Flashcards in Dermatology Deck (74):
When taking a dermatological history, what aspects should be explored?
History of presenting complaint
Past medical history
Quality of life impact and ICE
What aspects of the presenting complaint should be explored?
Duration and changes
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
What aspects of the past medical history should be explored?
History of atopy
What are the atopic conditions?
What system can be used to analyse skin type?
Fitzpatrick skin types
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)
What aspects of social history should be explored?
Exposure to chemicals
Improvement of symptoms when away from work
What aspects of a drug history should be explored?
Regular and recent drugs
Systemic and topical treatments used
How should the use of topical treatments be explored?
How long for?
How should quality of life impact and ICE be explored?
Impact of skin on life
When examining the skin what parts should be examined?
All sites, including:
How should a dermatological examination be conducted?
When palpating the skin, what should be assessed?
What mnemonic can be used to describe the skin?
S - site and distribution/size and shape
C - colour
A - associated changes
M - morphology
How can colour be described?
Erythema (blanching redness)
Purpura (red or purple non-blanching)
How can a lesion/rash’s morphology be described?
How does a macule feel on palpation?
How does a papule feel on palpation?
Raised but in a small area
How does a patch feel on palpation?
Flat but in a large area
How does a plaque feel on palpation?
Raised, but broader than it is high
How does a nodule feel?
Like a papule but >1cm
What is a vesicle?
A clear fluid filled lesion
What is a pustule?
A pus filled lesion
What is a bulla?
A large fluid filled lesion
What shape is an annualar lesion?
What presents with a wheal?
What shape is a discoid lesion?
What forms can a comedone come in?
Open (black head)
How can pigmented lesions be assessed?
A - asymmetry
B - border
C - colour
D - diameter
E - evolution
What surface features can be described?
What is scale?
Built up keratin
What is crust?
What is excoriation?
Erosion from scratching
What is erosion/ulceration?
Partial/full thickness loss of skin
What are fissures?
What hair findings can be found on examination?
What is alopecia?
Alopecia describes hair loss, can be patchy or diffuse
What is hypertrichosis?
Excess of hair
What is hirsuitism?
Excess androgenic pattern of hair in women
What nail findings can be found on examination?
What is koilonychia?
Spooning of the nails
What can koilonychia indicate?
What disease is pitting of the nails associated with?
What is onycholysis?
Separation of the nail from the nail bed
What diseases is onycholysis associated with?
How common is acne?
When can acne occur?
Infantile (due to maternal hormones in breast milk)
Adult (12% of women and 5% of men, 5% of both genders will have it for life)
What are the risks associated with acne?
Can have severe psychological affects
Where on the body is acne most common?
T-zone of the face
Describe the pathophysiology of acne
Follicular plugging occurs, causing increased sebum
Then become infected by propionobacterium acnes
What can cause acne?
Medication (especially the POCP)
When should acne be referred early?
In patients with darker skin types who are more prone to scarring
What is another name for eczema?
What symptom is required for an eczema diagnosis?
Where does eczema typically affect in children?
Where does eczema typically affect in adults?
Flexures e.g. cubical fossa and popliteal fossa
What do eczema lesions most commonly become infected with?
What can indicate a staph aureus infection in eczema?
One side looks different to the other
What is a serious complication of eczema?
Infections with herpes zoster/herpes simplex
What does eczema management consist of?
Education and advice
Antibiotics to treat infection
What education and advice should be given to eczema patients?
Keep nails short
Regular bath/shower (no soaps)
Avoid aqueous creams
How should eczema patients use moisturisers?
Apply as often as possible, at least 3-4 times/day
Use ointments or creams
What is another name for moisturisers?
When are creams more suitable then ointments?
For use in the day as they are less oily
What should be done in the case of resistant eczema?
Consider inadequate steroid treatment
Consider incorrect diagnosis
What is the most common form of psoriasis?
What is the average age of onset for psoriasis?
Describe the pathophysiology of plaque psoriasis
Increased rate of skin turnover leading to keratin excess
What is the normal turnover rate of skin?
What is the turnover rate of skin in plaque psoriasis?
Where does plaque psoriasis typically affect?
When can psoriasis look less scaly?
In flexural or genital psoriasis where the sweat makes it look more red and moist