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Approach to the diagnosis of dermatological disease

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Khushhal Farooqi
Khushhal Farooqi

How can I get a history of skin diseases from patients and perform physical examinations? Here you can easily learn.

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Approach to the DIAGNOSIS of DERMATOLOGICAL DISEASE Prepared and edited by: Associate prof. Dr. Khushhal Farooqi 2020 1
The patient is the doctors best tex Dermatologic diagnosis depends on the examiners skill in skin inspection. 2
Exposure and lighting Patient must be properly gowned Extra lighting Always encourage the patient to undress completely; no peekaboo Develop a systematic approach and use it for every skin examination. Gently use your fingers to glide across the skin- your touch can One should do hand hygiene prior to and after touching the patient. How to perform a skin examination 3
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HISTORY OF CUTANEOUS DISORDERS A PROBLEM-FOCUSED HISTORY is sufficient for most common skin disorders. If, the patient has systemic complaints, or if diseases such as lupus erythematous or vasculitis are suspected, a DETAILED OR COMPREHENSIVE HISTORY may be needed. 5
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FITZPATRICK'S COLOR ATLAS AND SYNOPSIS OF CLINICAL DERMATOLOGY EIGHTH EDITION 2017 PHYSICAL EXAMIN Appearance Uncomfortable, toxic well. Vital Sign Pulse, Temperature Respiration Skin: learning to red 7
拆悋惘 惶愆悽惠 惆 愃悋惘 惆 惠擧愕拆 惆Prerequisites 1. Types of skin lesions 2. Colour 3. Margination 4. Consistency 5. Shape 6. ARRANGEMENT 7. DISTRIBUTION TYPES OF SKIN LESIONS拆惆 惠惘 悋惡悋 惆 擧 惆 惆悋愕 8
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Shaping Letters Into Words: Further Characterization of Identified Lesions 18
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Forming Sentences and Understanding the Text Confluence Yes or no Number Single or multiple lesions. Arrangement Multiple lesions may be (1) Grouped: herpetifonn, arciform, annular, reticulated (net-shaped), linear, Serpiginous (snakelike) or (2) Disseminated: scattered discrete lesions. 20
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Our Skin Is Covered With Invisible Stripes 23
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Approach to the diagnosis of dermatological disease
PRELIMINARY HISTORY This initial history is composed of two parts that correlate with the Chief complaint and The history of the present illness in the standard history format. 26
CHIEF COMPLAINT In eliciting the chief complaint, one can often learn much by asking an open-ended question, such as, What is your skin problem? This is followed by four general questions regarding the history of the present illness. 27
HISTORY OF THE PRESENT ILLNESS Onset and Evolution o When did it start? o Has it gotten better or worse? For most skin conditions, this is important information. Symptoms o Does it bother you? o Does it itch?. Treatment to Date Ive already tried that and it didnt work! 28
REVIEW OF SYMPTOMS This should be done as Indicated by the clinical situation, with particular attention to possible connections between signs and disease of other organ systems (e.g., rheumatic complaints, myalgias, arthralgias, Raynaud phenomenon). 29
Review of Systems (ROS) A s k a b o u t Fever, chills, Fatigue, Weight changes, Lymphadenopathy, Joint pains, Wheezing, rhinitis, Menstrual history, Birth control methods, Depression, and anxiety. Additional ROS questions can be asked based on the patients chief complaint. 30
EXAMINATION TOOLS 1. Potassium hydroxide mount 2. Culture 3. Biopsy The gold standard for precise diagnosis of many skin conditions remains tissue biopsy. The two most commonly employed techniques are shave biopsy and punch biopsy. 4. Magnification with hand lens. 5. Wood lamp (ultraviolet long-wave light) is valuable in the diagnosis of certain skin and hair diseases and of porphyria. With the Wood lamp (365 nm), 6. Diascopy 7. Dermoscopy , Digital dermoscopy 31
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Approach to the diagnosis of dermatological disease

  • 1. Approach to the DIAGNOSIS of DERMATOLOGICAL DISEASE Prepared and edited by: Associate prof. Dr. Khushhal Farooqi 2020 1
  • 2. The patient is the doctors best tex Dermatologic diagnosis depends on the examiners skill in skin inspection. 2
  • 3. Exposure and lighting Patient must be properly gowned Extra lighting Always encourage the patient to undress completely; no peekaboo Develop a systematic approach and use it for every skin examination. Gently use your fingers to glide across the skin- your touch can One should do hand hygiene prior to and after touching the patient. How to perform a skin examination 3
  • 4. 4
  • 5. HISTORY OF CUTANEOUS DISORDERS A PROBLEM-FOCUSED HISTORY is sufficient for most common skin disorders. If, the patient has systemic complaints, or if diseases such as lupus erythematous or vasculitis are suspected, a DETAILED OR COMPREHENSIVE HISTORY may be needed. 5
  • 6. 6
  • 7. FITZPATRICK'S COLOR ATLAS AND SYNOPSIS OF CLINICAL DERMATOLOGY EIGHTH EDITION 2017 PHYSICAL EXAMIN Appearance Uncomfortable, toxic well. Vital Sign Pulse, Temperature Respiration Skin: learning to red 7
  • 8. 拆悋惘 惶愆悽惠 惆 愃悋惘 惆 惠擧愕拆 惆Prerequisites 1. Types of skin lesions 2. Colour 3. Margination 4. Consistency 5. Shape 6. ARRANGEMENT 7. DISTRIBUTION TYPES OF SKIN LESIONS拆惆 惠惘 悋惡悋 惆 擧 惆 惆悋愕 8
  • 9. 9
  • 10. 10
  • 11. 11
  • 12. 12
  • 13. 13
  • 14. 14
  • 15. 15
  • 16. 16
  • 17. 17
  • 18. Shaping Letters Into Words: Further Characterization of Identified Lesions 18
  • 19. 19
  • 20. Forming Sentences and Understanding the Text Confluence Yes or no Number Single or multiple lesions. Arrangement Multiple lesions may be (1) Grouped: herpetifonn, arciform, annular, reticulated (net-shaped), linear, Serpiginous (snakelike) or (2) Disseminated: scattered discrete lesions. 20
  • 21. 21
  • 22. 22
  • 23. Our Skin Is Covered With Invisible Stripes 23
  • 24. 24
  • 26. PRELIMINARY HISTORY This initial history is composed of two parts that correlate with the Chief complaint and The history of the present illness in the standard history format. 26
  • 27. CHIEF COMPLAINT In eliciting the chief complaint, one can often learn much by asking an open-ended question, such as, What is your skin problem? This is followed by four general questions regarding the history of the present illness. 27
  • 28. HISTORY OF THE PRESENT ILLNESS Onset and Evolution o When did it start? o Has it gotten better or worse? For most skin conditions, this is important information. Symptoms o Does it bother you? o Does it itch?. Treatment to Date Ive already tried that and it didnt work! 28
  • 29. REVIEW OF SYMPTOMS This should be done as Indicated by the clinical situation, with particular attention to possible connections between signs and disease of other organ systems (e.g., rheumatic complaints, myalgias, arthralgias, Raynaud phenomenon). 29
  • 30. Review of Systems (ROS) A s k a b o u t Fever, chills, Fatigue, Weight changes, Lymphadenopathy, Joint pains, Wheezing, rhinitis, Menstrual history, Birth control methods, Depression, and anxiety. Additional ROS questions can be asked based on the patients chief complaint. 30
  • 31. EXAMINATION TOOLS 1. Potassium hydroxide mount 2. Culture 3. Biopsy The gold standard for precise diagnosis of many skin conditions remains tissue biopsy. The two most commonly employed techniques are shave biopsy and punch biopsy. 4. Magnification with hand lens. 5. Wood lamp (ultraviolet long-wave light) is valuable in the diagnosis of certain skin and hair diseases and of porphyria. With the Wood lamp (365 nm), 6. Diascopy 7. Dermoscopy , Digital dermoscopy 31
  • 32. 32
  • 33. 33
  • 34. 34
  • 35. 35

Editor's Notes

  • #2: Peek-a- boo
  • #4: How to perform a skin examination Exposure and lighting Patient must be properly gowned Extra lighting always encourage the patient to undress completely; no peekaboo examinations!
  • #9: TCM-CADS