D2– Dermatology MCCQE 2002 Review Notes
APPROACH TO THE DERMATOLOGY PATIENT
HISTORY
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age, race, occupation (especially exposures), hobbies
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details of skin eruption should include:•location, onset, duration (persistent versus intermittent eruption)•alleviating and aggravating factors (plant contact, cosmetic/jewellery use,exposure to heat/cold/sunlight, relationship to foods/spices)• associated skin symptoms•changes in sensation (itchiness, burning, pain)•changes in surface (dryness versus discharge)•past history including investigations and therapy
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associated systemic symptoms (weight loss, malaise, fever, diarrhea, arthralgias, muscle weakness)
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medications and allergies
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past dermatological history
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family history of atopy, skin cancer, psoriasis
PHYSICAL EXAM
(How to describe a Lesion)
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S
ize
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C
olour (e.g. hyperpigmented, hypopigmented, erythematous)
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A
rrangement (e.g. solitary, linear, reticulated, grouped, herpetiform)
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L
esion morphology (see Table 2)
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D
istribution (e.g. dermatomal, intertriginous, symmetrical/asymmetrical, follicular)
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A
lways check hair, nails, mucous membranes and intertriginous areas
Table 1. Skin Phototypes
PhototypesColour of Skin WithoutSkin’s Response to Sun ExposureSun ExposureI
WhiteAlways burns, never tans
II
WhiteAlways burns, little tan
III
WhiteSlight burn, slow tan
IV
Pale BrownSlight burn, faster tan
V
BrownRarely burns, dark tan
VI
Dark brown/blackNever burns, dark tan
DEFINITIONS
PRIMARY MORPHOLOGICAL LESIONS
Table 2. Types of Lesions
< 1 cm Diameter
≥
1 cm DiameterRaised Superficial Lesion
Papule (e.g. wart)Plaque (e.g. psoriasis)
Palpable Deep (dermal)
Nodule (e.g. dermatofibroma)Tumour (e.g. lipoma)
Lesion (not necessarily raised)Flat Lesion
Macule (e.g. freckle)Patch (e.g. vitiligo)
Elevated Fluid-filled Lesions
Vesicle (e.g. herpes simplex virus (HSV))Bulla (e.g. bullous pemphigoid)
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primary lesion
: an initial lesion that has not been altered by trauma or manipulation, and hasnot regressed
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pustule
: a vesicle containing purulent exudate (white, yellow, green)
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cyst
: a nodule containing semisolid or fluid material
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erosion
: a disruption of the skin involving the epidermis alone
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ulcer
: a disruption of the skin that extends into the dermis or deeper
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wheal
: a special form of papule or plaque that is blanchable andtransient, formed by edema in the dermis (e.g. urticaria)
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scar
: replacement fibrosis of dermis and subcutaneous tissue
SECONDARY MORPHOLOGICAL LESIONS
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develop during the evolutionary process of skin disease, or are created by manipulationor complication of primary lesion lesion (e.g. rubbing, scratching, infection)
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crust
: dried serum, blood, or purulent exudate originating from a lesion (e.g. impetigo)
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scale
: excess keratin (e.g. seborrheic dermatitis)
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