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Dermatology

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Dermatology

  1. 1. http://www.flickr.com/photos/epsos/4883281674/sizes/o/in/photostream/
  2. 2. Dermatology: skin health and disease Catherine Hyde GP and Teaching fellow Year 1 clinical co-lead 25th November 2012
  3. 3. What % of the population is affected by skin problems at any time? A. 2% B. 10% C. 30% D. 70%
  4. 4. What % of the population is affected by skin problems at any time? A. 2% B. 10% C. 30% D. 70%
  5. 5. Plan •What do I need to know •Keratinocytes & psoriasis •80 year old man with a skin lesion • keratinocytes and melanocytes •Questions
  6. 6. What do I need to know? Knowledge • Normal skin – and how this relates to pathology • Terminology for skin • Common disease • Systemic disease with skin manifestations • Rare and serious disease: recognition and referral • Common benign conditions • Treatment ladder for common diseases and one name of each brand of treatment
  7. 7. What do I need to know? Skills • Taking history and examining skin • Pattern recognition • Managing uncertainty epSos.de.CuteDogPuppy Onflicker.com http://www.flickr.com/photos/epsos/4883281674/
  8. 8. What is the main function of the skin? A. Protecting from mechanical stresses and micro-organisms B. Synthesis of vitamin D C. Regulating body temperature and fluid loss D. Sensing the environment and potential damage
  9. 9. What is the main function of the skin? A. Protecting from mechanical stresses and micro-organisms B. Synthesis of vitamin D C. Regulating body temperature and fluid loss D. Sensing the environment and potential damage
  10. 10. Normal Skin
  11. 11. Yellowraincoatsbychispita_666flickr.com http://www.flickr.com/photos/gusilu/2699275381 Epidermis
  12. 12. Keratinocytes • Epidermis is mostly keratinocytes, migrate from the basal layer differentiating • 40-50 days • Active in Vitamin D synthesis
  13. 13. Psoriasis Mysiana (2007) Pink. Flickr.com [accessed 18/03/2012] http://www.flickr.com/photos/mysiann/163870507 4/sizes/l/in/photostream/ Keratinocyte Abnormal differentiation Hyperproliferation Psoriasis Common 1-2% population Multiple lesions Separate (discrete) On knees and arms (extensor surfaces) Discoid Red/erythematous/salmon pink Scaly
  14. 14. Psoriasis Treatment Ladder Topical Moisturisers Coal tar vitamin D analogues Immunosuppressants (Steroids/dithranol ) For widespread disease Phototherapy Chemotherapy (low dose) Biological therapy
  15. 15. Skin Treatment – in general • Nothing - reassure and advised • Review eg after 6weeks • Put something on it - moisturiser - antifungal/antibiotic - steroid - immunosuppressant/specials • Take something for it :antibiotic/ antifungal/immunosupressant • Burn it off (cautery/cryotherapy) • Cut it out
  16. 16. 80 yr old man Senile Keratosis Senile : older age Keratosis: from keratinocytes Senile Keratosis: Benign proliferation of keratinocytes Normal skin with mole (naevus)
  17. 17. Senile Keratosis 1. Inspect Generally Single or Multiple lesions Discrete (separate) or confluent (flow together) 2. Describe individual lesion SCAM Size (the widest diameter), Shape Colour Associated secondary change Morphology, Margin (border) 0.5 cm Oval Pigmented (no erythema) Raised Clear well-defined border
  18. 18. Senile Keratosis 3. Palpate the lesion Surface Consistency Mobility Tenderness Temperature Raised Waxy/warty Non-mobile Non-tender Normal temperature 2b For any pigmented lesions ABCDEF: • Asymmetry • Border – risk of malignant melanoma if irregular or indistinct • Colour – haphazard, different shades • Diameter • Elevation • Fitting in with other moles
  19. 19. Senile Keratosis
  20. 20. 80 yr old man Normal skin with mole (naevus)
  21. 21. If lung cancer affects 41,000 people per year, malignant melanoma affects? A.1,000 B.3,000 C.9,000 D.11,000
  22. 22. If lung cancer affects 41,000 people per year, malignant melanoma affects? A.1,000 B.3,000 C.9,000 D.11,000
  23. 23. Melanocytes • Melanocytes: in epidermis, produce melanin which protects skin against UV radiation • Melanoma : malignant proliferation of melanocytes 1. Inspect Generally Single lesion Skin generally sun damaged
  24. 24. Malignant melanoma 2. Describe individual lesion SCAM Size (the widest diameter), Shape Colour Associated secondary change Morphology, Margin (border) 0.7 cm Discoid = cicular Pigmented Surrounding erythema Flat Irregular border
  25. 25. Malignant melanoma 2b For any pigmented lesions :ABCDEF • Asymmetry • Border • Colour • Diameter • Elevation • Fitting in with other moles Asymmetrical Irregular border 3 different shades of colour 0.7cm Flat Different from surrounding skin 3. Don’t forget to palpate
  26. 26. Malignant melanoma
  27. 27. Of the 36,000 possible diagnoses in medicine, how many are dermatological? A. 1,000 B. 4,000 C. 9,000 D. 13,000
  28. 28. Of the 36,000 possible diagnoses in medicine, how many are dermatological? A. 1,000 B. 4,000 C. 9,000 D. 13,000
  29. 29. Uncertainty in dermatology Images from John Hopkins Medical Institute. DermAtlas.org (2000) http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459[ accessed 18 march 2012] Definitely melanoma Definitely not melanoma: Definitely senile keratosis
  30. 30. Uncertainty in dermatology Images from John Hopkins Medical Institute. DermAtlas.org (2000) http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459 [ accessed 18 march 2012] Definitely melanoma Definitely not melanoma: Definitely senile keratosis Urgent referral and treatment Review in 6 weeks Reassure & advise
  31. 31. What have we covered? • Skin is important in health and disease • What do I need to know about dermatology • How to describe a lesion • Keratinocytes & Psoriasis – from basics to management • Melanocytes and melanoma • Managing uncertainty in skin
  32. 32. Useful Information • http://dermnetnz.org/ excellent images and treatment advice • British Association of Dermatology (bad.org.uk ) Dermatology: Handbook for medical students & junior doctors 2009. • ABC of dermatology. Buxton, PK and Morris-Jones ,R. BMJ books. London. 2009. • Notes on dermatology. Liz Tatman. www.askdoctorclarke.com Questions?

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