Flashcards in Dermatology Deck (22)
How to take a dermatological history ?
For dark lesions or moles, pay attention to questions marked with an asterisk (*).
-Nature, site and duration of problem
HISTORY OF PRESENTING COMPLAINT:
-Initial appearance and evolution of lesion*
-Symptoms (particularly itch and pain)*
-Aggravating and relieving factors
-Previous and current treatments (effective or not):
-Recent contact, stressful events, illness and travel
-History of sunburn and use of tanning machines*
-Skin type (see page 70)*
-History of atopy i.e. asthma, allergic rhinitis, eczema
-History of skin cancer and suspicious skin lesions
-Family history of skin disease*
-Occupation (including skin contacts at work)
-Improvement of lesions when away from work
MEDICATION AND ALLERGIES:
-Regular, recent and over-the-counter medications
IMPACT OF QOL:
-Impact of skin condition and concerns
Structure of describing a rash ?
-Distribution – where is it? E.g. flexures/extensor
-Configuration – grouping of the rash – e.g. linear, annular, clustered
-Morphology – what sort of lesions
How to examine the skin ?
-Site and number of lesion(s)
-If multiple, pattern of distribution and configuration
DESCRIBE the individual lesion:
-Size (the widest diameter), Shape
-Associated secondary change
-Morphology, Margin (border)
*If the lesion is pigmented, remember ABCD (the presence of any of these features increase the likelihood of melanoma):
-(A)symmetry (lack of mirror image in any of the four quadrants)
-Two or more (C)olours within the lesion
-(D)iameter > 6mm
PALPATE the individual lesion:
-Examine the nails, scalp, hair and mucous membranes
-General examination of all systems
What do each of these configuration terms mean ?
-Discrete = Individual lesions separated from each other
-Confluent = Lesions merging together
-Linear = In a line
-Target = Concentric rings (like a dartboard)
-Annular = ring shaped
-Discoid / nummular = A coin-shaped/round lesion
What is a macule ?
Flat (non-palpable) area of altered colour <0.5cm e.g. freckle
What is a patch ?
Flat area of altered colour >0.5cm e.g. port-wine stain
What is a papule ?
Solid raised lesion <0.5cm e.g. xanthomata
What is a nodule ?
Solid raised lesion >0.5cm with deeper component e.g. granuloma
What is a vesicle ?
Raised, clear, fluid filled lesion <0.5cm e.g. HSV
What is a bulla ?
Raised, clear, fluid filled lesion >0.5cm
What is a pustule ?
Pus containing lesion <0.5cm e.g. acne
What is a abscess ?
Localised accumulation of pus in dermis or subcutaneous tissuee.g. periungual
What is a weal ?
Transient, raised lesion due to dermal oedema e.g. urticaria
What is a boil ?
Staphylococcus infection around or within hair follicle
What is excoriation ? (secondary lesion)
Loss of epidermis following trauma e.g. eczema
What is lichenification ? (secondary lesion)
Well-defined roughening of skin with attenuation of skin markings
What is scale ? (secondary lesion)
Flakes of stratum corneum e.g. psoriasis (silver scaling)
What is crust ? (secondary lesion)
Rough surface of dried blood, serum or bacteria e.g. burst blister
What is a scar ? (secondary lesion)
New fibrous tissue occurring post wound healing, may be atrophic (thinning), hypertrophic (hyperproliferation within boundary), or keloidal (beyond boundary)
What is an ulcer ? (secondary lesion)
Loss of epidermis and dermis
What is a fissure ? (secondary lesion)
Epidermal crack due to excess dryness, e.g. eczema