Dermatology Physical Exam and History Taking

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Questions and Answers

What is the primary reason for the formation of crusts on the skin?

Erosion of the epidermis (correct)

Allergic reaction to environmental factors

Inflammation of the skin

Dryness of the skin

What is the characteristic shape of excoriations on the skin?

Triangular

Linear (correct)

Circular

Oval

What is the term for a skin lesion that is shaped like a coin or disc?

Annular

Discoid (correct)

Circular

Nummular

What is the most common inflammatory skin disease worldwide?

Atopic dermatitis Signup and view all the answers

What percentage of people are affected by atopic dermatitis during their lifetime?

15% Signup and view all the answers

What is the main treatment for atopic dermatitis in all age groups?

Topical corticosteroids Signup and view all the answers

What is a common factor that triggers atopic dermatitis?

All of the above Signup and view all the answers

What is the term for a superficial skin-colored or pale skin swelling?

Wheal Signup and view all the answers

What is the recommended treatment for face lesions in severe cases?

Methylprednisolone aceponate 0.1% ointment/FO once daily Signup and view all the answers

What is the recommended treatment for trunk and limb lesions in severe cases?

Mometasone furoate 0.1% ointment once daily Signup and view all the answers

What is the purpose of bleach baths in treating atopic skin?

To prevent bacterial infection Signup and view all the answers

What is the typical age range for cradle cap in infants?

3-12 weeks Signup and view all the answers

What is a characteristic of cradle cap versus atopic dermatitis?

No itching is present Signup and view all the answers

What is the recommended treatment for moderate cradle cap cases?

Massage liquid paraffin or baby oil into lesions overnight Signup and view all the answers

What should be avoided in treating cradle cap?

Food-containing products Signup and view all the answers

What is the typical outcome for cradle cap?

It clears spontaneously in a few weeks Signup and view all the answers

What is the term for a drug reaction that affects the structure or function of the skin, its appendages, or mucous membranes?

Cutaneous drug reaction Signup and view all the answers

Which of the following drugs is commonly associated with cutaneous drug reactions?

Beta-lactam antibiotics Signup and view all the answers

When should a pharmacist ask about a patient's history of previous reactions to drugs?

Before dispensing medication Signup and view all the answers

What should a patient's profile include in the event of a cutaneous drug reaction?

A record of the reaction Signup and view all the answers

Where should all adverse drug reactions, including cutaneous drug reactions, be reported?

The Adverse Event Management System (AEMS) Signup and view all the answers

Under what circumstances should a patient be referred to a doctor or GP?

All cutaneous drug reactions should be referred Signup and view all the answers

What is the primary purpose of a physical examination in dermatology?

To more accurately differentiate and diagnose skin conditions Signup and view all the answers

What is the significance of documenting the 'distribu/on' of a skin lesion?

It indicates whether the lesion is symmetrical or asymmetrical Signup and view all the answers

What is the importance of asking about animal contacts in a patient's history?

To identify potential sources of skin infections Signup and view all the answers

Why is it essential to use common terminology and descriptive terms in dermatology?

To communicate effectively with other healthcare professionals Signup and view all the answers

What is the primary purpose of asking about a patient's dietary history in dermatology?

To understand how diet affects the integrity of skin conditions Signup and view all the answers

What is the significance of asking about a patient's previous history or family history in dermatology?

To determine the patient's genetic predisposition to skin conditions Signup and view all the answers

What is the importance of considering privacy in a consultation room during a physical examination?

To ensure the patient's modesty is maintained Signup and view all the answers

Why is it important to clearly explain the procedure and gain the patient's consent during a physical examination?

To respect the patient's autonomy and rights Signup and view all the answers

What is the primary cause of contact dermatitis?

Skin contact with external agents Signup and view all the answers

What is the recommended treatment for irritant contact dermatitis?

Avoiding further contact with the allergen Signup and view all the answers

What percentage of the population is allergic to nickel?

8% Signup and view all the answers

Why is it important to allow sufficient time for absorption between topical applications?

To reduce systemic adverse effects Signup and view all the answers

What is the recommended treatment for severe and acute contact dermatitis?

Oral prednisolone Signup and view all the answers

What is the advantage of topical administration of drugs?

It reduces systemic adverse effects Signup and view all the answers

What is the primary location of contact dermatitis in most cases?

Hands Signup and view all the answers

What is the recommended treatment for occupational contact dermatitis?

Avoiding further contact with the allergen and using emollients Signup and view all the answers

Study Notes

Dermatology

Importance of physical examination and history taking in dermatology
Key aspects of physical examination:
- Accurate differential diagnosis
- Consideration of privacy and patient consent
- Empathy and gaining patient trust
Key aspects of history taking:
- History of presenting complaint (onset, duration, periodicity)
- Site of onset and distribution of lesions
- Feel of lesions (smooth, rough, etc.)
- Aggravating or relieving factors
- Previous medical history and family history
- Occupational and recreational activities
- Dietary history and potential allergens

Terminology of Skin Conditions

Importance of understanding and using common terminology
Descriptive terms:
- Crusting (arises from plasma exudate through eroded epidermis)
- Excoriation (scratching that removes epidermis or causes localized damage)
- Annular, discoid/nummular, and wheal/weal lesions
Common types of dermatoses:
- Nonspecific inflammatory response of the skin
- Affects 1 in 5 people during their lifetime
- Isolated short episodes vs. chronic conditions
- Endogenous and exogenous causes

Atopic Dermatitis (Atopic Eczema)

Most common inflammatory skin disease worldwide
Affects 15% of people worldwide
Inherited tendency, environmental factors, and triggers
Started in infancy, affecting up to 20% of children
Generalized skin dryness, itch, and rash
Treatment:
- Avoid aggravating factors
- Moisturize with emollients
- Topical corticosteroids
- Modified dressings
- Treat infections (bleach baths, antibiotic therapy)

Case Study 2: Infantile Seborrheic Dermatitis (Cradle Cap)

Key questions to ask:
- Age of child
- Itchiness
- Rash location
- Family history
- Product usage
Treatment:
- Self-limiting, clears spontaneously in a few weeks
- Mild cases: gentle emollient and shampooing
- Moderate cases: massage liquid paraffin or baby oil into lesions
- Persistent cases: salicylic acid 2% + LPC 2% + Sulphur 2% in Aqueous Cream

Case 3 - Contact Dermatitis

Key questions to ask:
- Rash location
- Onset of rash
- Triggering factors
Treatment:
- Avoid further contact with allergen
- Use rubber gloves with cotton liner
- Apply emollients after finishing work
- Short course of topical corticosteroids
- Oral prednisolone/sone 25-50mg once daily for 5-7 days (severe and acute cases)

Topical Treatment of Skin Conditions

General considerations:
- Topical administration preferred due to direct contact between drug and tissue
- Minimizing systemic adverse effects
- Allow sufficient time for absorption between applications
Side effects of topical corticosteroids

Cutaneous Drug Reactions

Definition: Adverse reactions affecting skin, appendages, or mucous membranes
Common adverse skin reactions to systemic drugs:
- Morbilliform or maculopapular skin reactions
- Urticaria and angioedema
- Fixed drug eruptions
- Erythema multiforme
- DRESS and Stevens-Johnson syndrome
Reporting cutaneous drug reactions:
- Refer to prescribing doctor or GP
- Record reaction on patient's profile
- Report to TGA (Therapeutic Goods Administration)

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Description

Learn about the steps involved in performing a physical examination and taking a patient's history in dermatology, including gaining consent, demonstrating empathy, and recognizing skin problems.