- Clinical science
Dermatology is the branch of medicine concerned with the skin, hair, and nails, as well as the conditions associated with them. Basic knowledge of dermatology is essential for every physician, as approximately 50% of skin-related consultations are initially assessed by non-dermatologists. In the United States, the most common conditions seen by dermatologists include acne, actinic keratoses, non-melanoma skin cancers, benign tumors, and contact dermatitis. Skin lesions may be primary or secondary. Primary lesions (e.g., macules or papules) appear as a direct result of a disease process. Secondary lesions such as scales or ulcers may develop from primary lesions or result from external trauma (e.g., infections, scratching). Dermatological conditions can often be diagnosed based on patient history and physical examination but may require laboratory testing or biopsy to confirm the diagnosis. Dermatological diseases are managed with medication (topical and systemic) and procedures such as surgery, cryotherapy, radiotherapy, or phototherapy. Topical treatments are often the first choice because they cause fewer systemic side effects and are easily administered.
- Chief complaint
- Seek to address the patient's main concern by beginning with an open-ended question.
- History of present illness
Past medical history
- Underlying diseases may be responsible for skin findings (e.g., erythema nodosum in chronic bowel disease).
- Drug interactions may lead to skin irritations. Therefore, it is important to note any changes in the patient's drug regimen.
- Review of systems
- "Café au lait" spots in young children may be part of an inherited disease such as neurofibromatosis.
- Taking a family history of skin diseases helps to determine the correct diagnosis.
- Certain skin conditions may be due to work-related chemical exposure.
- In patients with genital ulcers, sexual history must be taken into account. Sexual partners may need to be treated as well.
- A complete skin exposure history may be necessary for patients with contact dermatitis,
- Physical examination
- Definition of lesions (primary/secondary lesions)
- Description of lesions
- Number (single/multiple)
- Color (e.g., pinkish discoloration in cutis marmorata)
- Texture (e.g., atrophic, calloused, crusty, verrucous)
- Shape (e.g., round, oval, annular)
Basic examination techniques
- Palpation: evaluation of consistency (e.g., softness, firmness) and depth
- Typical signs
- Dermatoscope inspection
- Biopsy (histological examination of lesions)
- Laboratory studies
The mouth, scalp, and nails should not be overlooked!
|Plaque (dermatology)|| |
|Fissure (crack, cleft)|
|Excoriation (scratch marks)|
|Skin atrophy|| |
|Subtypes of hematomas = purpura||Nonpalpable purpura|| |
| Ecchymosis || |
| Palpable purpura |
|Further lesions||Lichenification|| |
|Hypergranulosis|| || |
|Hyperkeratosis|| || |
The external nature of the skin allows a variety of treatment options, including:
- Systemic medications
- Topical medications
- Physical procedures
Types of topical preparations
Drugs must be absorbed into the skin to be effective. Therefore, choosing the proper type of topical preparation for the pharmacological agent is important. Examples include:
- Lotions, foams, and gels
Topical steroids are the most frequently used topical treatment in dermatology.
- High therapeutic value
- Relatively safe: few local and systemic adverse effects
- Most common side effects:
- Skin atrophy
- Steroid acne
- Common examples:
|Hydrocortisone (1%)||Low||For mild and chronic dermatoses and for use on the face|
|Triamcinolone (0.1%)||Medium||For intermediate severity|
|Clobetasol (0.05%)||High||For more severe dermatoses|