http://www.flickr.

com/photos/epsos/4883281674/sizes/o/in/photostream/

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Dermatology: skin health and disease

Catherine Hyde Click to edit Master subtitle style GP and Teaching fellow Year 1 clinical co-lead 25th November 2012

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A. B. C. D.

2% 10% 30% 70%

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What % of the population is affected by skin problems at any time?

A. B. C. D.

2% 10% 30% 70%

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What % of the population is affected by skin problems at any time?

Plan

Keratinocytes & psoriasis 80 year old man with a skin lesion

keratinocytes and melanocytes

Questions

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What do I need to know

What do I need to know?

Normal skin and how this relates to pathology Terminology for skin Common disease Systemic disease with skin manifestations Rare and serious disease: recognition and referral Common benign conditions

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Knowledge

What do I need to know?

Skills

Pattern recognition
epSos.de. Cute Dog Puppy On flicker.com http://www.flickr.com/photos/epsos/4883281

Managing uncertainty

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Taking history and examining skin

What is the main function of the skin?

A.

Protecting from mechanical stresses and micro-organisms Synthesis of vitamin D Regulating body temperature and fluid loss Sensing the environment and potential damage

B. C.

D.

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What is the main function of the skin?

A.

Protecting from mechanical stresses and micro-organisms Synthesis of vitamin D Regulating body temperature and fluid loss Sensing the environment and potential damage

B. C.

D.

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Normal Skin
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Yellow raincoats by chispita_666 flickr.com http://www.flickr.com/photos/gusilu/2699275381

Epidermis

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Keratinocytes
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Epidermis is mostly keratinocytes, migrate from the basal layer differentiating 40-50 days Active in Vitamin D synthesis

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Psoriasis
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Keratinocyte Abnormal differentiation Hyperproliferation Psoriasis Common 1-2% population Multiple lesions Separate (discrete) On knees and arms (extensor surfaces) Discoid Red/erythematous/salmon pink Scaly

Mysiana (2007) Pink. Flickr.com [accessed 18/03/2012] http ://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/

Psoriasis
Treatment Ladder Topical Moisturisers Coal tar vitamin D analogues Immunosuppressants (Steroids/dithranol ) For widespread disease Phototherapy Chemotherapy (low dose) Biological therapy
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Skin Treatment in general

Review eg after 6weeks Put something on it - moisturiser

- antifungal/antibiotic - steroid immunosuppressant/specials

Take something for it :antibiotic/ antifungal/immunosupressant Burn it off (cautery/cryotherapy)

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Nothing - reassure and advised

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80 yr old man

Normal skin with mole (naevus) 10/27/12

Senile Keratosis Senile : older age Keratosis: from keratinocytes

Senile Keratosis: Benign proliferation of keratinocytes

Senile Keratosis
1. Inspect Generally Single or Multiple lesions Discrete (separate) or confluent (flow together) 10/27/12

2. Describe individual lesion SCAM Size (the widest diameter), Shape Colour Associated secondary change Morphology, Margin

0.5 cm Oval Pigmented (no erythema) Raised Clear well-defined

Senile Keratosis
2b For any pigmented lesions ABCDEF: Asymmetry Border risk of malignant melanoma if irregular or indistinct Colour haphazard, different shades Diameter Elevation Fitting in with other moles 10/27/12

3. Palpate the lesion Surface Consistency Mobility Tenderness

Raised Waxy/warty Non-mobile Non-tender Normal temperature

Senile Keratosis
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80 yr old man
10/27/12 Normal skin with mole (naevus)

A. B. C. D.

1,000 3,000 9,000

11,000

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If lung cancer affects 41,000 people per year, malignant melanoma affects?

A. B. C. D.

1,000 3,000 9,000

11,000

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If lung cancer affects 41,000 people per year, malignant melanoma affects?

Melanocytes

Melanoma : malignant proliferation of melanocytes 1. Inspect Generally Single lesion Skin generally sun damaged

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Melanocytes: in epidermis, produce melanin which protects skin against UV radiation

Malignant melanoma
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Malignant melanoma
3. Dont forget to palpate 10/27/12

2b For any pigmented lesions :ABCDEF Asymmetry Border Colour Diameter Elevation Fitting in with other moles

Asymmetrical Irregular border 3 different shades of colour 0.7cm Flat Different from surrounding skin

Malignant melanoma
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A. B. C. D.

1,000 4,000 9,000

13,000

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Of the 36,000 possible diagnoses in medicine, how many are dermatological?

A. B. C. D.

1,000 4,000 9,000

13,000

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Of the 36,000 possible diagnoses in medicine, how many are dermatological?

Uncertainty in dermatology
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Definitely melanoma

Definitely not melanoma: Definitely senile keratosis

Images from John Hopkins Medical Institute. DermAtlas.org (2000) http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459 [ accessed 18 march 2012]

Uncertainty in dermatology
10/27/12 Definitely melanoma Urgent referral and treatment Definitely not melanoma: Definitely senile Review keratosis Reassure & in 6 advise weeks
Images from John Hopkins Medical Institute. DermAtlas.org (2000) http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459 [ accessed 18 march 2012]

What have we covered?

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Skin is important in health and disease What do I need to know about dermatology How to describe a lesion Keratinocytes & Psoriasis from basics to management Melanocytes and melanoma Managing uncertainty in skin

Useful Information
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http://dermnetnz.org/ excellent images and treatment advice British Association of Dermatology (bad.org.uk ) Dermatology: Handbook for medical students & junior doctors 2009. ABC of dermatology. Buxton, PKand MorrisJones,R. BMJ books. London. 2009. Notes on dermatology. Liz Tatman. www.askdoctorclarke.com