Recommended
More Related Content
What's hot
What's hot (15)
Similar to Dermatology presentation 2
Similar to Dermatology presentation 2 (20)
Recently uploaded
Recently uploaded (20)
Dermatology presentation 2
- 1. Slide 1 DERMATOLOGY ASSESSMENT By Natalie fisher – dermatology nurse specialist ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 SKIN • Largest organ of the body • Provides protection, body temperature regulation and vit D synthesis. • Comprised of 3 layers 1.Epidermis. 2.Dermis 3.Subcutaneous ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 SKIN CONDITIONS • Skin conditions affect 20-30% of the population at any one time. • Studies suggest that only 15% of the population consult their gps about skin complaints. Approximately 5% are then referred on for specialist advice. • A thorough assessment of a dermatology patient helps lead to effective management. • Obtaining a detailed history may provide clues to diagnosis and required treatment/management. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 2. Slide 4 QUESTIONS TO ASK YOUR PATIENT:- • How long has the condition been present? • How often does it occur/recur? • Are there any seasonal variants? • Is there a family history of skin disease? • What are the patients hobbies or occupation? • What medication is the patient taking? • Are there any known allergies? • Previous/present treatments and their effectiveness? ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 5 PHYSICAL SKIN ASSESSMENT Make a point of touching your patient (with consent!) This will give you information about skin texture and temperature. This also helps to break down the physical barrier which many dermatology patients experience. Patients may feel uncomfortable/embarrassed about exposing their skin for various reasons eg. Stigma, religion, culture and upbringing. Skin tells a story and needs to be examined thoroughly, looking at distribution, character and shape of lesions. Preferably this should be done in good natural light. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 6 Character:- is there redness (erythema), scaling, crusting, exudate? Are there excoriations, blisters, pustules, papules? Are the lesions all he same (monomorphic) or variable (polymorphic)? Shape:- Are the lesions small, large, annular (ring shaped) or linear? Distribution:- does it affect peripheral parts such as limbs, fingers or ears? Is it mainly confined to the trunk? Light exposed areas? ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 3. Slide 7 MACULE • A flat mark • only appreciated by visual inspection • Well defined area of colour change • Could be Brown, red, white or tan • Example- vitiligo ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 8 NODULE • Elevated • Firm • Defined • Palpable • Can involve all layers of the skin • Generally larger than 5mm in diameter • Eg dermatofibroma ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 9 PAPULE • An elevated 'spot' • Palpable • firm • defined lesion. • Varying in size up to 1cm • No visible fluid • Example-fibrous papule ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 4. Slide 10 PLAQUE • Elevated • Flat topped • Firm • Rough • Greater than 2cm in diameter • Example: psoriasis ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 11 WHEAL • Elevated • Irregular shaped area of cutaneous oedema • Solid • Variable diameter • Red, pale pink or white in colour • Example : urticaria ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 12 VESICLE • Elevated • defined • Superficial fluid filled blister • Usually less than 5mm in diameter • Example: pompholyx ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 5. Slide 13 BULLA • Vesicle greater than 5mm in diameter • Example: bullous pemphigoid ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 14 PUSTULE • Elevated • Superficial • Similar to Vesicle but filled with puss. • Example: impetigo ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 15 TRY TO DESCRIBE:- ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 6. Slide 16 TRY TO DESCRIBE:- ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 17 TRY TO DESCRIBE:- ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 18 TRY TO DESCRIBE:- ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 7. Slide 19 SECONDARY LESIONS • Result of changes over time cause by disease progression, manipulation (scratching, rubbing, picking) or treatment. A.Scale – heaped up keratinised cells, flaky, irregular, thick or thin, variable size, example psoriasis. B.Crust – dried serum, exudate, slightly elevated, size variable, example impetigo. C.Excoriation – loss of epidermis, usually due to scratching, example atopic eczema. D.Lichenification – rough, thicken epidermis, accentuated skin markings caused by rubbing or scratching, example chronic eczema. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 20 TO SUMMARISE • A skin assessment/referral should include the following:- 1.Description of the condition, duration and location. 2.Treatments tried to date and their effectiveness 3.Past medical history, relevant family history 4.Current medication 5.Reason for referral- diagnosis, management, further information. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 21 DERMATOLOGY INTERVENTIONS By Natalie fisher – dermatology nurse specialist ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 8. Slide 22 PATCH TESTING • Patch testing is a useful tool in discovering what may be causing contact dermatitis. • It does not detect allergies relating to diet or anything inhaled which may result in sneezing, asthma or hives. • A RAST (Radioallergosorbent) test can be performed for these allergies (ie pollen, house dust mite, food groups etc) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 23 BEFORE PATCH TESTING:- • Not advisable if pregnant • Antihistamines should be avoided for 48 hours prior to the first appointment. • Topical corticosteroids should be stopped 3-4 days before. • Oral steroids should be stopped under supervision of the prescribing doctor. • Emollients should not be applied to the back 24 hours before test. • Sun bathing should be avoided for 4 weeks prior (or avoided at all times!!) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 24 PATCH TESTING SERIES:- • British standard- 41 substances ie metals, perfumes, rubber, preservatives • Cosmetic series • Sunscreen • Hairdressing • Steroid • Patients own products ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 9. Slide 25 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 26 THE PROCESS:- ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 27 DURING THE WEEK:- • It is essential that the patient keeps his/her back dry • No showers, baths or strenuous physical activity. Limit excessive bending or twisting If patches become loose, micropore tape can be used to tape down the edges. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 10. Slide 28 PATCH TEST READING ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 29 EXAMPLE ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 30 ONCE COMPLETE:- • Once allergens are identified, patient is advised on avoidance and provided with information leaflet. • Some allergens are particularly tricky to avoid (nickel-coins, keys) • Further patch testing may be required to different series. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 11. Slide 31 SKIN SURGERY ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 32 PATIENT ASSESSMENT • Requirement for surgery – diagnosis or treatment, if treatment ?appropriate setting? • Other treatment options discussed eg PDT, cryotherapy, other medications. • Is patient taking warfarin? • Previous allergic reaction to anaesthetic • Pace maker? ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 33 PUNCH BIOPSY • Used to obtain full thickness skin specimen. • Local anaesthetic • Aseptic technique • Size of punch biopsy 3,4,5mm • If taking from rash, choose an area where currently 'active' not an old lesion. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 12. Slide 34 SHAVE EXCISION • When we know the diagnosis and that the lesion is benign. • Bleeding stopped with cautery (silver nitrate if patient has a pacemaker) • If done for cosmetic reasons patient must be aware that the scar will be the same size as the lesion, just flat (unless keloid forms) • Used for skin tags, seborrheic keratosis, cutaneous horn. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 35 CURETTAGE AND CAUTERY • Good for effective treatment of seborrheic keratosis, viral warts, skin tags and basal cell carcinomas (providing they are not large, deep or recurring) • Involves 'scraping off' lesion and using cautery to stop bleeding (and destroy remaining tumour cells if treating bcc) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 36 EXCISION • Complete removal of lesion. • Histology results will explain if further re-excision needed to obtain clear margins. • Sometimes Mohs surgery required o Skin cancers in high risk place (face) o Recurrent or incompletely excised tumours o Lesions which can spread-ie SCC ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 13. Slide 37 Patients provided with aftercare leaflet and advised how to care for wound. Advised when sutures will need removing. Often prescribed topical antibiotic (wound infection occurs in approx 1% of skin surgeries) Silicone gel preparations can help with prevention of keloid scar All specimens must be sent for histology even if confident of diagnosis. Patient advised results can take 4-6 weeks General points:- ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 38 PSYCHOSOCIAL IMPACT OF LIVING WITH A SKIN DISEASE By Natalie fisher – dermatology nurse specialist ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 39 THE PSYCHOSOCIAL IMPACT • There has been stigma attached to skin diseases for centuries • Lepers were cast out from society in biblical times and considered unclean, many of these 'lepers' had other diseases such as psoriasis and eczema. • The stigmatisation wasn't only a public health measure to control spread but an expression of fear, ignorance and prejudice. • Skin diseases are often obvious and visible. • Sufferers have to not only cope with the condition but also the reaction of others. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 14. Slide 40 THE IMPACT ON PATIENTS LIVES • ‘When giving advice to patients on how to manage their condition, health professionals should recognise the burden of the treatment itself in addition to the physical symptoms. Medical and nursing training programmes should reflect this.’ (Parliamentary group on skin APPGS, 2013) • Common psychological problems associated with skin disease include 1. feelings of stress 2. anxiety 3. anger 4. depression 5. shame 6. social isolation 7. low self-esteem 8. embarrassment ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 41 Skin conditions are often incurable and treatments are aimed at reducing symptoms Treatments can be complicated and often place restrictions on patients. Often a gap between patients expectations and what is medically achievable. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 42 EFFECT ON CHILDREN • Childhood skin conditions affect not only the child but the whole family. • It can affect:- a. Sleep b. Schooling c. Development d. Relationships • Parents can suffer unfair criticism and be deemed neglectful by those who underestimate the severity of the child's skin condition. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
- 15. Slide 43 'Experiencing social exclusion over a prolonged period of time during childhood is likely to have an effect on the development of personality, particularly in relation to vulnerability to experience shame' (Kent and Thompson, 2002) ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 44 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 45 SKIN CAMOUFLAGE • Skin camouflage is the application of highly pigmented creams which are designed to mask various skin complaints. • They are significantly different from ordinary cosmetics. • They are waterproof so patient can swim with fear of it being washed off. • Used to cover non-contagious skin conditions and scars. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________