3.overview of diagnosis and management in dermatology rp

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3.overview of diagnosis and management in dermatology rp

  1. 1. An Overview of Diagnosis andManagement in Dermatology Dr Robert Paver Dermatologist Medical Director Skin and Cancer Foundation Westmead
  2. 2. System of Diagnosis in DermatologyHistoryExaminationInvestigation
  3. 3. HistoryHistory of present illness: duration, site of onset,changes in appearance, symptoms (local/systemic),previous and current treatments and the response tothemPast History: Similar skin problems, other skinproblems, systemic diseases,Allergies , MedicationsFamily history: genetic issues eg atopy, infections egimpetigo, infestations eg scabiesOccupation and hobbies: eg hair dresser and handdermatitis, outdoor worker and skin cancer
  4. 4. Examination – Bright Light and magnificationSite and distribution are important clues eg sunexposed or flexural etcCharacteristics of individual lesions (morphology)including: type, size, shape, outline, colour, surfacefeatures (smooth, scaly, weeping)Palpation (superficial or deep)Secondary sites eg nails with psoriasis, fingers andwrists with scabies
  5. 5. Investigations - to Confirm Diagnosis and check for other features Dermoscopy Biopsy: punch, shave, curette, incision Allergy tests – prick tests, patch tests type1 or 4 Scrapings and clippings ?tinea, ?scabies Bloods and urine etc eg lupus, Xrays, ultrasound, scans eg sarcoid, tumours
  6. 6. Simple Classification of Skin Diseases Infections Bacterial: cellulitis, impetigo etc Fungal: thrush, tinea Viral: measles, herpes, warts Parasites: scabies, nits, lice Tumours and lumps Benign: cysts, moles, skin tags Malignant: BCC, SCC, melanoma
  7. 7. Simple Classification of Skin DiseasesSpecific Common Inflammatory Skin Diseases Dermatitis - Exogenous (caused by external factors) allergic or irritant - Endogenous (genetically predetermined) atopic, discoid, seborrhoeic, asteatotic Psoriasis Acne Rosacea
  8. 8. Simple Classification of Skin Diseases Other Less Common Inflammatory Skin Diseases Urticaria (hives) Lichen planus Pityriasis rosea Miliaria (heat rash) Pregnancy rashes
  9. 9. Simple Classification of Skin Diseases Inherited disorders: Neurofibromatosis, tuberous Sclerosis Pigmentary disorders: vitiligo, pityriasis alba Disorders of hair and nails: alopecia areata, onycholysis Vascular disorders: venous ulcers, vasculitis Autoimmune : LE, scleroderma, bullous diseases
  10. 10. Simple Classification of Skin DiseasesPruritus (itch): skin problems, systemic problemsSystemic diseases and the skin: xanthomas, acanthosis nigricansCutaneous drug reactions: many and varied
  11. 11. Treatment of Skin Disease - Topical Active ingredients Barrier protection Moisturizing Drying Keratolytic (peeling) Anti infective Anti inflammatory Anti proliferative
  12. 12. Treatment of Skin Disease - SystemicSystemic Antibiotics Antifungals Antivirals Anti inflammatory Anti tumour Antihistamines Steroids Immunosupressants etc)
  13. 13. ReferencesAustralasian College of Dermatologists Online StudentTeaching ModulesImages and Explanations of all skin diseases www.dermnetnz.orgLecture Notes on Dermatology (Brown and Burns)Blackwell PublishingSkin Disease Diagnosis and Treatment (Habif) Elsevier Mosby Publishing
  14. 14. The End

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