1. Dermatology

2. OSCE
Describing skin rashes and lesions
Skin exam
Explaining eczema and psoriasis
Progress test
Example questions
Systemic associations

3. Where is it? Localised vs diffuse Symmetrical distribution
Which body parts are affected?

4. What does it look like? Size Shape Edge (well- or poorly- demarcated)
Colour (erythematous, pigmented)

5. <5mm >5mm
Macule Skin patch
Plaque
Papule Nodule
Vesicle Bulla
Pustule Pustule

6. Associated with Crusting Scaling Lichenification Excoriation
Surrounding skin?

8. Erythema ab igne Long term exposure to heat Heat packs, radiators
Gets better once source of heat is removed

10. Impetigo Bacterial infection Staph aureus or strep pyogenes
Often children 2-5
Contagious
Treated with topical antibiotics, lasts about 3 weeks

12. Vitiligo Loss of pigment Multifactorial, probably immune related
No cure, can be treated with UV light and steroid creams

14. Rosacea
Long-term, unknown aetiology but may involve triggers such as alcohol, foods, menopause, stress
Mild cases treated with cosmetics and avoiding triggers
Medications: topical metronidazole, oral tetracyclines

15. Skin exam Expose patient to underwear (or say you would)
Check skin systemically (top → bottom, arms → legs)
Maintain dignity with a blanket
If you see a rash or lesion, palpate and describe it
Remember SONG
Cover up patient, present findings
To complete... take a history, use dermatoscope, systemic examinations, scrapes/biopsies

16. REAL PATIENTS???
Eczema
Psoriasis
?other things you may see

17. Eczema
“On the flexor surface, there is an erythematous, dry, scaly rash with multiple vesicles, associated with excoriation and lichenification. This is consistent with atopic eczema”

18. Psoriasis
“On the extensor surface, there is a well-demarcated hyperkeratotic, scaly plaque with underlying erythema. This is consistent with plaque psoriasis”

19. Seborrheic keratosis
Very common in older patients, NOT malignant, has a stuck on appearance.

20. Actinic keratosis
Pre-malignant (SCC), due to sun exposure. Removed with 5-FU or cryotherapy

21. Naevi (moles)
Benign, pigmented

22. Cherry angioma
Occur in middle age, clusters of capillaries, numbers increase with age, benign

23. Acrochordon (skin tag)
Benign, often on skin folds, benign

24. Dermatosis papulosa nigra
Starts in adolescence, benign, occurs more in individuals with dark skin

25. Explaining eczema
Water
Immune cells

26. Explaining eczema

27. Fingertip units

28. Explaining psoriasis
Top layer of skin
Immune cells

29. Explaining psoriasis

30. A 22 year old woman comes into GP
A 22 year old woman comes into GP. She has a 2 month history of weight loss and foul smelling stools. On examination you notice a symmetrical papulovesicular rash across her extensor surfaces with associated excoriation. Tissue transglutanimase antibodies are negative. What is the most likely underlying diagnosis?
A. Inflammatory bowel disease
B. Milk protein allergy
C. ANCA vasculitis
D. Coeliac disease
E. Atopic eczema

31. D. Coeliac disease
Rash is dermatitis herpetiformis

32. A 32 year old woman comes into GP with anxiety
A 32 year old woman comes into GP with anxiety. On examination you see a p'eau d'orange rash on the shins. What is the most appropriate next investigation?
A. Thyroid function tests
B. Liver function tests
C. Full blood count
D. Urinalysis
E. Spirometry

33. A. Thyroid function tests
This is pretibial myxedema, which is associated with Graves disease

34. A 56 year old obese man comes into GP with frequent urination
A 56 year old obese man comes into GP with frequent urination. On examination you see hyperpigmentation of the skin folds. What is the most likely diagnosis?
Urinary tract infection
Type 2 diabetes mellitus
Vitiligo
Psychogenic polydipsia
Diuretic treatment

35. B. Type 2 diabetes mellitus
This is acanthosis nigricans, which is associated with endocrine disorders such as type 2 diabetes, Cushing’s, PCOS and hypothyroidism

36. A nulliparous 24 year old woman comes into gynaecology clinic after three miscarriages over the last 2 years. On examination you see a lace patterned discoloration over the skin of her legs. What is the most likely diagnosis?
A. Antiphospholipid syndrome
B. Erythema ab igne
C. Cervical incompetence
D. Type 2 diabetes mellitus
E. Graves disease

37. A. Antiphospholipid syndrome
The rash is livedo reticularis, which is associated with APS, vasculitis and many other systemic conditions

38. A 30 year old woman comes into GP with frequent mouth ulcers, joint aches and fatigue. On examination of her face you notice a discoid erythematosus rash associated with crusting and scaling. She tells you this is worse on a sunny day. What is the most likely diagnosis?
A. Inflammatory bowel disease
B. Dermatophytosis (ringworm)
C. Impetigo
D. Discoid eczema
E. SLE

39. E. SLE
The rash is discoid lupus, which can be an isolated lupus (discoid lupus erythematosus) or associated with SLE

40. A 23 year old man comes to GP with a history of weight loss, abdominal pain, joint pain and diarrhoea. On examination you notice tender 3-5cm nodules on both legs. What is the most likely diagnosis?
A. Hodgkins lymphoma
B. Coeliac disease
C. Inflammatory bowel disease
D. Lynch syndrome
E. Giardiasis

41. C. Inflammatory bowel disease
The rash is erythema nodosum, and is associated with inflammatory bowel disease. Pyoderma gangrenosum is also associated with IBD