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what are the 10 main parts to the HPC of a dermatology patient?
- 1. when: longstanding, enlarging (BCC), childhood (eczema), sudden onset (drug eruption)
- 2. where: sun exposed (melanoma), hands (contact dermatitis), extensors, flexors
- 3. what looked like & how changing (melanoma)
- 4. symptoms: itch/bleed
- 5. aggravating/relieving: sunlight in lupus
- 6. impact on QOL: acne psych/relationships
- 7. Rx already tried: emollient, photo, topical steroids, systemic
- 8. risk factors: sun exposure (sailor, gardener, australia, red hair blue eye)
- 9. atopic history: asthma, eczema, hayfever
- 10. previous malignancy: recurrent BCC, metastasic disease
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what are the 4 things to include when describing a skin lesion?
- description
- surface characteristic
- distribution
- morphology
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what are the 7 main different descriptions?
- macule/patch
- papule
- nodule
- plaque
- vesicle
- pustule
- bulla
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what is a macule?
- FLAT
- skin discolouration - white (loss of melanin), erythema (vascular dilatation+inflamm)
- <0.5cm
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what is a papule?
elevated lesion <0.5cm
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what is a nodule?
- elevated lesion >0.5cm
- eg molluscum
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what is a plaque?
- FLAT
- raised lesion
- (shelf like)
- eg psoriasis
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what is a vesicle
- fluid filled lesion
- <0.5cm
- eg herpes simplex
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what is a pustule?
pus filled lesion eg acne
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what is a bulla?
- fluid filled lesion
- >0.5cm
- eg after insect bite reaction
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what are the 5 different surface characteristics of a skin lesion?
- scale
- ulcer
- crust
- excoriation
- lichenification
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what is scale?
visible, palpable flake of aggregated EPIDERMAL CELLS
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what is crust?
dried exudate
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what is lichenification?
- flat surfaced
- hard thickening of the skin with accentuated skin markings
- reaction to long standing scratching and inflammation
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what is an excoriation?
- superficial ulceration secondary to scratching
- loss of epidermis
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what is a nummular lesion?
coin like lesion
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what is the difference between an ulcer and an erosion?
- erosion: superficial loss of EPIDERMIS that heals without scarring
- ulcer: loss of whole thickness of epidermis and upper dermis
- healing results in scar
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what are the different distributions?
- localised: tumour
- generalised: rash
- regional: eg wrists
- contact dermatitis
- dermatomal: shingles
- photosensitive area
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what are the different forms of a generalised rash?
- peripheral v central
- flexors
- extensors
- symmetrical: endogenous or exogenous from hairdresser or nurse with gloves
- asymmetrical: exogenous - chef with knife in dominant hand
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what are the 5 different morphologies?
- monomorphic: all look same
- pleomorphic: eg looks different
- clustered: eg HSV, insect bites
- annular: tinea corporis
- koebnerisation: eg psoriasis
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which rash can be described as pleomorphic?
chickenpox
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what are the 3 main skin conditions that show koebnerisation?
- psoriasis
- Lichen planus
- viral warts
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which 3 other places should you examine in dermatology?
- mouth
- nails
- lymph nodes
- organomegaly
- pedal pulses - leg ulcers
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what is the difference between patch testing and prick testing?
- patch testing places substances on the SURFACE of the skin
- identifies SKIN allergies
- prick testing tests for allergies that don't necessarily occur on skin eg allergy to pollen, foods,
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what is the difference in hypersensitivity reactions between patch and prick testing?
- patch: cell mediated type IV hypersensitivity eg hair dye, nickel, latex - contact dermatitis
- prick: IgE mediated, type 1 hypersensitivity - mast cells have IgE receptors and degranulate
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what investigations can be done in derm?
- 1. photograph the skin lesion to monitor changes
- 2. dermoscopy: magnifying glass- see different LAYERS of skin
- 3. mycology: eg fungus - need to confirm the diagnosis as it is 6-8 weeks of oral Rx
- 4. swabs - microbiology/PCR for viral
- 5. biopsy: histology/stains/immunofluorescence studies
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