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Flashcards in Dermatology Deck (74):
1

When taking a dermatological history, what aspects should be explored?

Presenting complaint

History of presenting complaint

Past medical history

Family history

Social history

Drug history

Quality of life impact and ICE

2

What aspects of the presenting complaint should be explored?

Nature (rash/lesion)

Site

Duration and changes

3

What aspects of the history of the presenting complaint should be explored?

Initial appearance and evolution

Symptoms (particularly itch/pain)

Aggravating and relieving factors

Previous and current treatments

4

What aspects of the past medical history should be explored?

Systemic diseases

History of atopy

Skin cancer

Sunburn/sun-bed use

Skin type

5

What are the atopic conditions?

Asthma

Eczema

Hay-fever

6

What system can be used to analyse skin type?

Fitzpatrick skin types

7

What aspects of family history should be explored?

Family history of skin disease (e.g. psoriasis)

Family history of atopy

Family history of autoimmune disease (e.g. alopecia, vitiligo)

8

What aspects of social history should be explored?

Occupation

Sun exposure

Exposure to chemicals

Improvement of symptoms when away from work

9

What aspects of a drug history should be explored?

Regular and recent drugs

Systemic and topical treatments used

10

How should the use of topical treatments be explored?

Where applied?

How much?

How long for?

11

How should quality of life impact and ICE be explored?

Impact of skin on life

Ideas

Concerns

Expectations

12

When examining the skin what parts should be examined?

All sites, including:

Nails

Mucosa

Hair

13

How should a dermatological examination be conducted?

Inspect

Palpate

Describe

14

When palpating the skin, what should be assessed?

Flat/raised

Warmth

15

What mnemonic can be used to describe the skin?

S - site and distribution/size and shape
C - colour
A - associated changes
M - morphology

16

How can colour be described?

Erythema (blanching redness)

Purpura (red or purple non-blanching)

Pigmented/hyperpigmented (brown/black)

Hypopigmented

17

How can a lesion/rash’s morphology be described?

Macule

Papule

Patch

Plaque

Nodule

Vesicle

Pustule

Bulla

Annular

Wheal

Discoid

Comedone

18

How does a macule feel on palpation?

Flat

19

How does a papule feel on palpation?

Raised but in a small area

20

How does a patch feel on palpation?

Flat but in a large area

21

How does a plaque feel on palpation?

Raised, but broader than it is high

22

How does a nodule feel?

Like a papule but >1cm

23

What is a vesicle?

A clear fluid filled lesion

24

What is a pustule?

A pus filled lesion

25

What is a bulla?

A large fluid filled lesion

26

What shape is an annualar lesion?

Ring shaped

27

What presents with a wheal?

Urticaria

28

What shape is a discoid lesion?

Coin shaped

29

What forms can a comedone come in?

Open (black head)

Closed

30

How can pigmented lesions be assessed?

A - asymmetry
B - border
C - colour
D - diameter
E - evolution

31

What surface features can be described?

Scale

Crust

Excoriation

Erosion/ulceration

Fissures

32

What is scale?

Built up keratin

33

What is crust?

Dried exudate

34

What is excoriation?

Erosion from scratching

35

What is erosion/ulceration?

Partial/full thickness loss of skin

36

What are fissures?

Cracks

37

What hair findings can be found on examination?

Alopecia

Hypertrichosis

Hirsuitism

38

What is alopecia?

Alopecia describes hair loss, can be patchy or diffuse

39

What is hypertrichosis?

Excess of hair

40

What is hirsuitism?

Excess androgenic pattern of hair in women

41

What nail findings can be found on examination?

Koilonychia

Pitting

Onycholysis

42

What is koilonychia?

Spooning of the nails

43

What can koilonychia indicate?

Iron deficiency

44

What disease is pitting of the nails associated with?

Psoriasis

45

What is onycholysis?

Separation of the nail from the nail bed

46

What diseases is onycholysis associated with?

Psoriasis

Thyroid disease

47

How common is acne?

Very common

48

When can acne occur?

Infantile (due to maternal hormones in breast milk)

Adolescent

Adult (12% of women and 5% of men, 5% of both genders will have it for life)

49

What are the risks associated with acne?

Painful

Scarring

Can have severe psychological affects

50

Where on the body is acne most common?

T-zone of the face

Shoulders

Chest

51

Describe the pathophysiology of acne

Follicular plugging occurs, causing increased sebum

Then become infected by propionobacterium acnes

52

What can cause acne?

Hormones

Cosmetics

Medication (especially the POCP)

53

When should acne be referred early?

In patients with darker skin types who are more prone to scarring

54

What is another name for eczema?

Atopic dermatitis

55

What symptom is required for an eczema diagnosis?

Itchy

56

Where does eczema typically affect in children?

Face

57

Where does eczema typically affect in adults?

Flexures e.g. cubical fossa and popliteal fossa

58

What do eczema lesions most commonly become infected with?

Staph aureus

59

What can indicate a staph aureus infection in eczema?

One side looks different to the other

60

What is a serious complication of eczema?

Infections with herpes zoster/herpes simplex

61

What does eczema management consist of?

Education and advice

Moisturiser

Steroids

Antibiotics to treat infection

62

What education and advice should be given to eczema patients?

Keep nails short

Regular bath/shower (no soaps)

Avoid aqueous creams

63

How should eczema patients use moisturisers?

Apply as often as possible, at least 3-4 times/day

Use ointments or creams

64

What is another name for moisturisers?

Emollients

65

When are creams more suitable then ointments?

For use in the day as they are less oily

66

What should be done in the case of resistant eczema?

Investigate compliance

Consider inadequate steroid treatment

Consider infection

Consider incorrect diagnosis

67

What is the most common form of psoriasis?

Plaque psoriasis

68

What is the average age of onset for psoriasis?

28

69

Describe the pathophysiology of plaque psoriasis

Increased rate of skin turnover leading to keratin excess

70

What is the normal turnover rate of skin?

23 days

71

What is the turnover rate of skin in plaque psoriasis?

5 days

72

Where does plaque psoriasis typically affect?

Elbows

Knees

Trunk

73

When can psoriasis look less scaly?

In flexural or genital psoriasis where the sweat makes it look more red and moist

74

What can flexural/genital psoriasis often be confused for?

Fungal infection