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Dermatology
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Objectives 1.1 Demonstrate appropriate history-taking for patients with skin problems, including past personal history, family history, chemical contacts 1.2 Describe a skin lesion or rash using dermatologically accurate terms 1.3 Understand how to recognise common skin conditions in primary care
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It’s Common 24% of the population in any 12-month period 1
One in seven GP consultations 2 90% of diseases of the skin are managed exclusively in Primary Care3
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It’s Important Marker of underlying systemic disease/malignancy
Huge psychiatric burden (35% Patients referred to dermatology outpatients4)
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Objective 1.1 Demonstrate appropriate history-taking for patients with skin problems, including past personal history, family history, chemical contacts
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Dermatological History
Associated symptoms? Proximity to recent treatments? Behaviour of the condition (eg: relax/remit) How did it look initially?
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Dermatological History
Is it anywhere else? What affects it? Any recent travel? Patients ethnic origin?
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Dermatological History
How does it affect the patient?
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Dermatological History
PMH Any skin related disorders DM, transplant Systemic conditions etc Fam history psoriasis eczema
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Dermatological History
DH Steroids Allergy Alcohol SH Occupation Who lives with patient Living arrangements Hobbies
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Dermatological History
DH Steroids Allergy ALCOHOL SH Occupation Who lives with patient Living arrangements Hobbies
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The Language of Dermatology
1. 2 Describe a skin lesion or rash using dermatologically accurate terms
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The Language of Dermatology
Distribution Configuration Morphology
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Distribution Localised Regional Generalised Universal
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Configuration Linear Dermatomal Annular Grouped Reticular
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Morphology Macule – well circumscribed and flat (<1cm)
Patch – flat lesion > 1cm
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Morphology Papule – circumscribed, elevation of the skin (<1cm)
Nodule – circumscribed palpable mass (>1cm)
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Morphology Plaque – raised lesion >1cm eg psoriasis
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Morphology Pustule – raised lesion, with pus (<1 cm)
Vesicle – raised lesion, with clear fluid (<1 cm)
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Morphology Crust - a dried exudate (serous, purulent or haemorrhagic)
Excoriation – shallow haemorrhagic excavation resulting from scratching Lichenification: thickening of the skin with exaggerations of the skin creases
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Objective 1.3 Understand how to recognise common skin conditions in primary care
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What is the causative agent in this condition?
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What is this condition?
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What is this condition?
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What is this condition?
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What is the first line treatment for this condition?
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What is the diagnosis?
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True or False: This condition is a disease of poor hygiene?
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What is this condition
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What causes this condition?
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What is this condition?
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The Answers
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What is the causative agent in this condition? Answer: Staph Aureus
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Impetigo Staph. Aureus Managment Education
Topical Antibiotics (fusidic acid) Oral Antibiotics (flucloxacillin or erythromycin)
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What is this condition? Answer Dermatosis Neglecta
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Dermatosis Neglecta Build up of keratin, sebum and dirt
Worrying clinical sign Management Clean!! Rx underlying problem
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What is this condition?
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Pityriasis Versicolor
Fungal (Pityrosporum orbiculare) Clinical - trunk and proximal limbs Management Topical antifungal Systemic antifungal
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What is this condition?
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Vitiligo Autoimmune Complete Depigmentation No cure
Associations: pernicious anaemia, addison’s disease and thyroid disease
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Viral Warts Very Common Treat with Salicylate-based wart paint (3/12)
Cryotherapy Rarely needs Secondary Care input
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Rosacea Middle aged; cause unknown Sun, Stress, Spicy food, Alcohol
Management Avoid triggers Antibiotics Referral if complications rarely laser or surgery
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True or False: This condition is a disease of poor hygiene
True or False: This condition is a disease of poor hygiene? Answer: False
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Acne Clinical Diagnosis Management Education
Topical (benzoyl peroxide, retinoid, antibiotic) Oral (antibiotics, anti-androgen) Secondary (oral retinoid)
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Granuloma Annulare Autoimmune May be associated with Diabetes
Usually resolves, but may take two years
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Scabies Sarcoptes Scabiei Non-hair bearing skin
Malathion or Permethrin Creams Wash clothes/bedding Treat all others Pruritis may remain for weeks
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Psoriasis Several presentations Long term approach Treatment Ladder
If severe can jump up the ladder
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Useful Resource (Available via the intranet or:
(Available via the intranet or:
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Objectives 1.1 Demonstrate appropriate history-taking for patients with skin problems, including past personal history, family history, chemical contacts 1.2 Describe a skin lesion or rash using dermatologically accurate terms 1.3 Understand how to recognise common skin conditions in primary care, e.g. eczemas, psoriasis and infections, and instigate appropriate treatment.
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Take home messages Common Huge psychosocial impact Specific History
Systematic description RUH guide to Dermatology
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References RCGP Birmingham Research Unit. Weekly Returns Service Annual Report 2006 Kerr OC, Benton EC, Walker JJ et al Dermatological workload: primary versus secondary care. British Journal of Dermatology 2007: 157 (suppl. 1). Looked at burden of dermatological disease presenting across 13 general medical practices in Scotland, serving a population of 100,000, over a two week period. Skin complaints accounted for 14% of all consultations in this study Information from Hospital Episode Stats (2008) and data extrapolated from Birmingham RCGP Research Unit prevalence data 2006 in fact gave a figure of 6.1% of consultations for a skin problem resulting in a referral to secondary care Atlas of Clinical Dermatology 2nd Ed. Du Vivier (1995) Khalid Bashir1 et al (2010). Depression in Adult Dermatology Outpatients Journal of the College of Physicians and Surgeons Pakistan Vol. 20 (12):
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