Dermatology

Dermatology Required Readings:

Optional Reading: Dermatologic Conditions in Skin of Color, Part I

Optional Reading: Dermatologic Conditions in Skin of Color, Part II

Voice Over Powerpoint: Skin Biopsy Techniques

Getting a Handle on Dermatology:  Describing Skin Lesions

1. LOCATION, LOCATION, LOCATION

• ­ What is the involved body area?
• ­ Confined to a discrete area, or diffuse?
• ­ Is there involvement of face, palms, and soles?

2. SIZE MATTERS

• ­ If there are many lesions, what is the range in size?
• ­ Are the lesions each discrete, or do they coalesce and become confluent?

3. COLOR

• ­ Flesh-colored, red (blanching or not), brown, black, varied, blue, pearly, etc.

4. FLAT VS. RAISED

• ­ Macule: a flat lesion (< 1cm) that you cannot feel
• ­ Patch: a flat lesion (> 1cm) that you cannot feel
• ­ Papule: a raised lesion (< 1cm) that you can feel
• ­ Plaque: a raised lesion (> 1cm) that you can feel
• ­ Nodule: a palpable lesion (< 2cm) within the dermis or subcutis (rather than in the epidermis)
• ­ Tumor: a palpable lesion (> 2cm) within the dermis or subcutis (rather than in the epidermis)

5. WELL-MARGINATED?

• ­ A well marginated lesion transitions from normal to abnormal skin within 1 mm
• ­ A poorly marginated lesion changes more gradually, taking more than 1 mm to transition from normal to abnormal skin

6. BORDER

• ­ Is the border of the lesion regular, or irregular in contour?

7. EPITHELIAL DISRUPTION

• ­ A smooth lesion without scale or crust is “without epithelial disruption”
• ­ Lesions with epithelial disruption:
  • Scaly Lesions: flakes of dry, whitish material caused by abnormal keratinization
  • Crusted Lesions: due to dried secretions.  May be black (from blood – eschar), yellow (serum) or green (pus)
  • Hyperkeratotic Lesions: not scaly or crusted, but with an abnormal accumulation of the stratum corneum
  • Erosions: moist, superficial skin defect involving only the dermis
  • Ulcers: moist skin defect involving epidermis as well as deeper structures
  • Vesicles: well marginated fluid filled lesion less than 1 cm in diameter
  • Bulla: a vesicle over 1 cm in diameter
  • Pustule: a vesicle containing purulent material

8. MISCELLANEOUS

• ­ Telangiectasias: fixed, visible dilated blood vessels within the epidermis
• ­ Lichenification: accentuation of normal skin lines due to persistent rubbing or scratching
• ­ Excoriation: erosion or ulcer caused by scratching, rubbing or picking
• ­ Fissure: a linear split in the skin, through the epidermis and into the dermis
• ­ Purpura: extravasated blood in the skin – usually purplish, often palpable, and non-blanching

Source: www.DermNetNZ.org

Dermatology Resources

General Dermatology Websites:

1) DermNet New Zealand: Free online dermatology atlas: www.dermnetnz.org

2) Interactive Dermatology Atlas: Free online atlas, searchable by skin lesion characteristics, quiz mode: www.dermatlas.net

3) Derm101 website: Free reference and weekly clinical case challenge, case can be emailed to you weekly if you sign up online: www.derm101.com

General Dermatology App:

1) Derm101: Point of Care app. By Derm101.com. Requires free membership at derm101.com

Dermoscopy Websites:

1) Introduction to Dermoscopy: PHARMAC NZ Seminar Series of about 10 lectures. Free. Lengthy, but comprehensive: https://www.pharmac.govt.nz/seminars/seminar-resources/dermoscopy/

2) Introduction to Dermoscopy: MauiDerm 5-part series heavily based on the 2-step algorithm. For those who plan advanced use, including dermatologists. Free.

• 1/5 https://player.vimeo.com/video/37816898
• 2/5 https://player.vimeo.com/video/37816978
• 3/5 https://player.vimeo.com/video/37818780
• 4/5 https://player.vimeo.com/video/37818809
• 5/5 https://player.vimeo.com/video/37818873

3) Introduction to Dermoscopy for those who prefer written/image format rather than videos. Free.

https://www.dermnetnz.org/cme/dermoscopy-course/introduction-to-dermoscopy/

4) Dermoscopedia: Like wikipedia, for dermoscopy. Defines many terms. Free.

www.dermoscopedia.org

5) American Dermoscopy Annual Meeting: https://americandermoscopy.com/2018/

6) International Dermoscopy Society: Free membership, review of dermoscopy cases, international conferences: http://dermoscopy-ids.org

Dermoscopy Apps:

1) Dermoscopy Two Step Algorithm app. By Usatine. Free algorithm with images and photos to walk you through dermoscopic evaluation of skin lesions. Free.

2) Virtual Dermatoscope app. By Cardiff University. Free dermoscopy case reviews.