Transcript DPD Exam session 2008 - - - - - - - - - - - - - - - - - - - - -

Department of Dermatology © 2013

To be able to accurately describe lesions and rashes
to colleagues.

To be able to write a clear dermatology referral.
Department of Dermatology © 2013
Department of Dermatology © 2013
Department of Dermatology © 2013

Also notice the pattern of the rash.
Department of Dermatology © 2013

Urticaria is rarely visible when patients visit the doctor
but can be diagnosed by history.
Department of Dermatology © 2013

Patient may focus on an acute eruption and ignore
a chronic long-standing problem, which may be
related.
Department of Dermatology © 2013

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

Leishmaniasis – North Africa / Mediterranean.

Cutaneous larva migrans – tropical beaches.
Department of Dermatology © 2013

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

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
Department of Dermatology © 2013
Lesion
Example
Lesion
Small macule/
large patch:
Pustule:
Papule:
Vesicle:
Example
Department of Dermatology © 2013
Lesion
Example
Lesion
Nodule:
Bulla (blister):
Plaque:
Telangiectasia:
Example
Department of Dermatology © 2013

Colour
◦ Erythema (red)
◦ Pigmented (brown)

Crusting / scaling

Shape / patterns
◦ Annular / discoid / serpiginous

Well defined / ill defined
Department of Dermatology © 2013
Lesion
Example
Lesion
Scar:
Necrosis:
Excoriation:
Lichenification:
Example
Department of Dermatology © 2013
Department of Dermatology © 2013
Department of Dermatology © 2013
Department of Dermatology © 2013
Department of Dermatology © 2013
Department of Dermatology © 2013
Department of Dermatology © 2013

As always, patient history very important
◦ Check occupation

Key lesion terminology

For rash describe individual (primary) lesions and distribution
Department of Dermatology © 2013

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
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.
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?
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.
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.
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?