Dermatology

Question 1

Main function of skin

Answer 1

• Barrier and protection - epidermis
• Strength and flexibility - dermis
• Fat and insulation - SC tissue

Question 2

What is found in epidermis?

Answer 2

• Stratum corneum is outside layer which is thickest on palms and soles of feet
• Langerhan cells are found here - immune function

Question 3

What is found in the dermis?

Answer 3

• Made of collagen, elastin and fibrillin
• Nerves
• Glands
• Hair follicles
• Blood vessels

Question 4

Disease from epidermis

Answer 4

• Psoriasis
• Increased cell turnover
• Hyperproliferation/thickening of epidermis
• Causes scaly plaques
• Dilation of BV causes erythema

Question 5

Taking derm history

Answer 5

• Site and distribution
• Timing - onset and duration
• Aggravating and relieving factors
• PMH - inc skin diseases
• DH
• FH - atopy and skin disease
• SH - job, travel, sexual, sun exposure (inc sunbeds)
• Assess skin type - Fitzpatrick scale, eg burn easily?
• ICE
• Impact of disease on QOL

Question 6

Examples of skin disease which affect particular areas

Answer 6

• Flexural - eczema
• Mucous membranes - lichen planus with lace like reticular pattern

Question 7

Examination of derm

Answer 7

• Inspect
• Palpae
• Systemic check - whole skin, hair/scalp nails, mucous membranes
• Describe - SCAM

Question 8

SCAM description

Answer 8

• Site/distribution
• Colour/configuration
• Associations
• Morphology

USE ABCD for pigmented lesions
Check google docs derm doc for descriptors

Question 9

Treatment for acne - 1st line for mild/moderate

Answer 9

• Topical benzoyl peroxide + topical adapalene OR
• Topical tretinoin + topical clindamycin OR
• Topical benzoyl peroxide + topical clindamycin

Question 10

Treatment acne moderate/severe - 1st line

Answer 10

• Either of first 2 options from mild/moderate OR
• Topical adapalene + topical benzoyl peroxide + oral doxycycline/oral lymecycline
• Topical azelaic acid + oral doxycycline/oral lymecycline

OR can use COCP instead of oral abx
Isotretinoin is reserved for secondary care