1. http://www.flickr.com/photos/epsos/4883281674/sizes/o/in/photostream/

2. Dermatology: skin
health and disease
Catherine Hyde
GP and Teaching fellow
Year 1 clinical co-lead
25th November 2012

3. What % of the population is
affected by skin problems at
any time?
A. 2%
B. 10%
C. 30%
D. 70%

4. What % of the population is
affected by skin problems at
any time?
A. 2%
B. 10%
C. 30%
D. 70%

5. Plan
•What do I need to know
•Keratinocytes & psoriasis
•80 year old man with a skin lesion
• keratinocytes and melanocytes
•Questions

6. What do I need to know?
Knowledge
• Normal skin – and how this relates to pathology
• Terminology for skin
• Common disease
• Systemic disease with skin manifestations
• Rare and serious disease: recognition and referral
• Common benign conditions
• Treatment ladder for common diseases and one name of
each brand of treatment

7. What do I need to know?
Skills
• Taking history and examining skin
• Pattern recognition
• Managing uncertainty
epSos.de.CuteDogPuppy
Onflicker.com
http://www.flickr.com/photos/epsos/4883281674/

8. What is the main function of
the skin?
A. Protecting from mechanical stresses and
micro-organisms
B. Synthesis of vitamin D
C. Regulating body temperature and fluid
loss
D. Sensing the environment and potential
damage

9. What is the main function of
the skin?
A. Protecting from mechanical stresses and
micro-organisms
B. Synthesis of vitamin D
C. Regulating body temperature and fluid
loss
D. Sensing the environment and potential
damage

10. Normal Skin

11. Yellowraincoatsbychispita_666flickr.com
http://www.flickr.com/photos/gusilu/2699275381
Epidermis

12. Keratinocytes
• Epidermis is mostly keratinocytes, migrate
from the basal layer differentiating
• 40-50 days
• Active in Vitamin D synthesis

14. Psoriasis
Mysiana (2007) Pink. Flickr.com [accessed
18/03/2012]
http://www.flickr.com/photos/mysiann/163870507
4/sizes/l/in/photostream/
Keratinocyte
Abnormal differentiation
Hyperproliferation
Psoriasis
Common 1-2% population
Multiple lesions
Separate (discrete)
On knees and arms (extensor
surfaces)
Discoid
Red/erythematous/salmon pink
Scaly

15. Psoriasis
Treatment Ladder
Topical
Moisturisers
Coal tar
vitamin D analogues
Immunosuppressants
(Steroids/dithranol )
For widespread disease
Phototherapy
Chemotherapy (low dose)
Biological therapy

16. Skin Treatment – in general
• 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 (cautery/cryotherapy)
• Cut it out

18. 80 yr old man
Senile Keratosis
Senile : older age
Keratosis: from keratinocytes
Senile Keratosis: Benign
proliferation of keratinocytes
Normal skin with mole (naevus)

19. Senile Keratosis
1. Inspect Generally
Single or Multiple lesions
Discrete (separate) or
confluent (flow together)
2. Describe individual lesion
SCAM
Size (the widest diameter),
Shape
Colour
Associated secondary change
Morphology, Margin (border)
0.5 cm
Oval
Pigmented
(no erythema)
Raised
Clear well-defined border

20. Senile Keratosis
3. Palpate the lesion
Surface
Consistency
Mobility
Tenderness
Temperature
Raised
Waxy/warty
Non-mobile
Non-tender
Normal temperature
2b For any pigmented lesions
ABCDEF:
• Asymmetry
• Border – risk of malignant melanoma if
irregular or indistinct
• Colour – haphazard, different shades
• Diameter
• Elevation
• Fitting in with other moles

21. Senile Keratosis

22. 80 yr old man
Normal skin with mole (naevus)

23. If lung cancer affects 41,000
people per year, malignant
melanoma affects?
A.1,000
B.3,000
C.9,000
D.11,000

24. If lung cancer affects 41,000
people per year, malignant
melanoma affects?
A.1,000
B.3,000
C.9,000
D.11,000

25. Melanocytes
• Melanocytes: in epidermis, produce melanin which
protects skin against UV radiation
• Melanoma : malignant proliferation of melanocytes
1. Inspect Generally
Single lesion
Skin generally sun
damaged

26. Malignant melanoma
2. Describe individual lesion
SCAM
Size (the widest diameter),
Shape
Colour
Associated secondary change
Morphology, Margin (border)
0.7 cm
Discoid = cicular
Pigmented
Surrounding erythema
Flat
Irregular border

27. Malignant melanoma
2b For any pigmented lesions :ABCDEF
• Asymmetry
• Border
• Colour
• Diameter
• Elevation
• Fitting in with other moles
Asymmetrical
Irregular border
3 different shades of colour
0.7cm
Flat
Different from surrounding
skin
3. Don’t forget to palpate

28. Malignant melanoma

29. Of the 36,000 possible
diagnoses in medicine, how
many are dermatological?
A. 1,000
B. 4,000
C. 9,000
D. 13,000

30. Of the 36,000 possible
diagnoses in medicine, how
many are dermatological?
A. 1,000
B. 4,000
C. 9,000
D. 13,000

31. Uncertainty in dermatology
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 senile keratosis

32. Uncertainty in dermatology
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 senile keratosis
Urgent referral
and treatment
Review in 6
weeks
Reassure &
advise

33. What have we covered?
• Skin is important in health and disease
• What do I need to know about
dermatology
• How to describe a lesion
• Keratinocytes & Psoriasis – from basics to
management
• Melanocytes and melanoma
• Managing uncertainty in skin

34. Useful Information
• http://dermnetnz.org/ excellent images and treatment 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
Questions?