1. Dermatology

2. 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

3. 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

4. It’s Important Marker of underlying systemic disease/malignancy
Huge psychiatric burden
(35% Patients referred to dermatology outpatients4)

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

6. Dermatological History
Associated symptoms?
Proximity to recent treatments?
Behaviour of the condition (eg: relax/remit)
How did it look initially?

7. Dermatological History
Is it anywhere else?
What affects it?
Any recent travel?
Patients ethnic origin?

8. Dermatological History
How does it affect the patient?

9. Dermatological History
PMH
Any skin related disorders
DM, transplant
Systemic conditions etc
Fam history
psoriasis
eczema

10. Dermatological HistoryDH
Steroids
Allergy
Alcohol SH
Occupation
Who lives with patient
Living arrangements
Hobbies

12. Dermatological HistoryDH
Steroids
Allergy
ALCOHOL SH
Occupation
Who lives with patient
Living arrangements
Hobbies

14. The Language of Dermatology
1. 2 Describe a skin lesion or rash using dermatologically accurate terms

15. The Language of Dermatology
Distribution
Configuration
Morphology

16. Distribution
Localised
Regional
Generalised
Universal

18. Configuration
Linear
Dermatomal
Annular
Grouped
Reticular

19. Morphology Macule – well circumscribed and flat (<1cm)
Patch – flat lesion > 1cm

20. Morphology Papule – circumscribed, elevation of the skin (<1cm)
Nodule – circumscribed palpable mass (>1cm)

21. Morphology
Plaque – raised lesion >1cm eg psoriasis

22. Morphology Pustule – raised lesion, with pus (<1 cm)
Vesicle – raised lesion, with clear fluid (<1 cm)

23. 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

24. Objective
1.3 Understand how to recognise common skin conditions in primary care

26. What is the causative agent in this condition?

27. What is this condition?

28. What is this condition?

29. What is this condition?

30. What is the first line treatment for this condition?

31. What is the diagnosis?

32. True or False: This condition is a disease of poor hygiene?

33. What is this condition

34. What causes this condition?

35. What is this condition?

36. The Answers

37. What is the causative agent in this condition? Answer: Staph Aureus

38. Impetigo Staph. Aureus Managment Education
Topical Antibiotics (fusidic acid)
Oral Antibiotics (flucloxacillin or erythromycin)

39. What is this condition? Answer Dermatosis Neglecta

40. Dermatosis Neglecta Build up of keratin, sebum and dirt
Worrying clinical sign
Management
Clean!!
Rx underlying problem

41. What is this condition?

42. Pityriasis Versicolor
Fungal (Pityrosporum orbiculare)
Clinical - trunk and proximal limbs
Management
Topical antifungal
Systemic antifungal

43. What is this condition?

44. Vitiligo Autoimmune Complete Depigmentation No cure
Associations: pernicious anaemia, addison’s disease and thyroid disease

46. Viral Warts Very Common Treat with Salicylate-based wart paint (3/12)
Cryotherapy
Rarely needs Secondary Care input

48. Rosacea Middle aged; cause unknown Sun, Stress, Spicy food, Alcohol
Management
Avoid triggers
Antibiotics
Referral if complications
rarely laser or surgery

49. True or False: This condition is a disease of poor hygiene
True or False: This condition is a disease of poor hygiene? Answer: False

50. Acne Clinical Diagnosis Management Education
Topical (benzoyl peroxide, retinoid, antibiotic)
Oral (antibiotics, anti-androgen)
Secondary (oral retinoid)

52. Granuloma Annulare Autoimmune May be associated with Diabetes
Usually resolves, but may take two years

54. Scabies Sarcoptes Scabiei Non-hair bearing skin
Malathion or Permethrin Creams
Wash clothes/bedding
Treat all others
Pruritis may remain for weeks

56. Psoriasis Several presentations Long term approach Treatment Ladder
If severe can jump up the ladder

59. Useful Resource (Available via the intranet or:
(Available via the intranet or:

60. 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.

61. Take home messages Common Huge psychosocial impact Specific History
Systematic description
RUH guide to Dermatology

62. 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):

63. THANKS FOR LISTENING!