3.overview of diagnosis and management in dermatology rp

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  • 1. An Overview of Diagnosis andManagement in Dermatology Dr Robert Paver Dermatologist Medical Director Skin and Cancer Foundation Westmead
  • 2. System of Diagnosis in DermatologyHistoryExaminationInvestigation
  • 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. 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. 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. 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. 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. Simple Classification of Skin Diseases Other Less Common Inflammatory Skin Diseases Urticaria (hives) Lichen planus Pityriasis rosea Miliaria (heat rash) Pregnancy rashes
  • 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. Simple Classification of Skin DiseasesPruritus (itch): skin problems, systemic problemsSystemic diseases and the skin: xanthomas, acanthosis nigricansCutaneous drug reactions: many and varied
  • 11. Treatment of Skin Disease - Topical Active ingredients Barrier protection Moisturizing Drying Keratolytic (peeling) Anti infective Anti inflammatory Anti proliferative
  • 12. Treatment of Skin Disease - SystemicSystemic Antibiotics Antifungals Antivirals Anti inflammatory Anti tumour Antihistamines Steroids Immunosupressants etc)
  • 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. The End