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Skins starting off

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If you can make the diagnosis you are there! ... Biopsy: special points, difficulties of dermal histopathology. Definitions. Macule ... – PowerPoint PPT presentation

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Title: Skins starting off


1
Skins starting off
  • Dr Bruce Davies

2
You are not alone!
  • Every registrar wants to talk about this!
  • From all countries and medical schools!
  • Which says something!

3
Introduction
  • If you can make the diagnosis you are there!
  • Most people try and do pattern recognition and
    when that fails are confused and lost
  • A systematic approach enables most diagnoses to
    be made
  • Dermatology is no different from other things but
    there are some special points

4
Summary
  • History
  • Examination
  • Dermatological Pharmacology
  • Nomenclature
  • Investigations
  • Definitions

5
History - 1
  • Time
  • When - did it start, how long
  • Where - did it start, is it now
  • Spread
  • Course - episodic, previous rashes, continuous

6
History - 2
  • Description
  • Patients description - distribution, shape, size,
    previous variation
  • Symptoms
  • Itch - think of scabies, lice, eczema, urticaria,
    exanthemata, psoriasis, dermatitis herpetiformis
  • Pain

7
History 3
  • Symptoms
  • Weeping/bleeding
  • Provoking factors - environment, sunlight,
    temporal, drugs, temperature, occupation, hobbies
  • Relieving factors - as above treatment including
    OTC

8
History - 4
  • Symptoms of associated structures
  • Mucous membranes
  • Scalp
  • Nails
  • General
  • Family, Contact, occupation
  • PMHx, Drug use, Atopy, bowels, joints

9
Examination
  • Knowing what the special dermatology
    morphological words mean is half the story
  • Distribution
  • Symmetry
  • Area affected - exposed, seborrheic,
    gravitational, napkin, dermatomal
  • Pattern - linear, clustered

10
Examination - 2
  • Morphology
  • Primary lesion - Macule, papule, nodule, pustule,
    vesicle, bulla, weal, plaque
  • Size
  • Colour / shine
  • Surface - scale, lichenification, exudate,
    ulceration.
  • Edge - regularity, distinctiveness
  • Associated features - Telangiectasis,
    vascularity, purpura, excoriation, scarring,
    involvement of hair follicles

11
Examination 3
  • Related structures
  • Hair / scalp
  • Nails
  • Mucous membranes
  • Other structures as relevant
  • E.g. lymph glands, joints etc

12
Investigation
  • Ultraviolet light
  • Fungal specimens how much, scrapings and
    clippings
  • Biopsy special points, difficulties of dermal
    histopathology

13
Definitions
  • Macule
  • From the Latin for a stain. Any change in colour
    or consistency, without elevation above the
    surface of surrounding skin. Does not blanch on
    pressure.
  • Papule
  • Circumscribed raised lesion lt1cm in diameter.
  • Nodule
  • Circumscribed raised lesion gt1cm in diameter.
  • A rash may be a mixture, hence "macular papular
    rash" etc.

14
Definitions - 2
  • Plaque
  • Think of a commemorative plaque stuck on the wall
    of a building. An area of skin raised slightly
    above the surrounding skin which is extensive,
    usually greater than 3cm across. Think of
    psoriasis.

15
Definitions - 3
  • Vesicles
  • Circumscribed raised lesions containing clear
    fluid. lt0.5cm in diameter.
  • Pustules
  • Circumscribed raised lesions containing cloudy
    fluid. lt0.5cm in diameter.
  • Not necessarily infected.
  • Bullae
  • Circumscribed raised lesions containing clear
    fluid. gt0.5cm in diameter.
  • CF "pustular bullae"
  • Can you "roll" it - i.e. push it, if you can its
    superficial as in superficial scalds, or deep
    seated when you can't move it.
  • Cyst
  • A fluid filled cavity below the dermis. The above
    lesions are in the dermis

16
Definitions - 4
  • Nummular / Discoid
  • From Latin for coins and discs. No real
    distinction. Flat disc like lesions of various
    sizes.

17
Definitions - 5
  • Erythema
  • From the Latin for redness, Dilatation of the
    superficial skin capillaries, causing redness.
    Always blanches.
  • Purpura
  • Damage to superficial skin capillaries that have
    leaked blood. Do not blanch.
  • Angioma
  • A tumour of blood vessels. Blanch, circumscribed.
  • Telangiectasia
  • Small permanently dilated blood vessels in the
    skin. Blanch, linear.

18
Definitions - 6
  • Erosion
  • An area of partial loss of the dermis or mucous
    membrane
  • Ulcer
  • An area of full loss of the dermis or mucous
    membrane.
  • Fissure
  • A crack or split in the dermis

19
Definitions - 7
  • Excoriation
  • Scoring of the dermis from abrasion - usually
    scratching.
  • Lichenification
  • Hard thickening of the skin, with exaggerated
    skin markings, folds and creases.

20
Definitions - 8
  • Crust
  • Dried serum
  • Scale
  • Excessive accumulation of keratin on the skin

21
Definitions - 8
  • Xeroderma
  • Dry skin
  • Icthyosis
  • From the Latin for fish. Excessively dry skin,
    scaly.
  • Beau's lines
  • Transverse lines on the nails after acute illness
  • Pompholyx
  • Blistering form of eczema may be vesicular or
    pustular. Podo for soles and cheiro- for palms.

22
Dermatological pharmacology
  • The introductory section of chapter 13 of BNF is
    compulsory reading!
  • Potency
  • The steroid ladder
  • The maximum absolute effect, nothing to do with
    dilution, or vehicle.
  • Value of getting to know own "ladder"

23
Least occlusive Vehicles The ladder of how
occlusive it is. Most occlusive Plastic or
plastic backed dressings Bandages Pastes
Ointments "Lipocreams" Creams Lotio
ns Solutions or "Applications"
24
  • Expients
  • Positive and negative effects
  • Moisturisers, Emollients and bath additives
  • The theory of and how they work.

25
  • White no sugar thanks
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