Extensor
• Photosensitive

Question 14

What do we look for in configuration?

Answer 14

• Discrete
• Confluent
• Linear
• Target

Question 15

what do we look for in colour?

Answer 15

• Erythematous (red and blanching)
• Purpuric (red/purple and non-blanching)
• Brown or black (pigmented or hyper pigmented)
• Hypopigmented (depigmented if total loss of colour)

Question 16

What do we look for in surface features?

Answer 16

• Scale (buit-up keratin)
• Crust (dried exudate)
• Excoriation (Erosion from scratching)
• Erosion/ulceration: Partial or full thickness loss

Question 17

What do we look for in morphology?

Answer 17

• Macule
• Papule
• Patch
• Plaque
• Nodule
• Vesicle
• Pustule
• Bulla
• Annular (ring shaped)
• Wheal (urticaria)
• Discoid/nummular
• Comedone (open or closed)

Question 18

What do you see in hair findings?

Answer 18

• Alopecia (Patchy)
• Alopecia (diffuse)
• Hypertrichosis
• Hirsuitism

Question 19

What would look for in nail findings?

Answer 19

• Koilonychia
• Pitting
• Onycholysis
• Clubbing