Dermatology

• 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

Objectives

• 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

It’s Common

• Marker of underlying systemic disease/malignancy

• Huge psychiatric burden (35% Patients referred to dermatology outpatients4)

It’s Important

• 1.1 Demonstrate appropriate history-taking for patients with skin problems, including past personal history, family history, chemical contacts

Objective

• Associated symptoms?

• Proximity to recent treatments?

• Behaviour of the condition (eg: relax/remit)

• How did it look initially?

Dermatological History

• Is it anywhere else?

• What affects it?

• Any recent travel?

• Patients ethnic origin?

Dermatological History

• How does it affect the patient?

Dermatological History

• PMH- Any skin related disorders- DM, transplant- Systemic conditions etc

• Fam history - psoriasis- eczema

Dermatological History

• DH - Steroids- Allergy- Alcohol

• SH - Occupation- Who lives with patient- Living arrangements- Hobbies

Dermatological History

• DH - Steroids- Allergy- ALCOHOL

• SH - Occupation- Who lives with patient- Living arrangements- Hobbies

Dermatological History

1. 2 Describe a skin lesion or rash using dermatologically accurate terms

The Language of Dermatology

• Distribution• Configuration• Morphology

The Language of Dermatology

• Localised • Regional • Generalised • Universal

Distribution

• Linear • Dermatomal• Annular • Grouped• Reticular

Configuration

• Macule – well circumscribed and flat (<1cm)

• Patch – flat lesion > 1cm

Morphology

• Papule – circumscribed, elevation of the skin (<1cm)

• Nodule – circumscribed palpable mass (>1cm)

Morphology

• Plaque – raised lesion >1cm eg psoriasis

Morphology

• Pustule – raised lesion, with pus (<1 cm) • Vesicle – raised lesion, with clear fluid (<1

cm)

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

Morphology

• 1.3 Understand how to recognise common skin conditions in primary care

Objective

The Answers

• Staph. Aureus

• Managment- Education- Topical Antibiotics (fusidic acid)- Oral Antibiotics (flucloxacillin or

erythromycin)

Impetigo

• Build up of keratin, sebum and dirt• Worrying clinical sign • Management- Clean!!- Rx underlying problem

Dermatosis Neglecta

• Fungal (Pityrosporum orbiculare)

• Clinical - trunk and proximal limbs

• Management - Topical antifungal- Systemic antifungal

Pityriasis Versicolor

• Autoimmune • Complete Depigmentation • No cure • Associations: pernicious anaemia,

addison’s disease and thyroid disease

Vitiligo

• Very Common

• Treat with Salicylate-based wart paint (3/12)

• Cryotherapy

• Rarely needs Secondary Care input

Viral Warts

• Middle aged; cause unknown • Sun, Stress, Spicy food, Alcohol

• Management- Avoid triggers- Antibiotics- Referral if complications- rarely laser or surgery

Rosacea

• Clinical Diagnosis

• Management- Education- Topical (benzoyl peroxide, retinoid,

antibiotic)- Oral (antibiotics, anti-androgen)- Secondary (oral retinoid)

Acne

• Autoimmune

• May be associated with Diabetes • Usually resolves, but may take two

years

Granuloma Annulare

• Sarcoptes Scabiei

• Non-hair bearing skin

• Malathion or Permethrin Creams• Wash clothes/bedding• Treat all others

• Pruritis may remain for 3 - 6 weeks

Scabies

• Several presentations

• Long term approach

• Treatment Ladder

• If severe can jump up the ladder

Psoriasis

http://www.ruh.nhs.uk/patients/services/clinical_depts/kinghorn_dermatology_unit/documents/GAL44941%20all%20pages%20in%20one3.pdf

(Available via the intranet or:http://www.ruh.nhs.uk/patients/services/clinical_depts/kinghorn_dermatology_unit/documents/GAL44941%20all%20pages%20in%20one3.pdf)

Useful Resource

• 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.

Objectives

• Common

• Huge psychosocial impact

• Specific History

• Systematic description

• RUH guide to Dermatology

Take home messages

1. RCGP Birmingham Research Unit. Weekly Returns Service Annual Report 2006

2. 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

3. 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

4. Atlas of Clinical Dermatology 2nd Ed. Du Vivier (1995)

5. Khalid Bashir1 et al (2010). Depression in Adult Dermatology Outpatients Journal of the College of Physicians and Surgeons Pakistan Vol. 20 (12): 811-813 813

References

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