Dermatology Terminology Department of Dermatology © 2013

Learning Outcomes To be able to accurately describe lesions and rashes to colleagues. To be able to write a clear dermatology referral. Department of Dermatology © 2013

Ask The Right Questions Department of Dermatology © 2013

Symptoms - Does it itch? Department of Dermatology © 2013 Scabies Psoriasis Eczema Bowens Tinea corporis Department of Dermatology © 2013

Symptoms - Is it painful? Also notice the pattern of the rash. Department of Dermatology © 2013

Intermittent or constant? Urticaria is rarely visible when patients visit the doctor but can be diagnosed by history. Department of Dermatology © 2013

Is it anywhere else? Patient may focus on an acute eruption and ignore a chronic long-standing problem, which may be related. Department of Dermatology © 2013

How did it start? In Pityriasis Rosea, a solitary patch appears for several days followed by large numbers all over the torso. The original herald patch is important. Department of Dermatology © 2013

Foreign travel? Leishmaniasis – North Africa / Mediterranean. Cutaneous larva migrans – tropical beaches. Department of Dermatology © 2013

Associated symptoms Some skin disorders follow a prior illness. Sore throats caused by Streptococcus precede guttate psoriasis. Drug eruptions are common with antibiotics. Department of Dermatology © 2013

Examining the patient The whole patient should be examined. Examine in a systematic fashion, eg hands, then arms, face and trunk. Remember scalp, nails and feet. Always palpate lesions/rashes. Request patient permission and check for pain first. Department of Dermatology © 2013

Rashes are composed of multiple (primary) lesions, arranged in particular patterns and affecting particular body sites. Department of Dermatology © 2013

Key terminology to describe lesions Example Small macule/ large patch: Pustule: Papule: Vesicle: Department of Dermatology © 2013

Lesion terminology (2) Nodule: Bulla (blister): Plaque: Lesion Example Telangiectasia: Department of Dermatology © 2013

Lesion terminology (3) Colour Crusting / scaling Shape / patterns Erythema (red) Pigmented (brown) Crusting / scaling Shape / patterns Annular / discoid / serpiginous Well defined / ill defined Erythrodermic psoriasis Tinea corporis Department of Dermatology © 2013

Secondary changes Scar: Necrosis: Excoriation: Lesion Example Lichenification: Department of Dermatology © 2013

Your go (1) Department of Dermatology © 2013

Your go (2) Department of Dermatology © 2013

Your go (3) Department of Dermatology © 2013

Your go (4) Department of Dermatology © 2013

Your go (5) Department of Dermatology © 2013

Your go (6) Department of Dermatology © 2013

Conclusion As always, patient history very important Check occupation Key lesion terminology For rash describe individual (primary) lesions and distribution Department of Dermatology © 2013

GROUP WORK Divide into 3 groups: Group 1 - Acne Group 2 - Eczema Group 3 - Psoriasis Discuss the questions on the laminated sheets for 10 minutes Plenary (7 minutes per group): Nominate a spokesperson Feedback to the whole group

ACNE - Case 1 This 17-year-old boy has had this problem since he was 13. He has bought numerous preparations from the pharmacy with little effect. Describe the features seen in this photo. Discuss the treatment options including follow-up and counselling issues.

ACNE - Case 2 This 16-year-old boy developed acne when he was 13. He has tried multiple other treatment with little success and is deeply disturbed about the appearance of his skin. Describe the features seen in this photo? What severity of acne does this patient have and why? Discuss the likely treatments he may have received. What is the treatment of choice? What counselling issues arise?

ECZEMA - Case 1 This 36-year-old man has had this type of eczema intermittently for two years. What questions do you need to ask this patient? What type of eczema is most likely? Discuss the management options.  

ECZEMA - Case 2 This 7-year-old boy has had this type of eczema since he was a baby. Describe the features seen in this photo and describe potential complications. What type of eczema has this patient got? What are common exacerbating factors? Discuss the management options.

PSORIASIS This 45-year-old man developed this problem over 25 years ago. Describe the features seen in this photo What type of psoriasis has this patient got? What other body sites would you wish to check? What treatment options and counselling issues would you discuss with the patient?