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Dermatology Handbook Flipbook PDF
Dermatology Handbook
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Dermatology A A A h h ha a an n nd d db b bo o oo o ok k k f f fo o or r r m m me e ed d di i ic c ca a al l l s s st t tu u ud d de e en n nt t ts s s & & & j j ju u un n ni i io o or r r d d do o oc c ct t to o or r rs s s British Association of Dermatologists
Dermatology: Handbook for medical students & junior doctors This publication is supported by the British Association of Dermatologists. First edition 2009 Revised first edition 2009 Second edition 2014 For comments and feedback, please contact the author at [email protected] 1 British Association of Dermatologists
Dermatology: Handbook for medical students & junior doctors Dermatology A A A h h ha a an n nd d db b bo o oo o ok k k f f fo o or r r m m me e ed d di i ic c ca a al l l s s st t tu u ud d de e en n nt t ts s s & & & j j ju u un n ni i io o or r r d d do o oc c ct t to o or r rs s s Dr Nicole Yi Zhen Chiang MBChB (Hons), MRCP (UK) Specialty Registrar in Dermatology Salford Royal NHS Foundation Trust Manchester M6 8HD Professor Julian Verbov MD FRCP FRCPCH CBiol FSB FLS Professor of Dermatology Consultant Paediatric Dermatologist Alder Hey Children’s Hospital Liverpool L12 2AP 2 British Association of Dermatologists
Dermatology: Handbook for medical students & junior doctors Contents Preface 5 Foreword 6 What is dermatology? 7 Essential Clinical Skills 8 Taking a dermatological history 8 Examining the skin 9 Communicating examination findings 10 Background Knowledge 23 Functions of normal skin 23 Structure of normal skin and the skin appendages 23 Principles of wound healing 27 Emergency Dermatology 28 Urticaria, Angioedema and Anaphylaxis 29 Erythema nodosum 30 Erythema multiforme, Stevens-Johnson syndrome, Toxic epidermal necrolysis 31 Acute meningococcaemia 32 Erythroderma 33 Eczema herpeticum 34 Necrotizing fasciitis 35 Skin Infections / Infestations 36 Erysipelas and cellulitis 37 Staphylococcal scalded skin syndrome 38 Superficial fungal skin infections 39 Skin Cancer 41 Basal cell carcinoma 42 Squamous cell carcinoma 43 Malignant melanoma 44 Inflammatory Skin Conditions 46 Atopic eczema 47 Acne vulgaris 49 Psoriasis 50 Blistering Disorders 52 Bullous pemphigoid 53 Pemphigus vulgaris 54 3 British Association of Dermatologists
Dermatology: Handbook for medical students & junior doctors Common Important Problems 55 Chronic leg ulcers 56 Itchy eruption 58 A changing pigmented lesion 60 Purpuric eruption 62 A red swollen leg 64 Management 65 Emollients 66 Topical/Oral steroids 66 Oral aciclovir 66 Oral antihistamines 66 Topical/Oral antibiotics 67 Topical antiseptics 67 Oral retinoids 67 Practical Skills 68 Patient education 69 Written communication 70 Prescribing skills 70 Clinical examination and investigations 71 71 Acknowledgements 72 4 British Association of Dermatologists
Dermatology: Handbook for medical students & junior doctors Preface This Handbook of Dermatology is intended for senior medical students and newly qualified doctors. For many reasons, including modern medical curriculum structure and a lack of suitable patients to provide adequate clinical material, most UK medical schools provide inadequate exposure to the specialty for the undergraduate. A basic readable and understandable text with illustrations has become a necessity. This text is available online and in print and should become essential reading. Dr Chiang is to be congratulated for her exceptional industry and enthusiasm in converting an idea into a reality. Julian Verbov Professor of Dermatology Liverpool 2009 Preface to the 2nd edition Nicole and I are gratifed by the response to this Handbook which clearly fulfils its purpose. The positive feedback we have received has encouraged us to slightly expand the text and allowed us to update where necessary. I should like to thank the BAD for its continued support. Julian Verbov Professor of Dermatology Liverpool 2014 5 British Association of Dermatologists
Dermatology: Handbook for medical students & junior doctors Foreword to First edition There is a real need for appropriate information to meet the educational needs of doctors at all levels. The hard work of those who produce the curricula on which teaching is based can be undermined if the available teaching and learning materials are not of a standard that matches the developed content. I am delighted to associate the BAD with this excellent handbook, designed and developed by the very people at whom it is aimed, and matching the medical student and junior doctor curriculum directly. Any handbook must meet the challenges of being comprehensive, but brief, well illustrated, and focused to clinical presentations as well as disease groups. This book does just that, and is accessible and easily used. It may be read straight through, or dipped into for specific clinical problems. It has valuable sections on clinical method, and useful tips on practical procedures. It should find a home in the pocket of students and doctors in training, and will be rapidly worn out. I wish it had been available when I was in need, I am sure that you will all use it well in the pursuit of excellent clinical dermatology! Dr Mark Goodfield President of the British Association of Dermatologists 6 British Association of Dermatologists
Dermatology: Handbook for medical students & junior doctors What is dermatology? • Dermatology is the study of both normal and abnormal skin and associated structures such as hair, nails, and oral and genital mucous membranes. Why is dermatology important? • Skin diseases are very common, affecting up to a third of the population at any one time. • Skin diseases have serious impacts on life. They can cause physical damage, embarrassment, and social and occupational restrictions. Chronic skin diseases may cause financial constraints with repeated sick leave. Some skin conditions can be life-threatening. • In 2006-07, the total NHS health expenditure for skin diseases was estimated to be around ₤97 million (approximately 2% of the total NHS health expenditure). What is this handbook about? • The British Association of Dermatologists outlined the essential and important learning outcomes that should be achieved by all medical undergraduates for the competent assessment of patients presenting with skin disorders(available on: http://www.bad.org.uk/library- media/documents/(Link2)%20Core%20curriculum(2).pdf). • This handbook addresses these learning outcomes and aims to equip you with the knowledge and skills to practise competently and safely as a junior doctor. 7 British Association of Dermatologists
Dermatology: Handbook for medical students & junior doctors Essential Clinical Skills • Detailed history taking and examination provide important diagnostic clues in the assessment of skin problems. Essential Clinical Skills – Taking a dermatological history Learning outcomes: 1. Ability to take a dermatological history 2. Ability to explore a patient’s concerns and expectations 3. Ability to interact sensitively with people with skin disease 4. Ability to examine skin, hair, nails and mucous membranes systematically showing respect for the patient 5. Ability to describe physical signs in skin, hair, nails and mucosa 6. Ability to record findings accurately in patient’s records Taking a dermatological history • Using the standard structure of history taking, below are the important points to consider when taking a history from a patient with a skin problem (Table 1). • For dark lesions or moles, pay attention to questions marked with an asterisk (*). Table 1. Taking a dermatological history Main headings Key questions Presenting complaint Nature, site and duration of problem History of presenting complaint Initial appearance and evolution of lesion* Symptoms (particularly itch and pain)* Aggravating and relieving factors Previous and current treatments (effective or not) Recent contact, stressful events, illness and travel History of sunburn and use of tanning machines* Skin type (see page 70)* Past medical history History of atopy i.e. asthma, allergic rhinitis, eczema History of skin cancer and suspicious skin lesions Family history Family history of skin disease* Social history Occupation (including skin contacts at work) Improvement of lesions when away from work Medication and allergies Regular, recent and over-the-counter medications Impact on quality of life Impact of skin condition and concerns 8 British Association of Dermatologists
Dermatology: Handbook for medical students & junior doctors Examining the skin • There are four important principles in performing a good examination of the skin: INSPECT, DESCRIBE, PALPATE and SYSTEMATIC CHECK (Table 2). Table 2. Examining the skin Main principles Key features INSPECT in general General observation Site and number of lesion(s) Essential Clinical Skills – Examining the skin If multiple, pattern of distribution and configuration DESCRIBE the individual lesion SCAM Size (the widest diameter), Shape Colour Associated secondary change Morphology, Margin (border) *If the lesion is pigmented, remember ABCD (the presence of any of these features increase the likelihood of melanoma): Asymmetry (lack of mirror image in any of the four quadrants) Irregular Border Two or more Colours within the lesion Diameter > 6mm PALPATE the individual lesion Surface Consistency Mobility Tenderness Temperature SYSTEMATIC CHECK Examine the nails, scalp, hair & mucous membranes General examination of all systems 9 British Association of Dermatologists