Transcript skin and its dysfunction

Is it Only Skin Deep?
Dermatologic Evidence of Systemic
Disease
MAJ Amanda Cuda, MD
7 Sept 2011
Objectives
• To review the dermatologic exam,
including hair and nails
• To learn dermatologic conditions
and their systemic associations
• To identify these same conditions
and associations from photographs
Dermatologic Exam
• Break up into pairs:
– Examine your partner’s hands and
fingers only, include fingernails
– Document exam using medical terms
– Present exam to your partner
Dermatologic Exam:
Patient seated
• Inspect the hair
– Pattern of distribution and texture
•
•
•
•
Inspect nail beds
Inspect nails for clubbing, pitting
Inspect skin of face and neck
Inspect skin over back
Dermatologic Exam:
Patient lying
• Inspect skin of chest
• Inspect skin of abdomen
• Inspect skin of lower extremities
Systemic Conditions
• Skin wellness = overall wellness
• Many manifestations, many conditions
Systemic Conditions
• View photo of a skin manifestation
• Write 3 descriptive exam findings
• Identify systemic condition(s)
Beau’s Lines
Onycholysis
Acanthosis Nigricans
Café au Lait Spots
Erythema Multiforme
Telangiectasia
Butterfly Rash
Heliotrope rash
Viral Exanthems
Viral Exanthems con’t
Purpura
Which of these skin
findings can be normal?
A. Acanthosis nigricans
B. Palpable purpura
C. Heliotrope rash
D. Café au Lait macule
[Default]
[MC Any]
[MC All]
Which of the following is not
a cause of this nail finding?
A. Diabetes Mellitus
B. Psoriasis
C. Thyrotoxicosis
D. Trauma
[Default]
[MC Any]
[MC All]
All of the following are
manifestations of an underlying
vasculitis except:
A. Acanthosis nigricans
B. Erythema multiforme
C. Purpura
D. Telangiectasia
[Default]
[MC Any]
[MC All]
Possible cause of this
nail finding?
A. Kawasaki Disease
B. Telogen Effluvium
C. Scarlet Fever
D. All of the above
[Default]
[MC Any]
[MC All]
Which of the following, pictured
here, was known as Sixth
Disease?
A. Rubella
B. Measles
C. Roseola
D. Scarlet Fever
[Default]
[MC Any]
[MC All]
Clinic Challenge
• Derm exam, hair and nails included,
• 1 patient/day for 1 week
Conclusion
• Reviewed dermatologic exam
• Learned dermatologic conditions
and their systemic associations
• Identified these conditions on photo
quiz
Questions?
References
• DeGowin RL, Brown DD. DeGowin’s Diagnostic
Examination, Seventh Edition.
• Fitzpatrick TB, Johnson RA, Wolff K, Suurmond D. Color
Atlas and Synopsis of Clinical Dermatology, Fourth Edition.
• Habif TP etal. Skin Diseases Diagnosis and Treatment,
Second edition.
• www.dermnet.com
• http://en.wikipedia.org/wiki
• http://www.myfootshop.com/
• www.mdconsult.com
• http://health.allrefer.com
• http://www.clevelandclinicmeded.com
• http://dermatlas.med.jhmi.edu
• http://emedicine.medscape.com