12. Dermatology

12. Dermatology
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12. Dermatology

By Andrew Harris
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Hi everyone!

Take yourself to the bathroom for a minute, and wash your face in the sink. Count to 30 while you’re doing it, and enjoy the warm (or cold) water on your skin cleaning the day’s grime away. I always find this to be incredibly refreshing and rejuvenating and a good way to sign post the start of a study session.

This week is about dermatology.

Everyone has skin! And if you probe long enough you’ll find that most people have at least one problem with their skin. It could be too oily, too dry or reactive to certain irritants. They may have a spot, lump or discolouration they are worried about. Skin is our most protective organ, and it needs to be looked after. Determining a patient’s risk of skin cancer should be part of any health check, and if at risk, should be reviewed again for a skin cancer check.

I have found that most non-cancerous skin conditions respond either to corticosteroids, antibiotics, anti-fungal creams or moisturising creams. So if I am ever stuck, I find a combination of these can always give the patient at least some partial relief until a more complete diagnosis is confirmed. Cancerous lesions should always be biopsied or excised using recommended guidelines. Biopsies are relatively easy so should be performed if in doubt.

Dermnet NZ is your best friend when it comes to dermatology. Please check out our dermatology quizzes on Amadeus Education. We aim to have a series of quizzes completed that will cover the essential curriculum. Going over and over images is the only way to know the conditions well by sight.

Be kind to yourself and keep remember to Slip, Slip, Slap, Slide and Seek if you’re out in the sun!

Dr Andrew Harris
Director of Amadeus Education.

Did you know?

According to BEACH data, 4.2% of all encounters in General Practice were specifically related to the skin. Consider this as you are preparing for your exams. (Source: General practice activity in Australia: 2015-16. https://bit.ly/2c4d8Em)

Presenting complaints:

These are the common presenting complaints that should be covered for this topic:

Common conditions:

These are the common conditions that should be reviewed for this topic:

Topics

Important reading

Dermatitis – including atopic dermatitis, seborrhoeic dermatitis

Psoriasis

Skin malignancies –  including SCC, BCC, melanoma, Excisions,

Fungal infections – including tinea, onychomycosis

Non-malignant lesions – including seborrhoeic keratosis, naevus,  actinic keratosis

Bacterial infection – including cellulitis, erysipelas, impetigo

Acne – including acne vulgaris, acne rosacea

Urticaria

Insect infections – including Scabies, head lice

Nail disorders – including koilynichia,  leukonychia,

Hair disorders – including alopecia areata,

Burns

Warts

Childhood rashes -measles, rubella, roseola, erythema infectiosum, smallpox, erythema multiforme, pityriasis rosea, varicella

Ulcers – including wound care

Medication doses:

These are the medications and doses that should be learned for the exam:

Condition

Medication

Acne vulgaris

  • Mild:

    • Topical tretinoin 0.025% daily for 6 weeks

    • OR

  • Benzoyl Peroxide + Clindamycin 5% + 1%, topically, daily for 6 weeks

  • Moderate-severe acne:

    • Oral doxycycline 50-100mg orally daily for 6 weeks

  • OR if pregnant

    • Erythromycin 250-500mg orally BD for 6 weeks

Corticosteroid topical preparations – Eczema/psoriasis

  • Mild (face/groin eczema):

    • hydrocortisone 1% ointment topically, daily

  • Moderate:

    • Betamethasone valerate 0.02% cream

  • Potent (Trunk/limb/fingers eczema/psoriasis. Scalp psoriasis):

    • Mometasone furoate 0.1% ointment/lotion topically, daily

  • Very potent:

    • Betamethasone diproprionate 0.05% in an optimised vehicle

Bacterial infections

  • Impetigo:

    • mupirocin 2% ointment topically BD for 5 days

  • Wide-spread impetigo or cellulitis:

    • Flucloxacillin 500mg (child: 12.5mg/kg up to 500mg orally, four times per day for 5-10 days

Rosacea

  • Mild:

    • Metronidazole 0.75% gel 1-2 times daily for 6-12 weeks

  • Severe:

    • Doxycycline 50-100mg orally daily for 8 weeks

Shingles

  • Valaciclovir 1g orally, 8 hourly for 7 days

Seborrhoic dermatitis

  • Anti-yeast shampoo + betamethasone diproprionate 0.05% lotion daily for 7 days

Tinea

  • Scalp:

    • Terbinafine 250mg orally daily for 4 weeks

  • Non-scalp:

    • Terbinafine 1% cream topically 1-2 daily for 7-14 days

Pityriasis versicolor

  • Selenium sulfide 2.5% shampoo topically daily applied to wet skin, leave for 10mins or overnight for 7-10 days

Mnemonics:

These are some important mnemonics relevant to this topic:

  • Melanoma – ABCDE (Asymmetry, border, color, diameter, evolution)

CHECKS:

Here are the list of recommended Checks that would be useful in your study for GP exams (accessed via subscription from http://gplearning.racgp.org.au):

  • Dermatology, April 2017
  • Dermatology, January 2014

Focus on clinical skills:

Here is a brief focus on some OSCE preparation topics related to this topic:

  • Acne counselling
  • Atopic dermatitis counselling
  • Psoriasis counselling
  • Skin examination playlist from GP Synergy: https://bit.ly/2TXAv2K

Focus on medicolegal:

Here is a brief focus on the medicolegal issues covered in Australian Family Physician:

Copyright © 2021 Andrew Harris