BCC / Clinical Consultation NLT

DERMATOLOGY

1) Psoriasis
- Skin lesions / Precipitating factors / joint pains / Cushing’s $
2) Vitiligo
- Skin lesions / Thyrotoxicosis / AP$
3) Neurofibromatosis
- Skin lesions / Increasing skin lump / Hypertension / Seizures
4) Acanthosis nigican
- Skin lesions / Risk factors – e.g. obesity, DM, hypothyroid, Cushing’s
5) Systemic sclerosis
- Skin changes / Raynauld’s $ / Joint pain / Swallowing problem / SOB (Lung fibrosis)
6) SLE / DLE
- Skin rash / Joint pain / Fatigue or unwell / Wt loss / SOB / Raynauld’s / APL$
7) Dermatomysitis
- Skin rash / Proximal myopathy / Swallowing problem
8) Tuberous sclerosis
- Skin lesions / Seizure / Haematuria
9) Sturge Weber’s $
- Skin lesions / Seizure
10) HHT
- Skin leions / Epistaxis / GI bleeding / SOB
11) Pemphigus / Pemphigoid
- Skin lesions

APPROACH
1) Bullous skin lesions
2) Scaly / Papulosquamous rash
3) Hypopigmented or Hyperpigmented lesion
4) Drug induced rash
5) Angio-oedema
6) Photosensitive rash
7) Skin lesions in front of the shin
8) Skin lesions + Seizure
9) Skin lesions in renal transplant patient
10) Skin lesions in DM patient
11) Leg ulcer

APPROACH TO DERMATOLOGY PROBLEMS

- Introduction
- Look at a glance to patient for spot diagnosis
- Focus history
- C/O
- SOCRATES - *Asso: - pain, pruritus, paresthesia, photosensitivity
- skin, nails, hair, mucous membrane, joints
- Background history – Past / Drugs* / Family / Personal
- Focus examination
- Primary site
- Others - Face *Skin, Nails, Hair, Mucous membrane, Joints
Limbs
Relevant system
- Concern
BCC / Clinical Consultation NLT
CAUSES OF BULLOUS SKIN LESIONS
BCC / Clinical Consultation NLT
CAUSES OF SCALY / PAPULOSQUAMOUS LESIONS

CAUSES OF HYPOPIGMENTATION
1. Vitiligo
2. Pityriasis alba: depigmented areas on the face, particularly in children, with or without scale
3. Pityriasis versicolor: hypopigmentation or, less commonly, hyperpigmentation can occur
4. Idiopathic guttate hypomelanosis: multiple small areas of depigmentation in chronically sun-exposed skin
5. Systemic sclerosis
6. Leprosy
7. Ash leaf patch
8. Birth marks
9. DLE (mixed hypo-hyper pigmentation)
10. Generalised – Albinism, rarely phenylketonuria and hypopituitarism

CAUSES OF HYPERPIGMENTATION
1. Acanthosis nigrican
2. Leprosy
3. Drug eruption
4. Fungal infections
5. Moles and freckles
6. Café au lait spots
7. DLE (mixed hypo-hyper pigmentation)
8. Chronic dermopathy – e.g. DM, CKD (mixed hypo-hyper pigmentation)
9. Healed ulcers/wound/skin lesions
10. Post-inflammatory skin lesions (mixed hypo-hyper pigmentation)
11. Pellagra
12. Generalised – Addison, Haemochromatosis,
BCC / Clinical Consultation NLT
SKIN LESION IN FRONT OF THE SHIN
1. Pretibial myxoedema
2. Erythema nodosum
3. Necrobiosis lipoidica diabetocorum
4. Pyaderma gangrenosum

CAUSES OF SKIN LESIONS IN DM PATIENTS

1. Necrobiosis lipoidica diabeticorum
2. Diabetic dermopathy,
3. Granuloma annulare,
4. Leg ulcers,
5. Eruptive xanthomata,
6. Vitiligo,
7. Acanthosis nigrican
8. Candidiasis

SKIN LESIONS IN RENAL TRANSPLANT PATIENT

1. Infection – Skin TB, Viral infection
2. Skin malignancy – SCC
3. Drug reactions

CAUSES OF SKIN LESIONS AND SEIZURES (NEURO-CUTANEOUS DISORDERS)

1. Neurofibromatosis
2. Tuberous sclerosis
3. Sturge Weber’s $

CAUSES OF PHOTOSENSITIVE RASHES

BCC / Clinical Consultation NLT
CAUSES OF ANGIOOEDEMA

CAUSES OF LEG ULCER

BCC / Clinical Consultation NLT