dermatology presentation 25 oct 2012 final
TRANSCRIPT
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
1/34
10/27/12
http://www.flickr.com/photos/epsos/4883281674/sizes/o/in/photostream/
http://www.flickr.com/photos/epsos/4883281674/sizes/o/in/photostream/http://www.flickr.com/photos/epsos/4883281674/sizes/o/in/photostream/ -
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
2/34
Click to edit Master subtitle style
10/27/12
Dermatology: skin healthand disease
Catherine HydeGP and Teaching fellowYear 1 clinical co-lead25th November 2012
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
3/34
10/27/12
What % of thepopulation is affected by
skin problems at anytime?
A. 2%B. 10%
C. 30%
D. 70%
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
4/34
10/27/12
What % of thepopulation is affected by
skin problems at anytime?
A. 2%B. 10%
C. 30%
D. 70%
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
5/34
10/27/12
Plan
What do I need to know
Keratinocytes & psoriasis
80 year old man with a skinlesion
keratinocytes andmelanocytes
Questions
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
6/34
10/27/12
What do I need to know?
Knowledge
Normal skin and how this relates topathology
Terminology for skin Common disease
Systemic disease with skin manifestations
Rare and serious disease: recognition andreferral
Common benign conditions
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
7/34
10/27/12
What do I need to know?
SkillsTaking history and examining skin
Pattern recognition
Managing uncertainty
epSos.de.Cute
Dog
Puppy
Onflicker.com
http://www
.flick
r.com/photos
/epsos/4
8 8328
http://www.flickr.com/photos/epsos/4883281674/http://www.flickr.com/photos/epsos/4883281674/http://www.flickr.com/photos/epsos/ -
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
8/34
10/27/12
What is the main
function of the skin?A. Protecting from mechanical
stresses and micro-organisms
B. Synthesis of vitamin D
C. Regulating body temperatureand fluid loss
D. Sensing the environment andpotential damage
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
9/34
10/27/12
What is the main
function of the skin?A. Protecting from mechanical
stresses and micro-organisms
B. Synthesis of vitamin D
C. Regulating body temperatureand fluid loss
D. Sensing the environment andpotential damage
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
10/34
10/27/12
Normal Skin
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
11/34
10/27/12
Ye
llowr a
incoat s
b
ychispita_6
66
flickr.co
m
ht
tp://www.flick
r.com/photos/g
usilu
/2 699275381
Epidermis
http://www.flickr.com/photos/gusilu/ -
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
12/34
10/27/12
Keratinocytes
Epidermis is mostly keratinocytes,migrate from the basal layerdifferentiating
40-50 days
Active in Vitamin D synthesis
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
13/34
10/27/12
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
14/34
10/27/12
Psoriasis
Mysiana (2007) Pink. Flickr.com [accessed18/03/2012] http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/
KeratinocyteAbnormal differentiationHyperproliferation
PsoriasisCommon 1-2% populationMultiple lesionsSeparate (discrete)On knees and arms (extensor
surfaces)
DiscoidRed/erythematous/salmonpink
Scaly
http://www.flickr.com/photos/mysiann/http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/http://www.flickr.com/photos/mysiann/ -
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
15/34
10/27/12
Psoriasis
Treatment LadderTopicalMoisturisersCoal tar
vitamin D analoguesImmunosuppressants(Steroids/dithranol )
For widespread diseasePhototherapyChemotherapy (lowdose)Biological therapy
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
16/34
10/27/12
Skin Treatment ingeneral
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 cauter cr othera
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
17/34
10/27/12
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
18/34
10/27/12
80 yr old man
SenileKeratosisSenile : older ageKeratosis: from
keratinocytes
Senile Keratosis: Benignproliferation ofkeratinocytes
Normal skin with mole(naevus)
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
19/34
10/27/12
Senile Keratosis
1. InspectGenerallySingle or MultiplelesionsDiscrete (separate)or confluent (flowtogether)
2. Describe individuallesion SCAMSize (the widestdiameter), ShapeColourAssociated secondary
changeMor holo , Mar in
0.5 cmOvalPigmented(no erythema)RaisedClear well-defined
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
20/34
10/27/12
Senile Keratosis
3. Palpate thelesionSurfaceConsistencyMobility
Tenderness
RaisedWaxy/warty
Non-mobileNon-tender
Normal temperature
2b For any pigmented lesionsABCDEF: Asymmetry Border risk of malignantmelanoma if irregular or indistinct Colour haphazard, different
shades Diameter Elevation Fitting in with other moles
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
21/34
10/27/12
Senile Keratosis
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
22/34
10/27/12
80 yr old man
Normal skin with mole(naevus)
If l ff t
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
23/34
10/27/12
If lung cancer affects41,000 people per year,
malignant melanomaaffects?
A. 1,000
B. 3,000
C. 9,000
D. 11,000
If l ff t
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
24/34
10/27/12
If lung cancer affects41,000 people per year,
malignant melanomaaffects?
A. 1,000
B. 3,000
C. 9,000
D. 11,000
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
25/34
10/27/12
Melanocytes
Melanocytes: in epidermis, produce melaninwhich protects skin against UV radiation
Melanoma : malignant proliferation ofmelanocytes
1. Inspect Generally
Single lesionSkin generally sun
damaged
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
26/34
10/27/12
Malignant melanoma
2. Describe individuallesion SCAMSize (the widest
diameter), ShapeColourAssociated secondarychangeMorphology, Margin(border)
0.7 cm
Discoid = cicularPigmentedSurrounding erythemaFlatIrregular border
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
27/34
10/27/12
Malignant melanoma
2b For any pigmented lesions
:ABCDEF Asymmetry
Border Colour
Diameter Elevation
Fitting in with other moles
AsymmetricalIrregular border3 different shades ofcolour0.7cmFlat
Different fromsurrounding skin
3. Dont forget topalpate
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
28/34
10/27/12
Malignant melanoma
O t e 36 000 poss e
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
29/34
10/27/12
O t e 36,000 poss ediagnoses in medicine,
how many aredermatological?A. 1,000
B. 4,000
C. 9,000
D. 13,000
O t e 36 000 poss e
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
30/34
10/27/12
O t e 36,000 poss ediagnoses in medicine,
how many aredermatological?A. 1,000
B. 4,000
C. 9,000
D. 13,000
-
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
31/34
10/27/12
Uncertainty indermatology
Images from John Hopkins Medical Institute. DermAtlas.org (2000)http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459 [ accessed 18 march 2012]
Definitelymelanoma
Definitely not
melanoma:Definitely senilekeratosis
http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459 -
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
32/34
10/27/12
Uncertainty indermatology
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 senilekeratosisUrgent
referral andtreatment
Reviewin 6weeks
Reassure &advise
http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459 -
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
33/34
10/27/12
What have we covered?
Skin is important in health anddisease
What do I need to know aboutdermatology
How to describe a lesion
Keratinocytes & Psoriasis frombasics to management
Melanocytes and melanoma
Managing uncertainty in skin
http://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxton -
7/31/2019 Dermatology Presentation 25 Oct 2012 Final
34/34
10/27/12
Useful Information
http://dermnetnz.org/ excellent images andtreatment 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
http://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://dermnetnz.org/http://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.askdoctorclarke.com/http://www.askdoctorclarke.com/http://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://dermnetnz.org/http://dermnetnz.org/