DERMATOLOGY OUTLINE FOR 5TH YEAR STUDENTS

The following is detailed description of Dermatology course and what students need to read during this course. The students should have this outline at hand while reading various seminar topics as emphasis should be directed towards more important and common things as detailed down. For the more common topics students are encouraged to read about in more depth however for less common topics only very basic knowledge is advised. When especially reading about treatment students should mainly focus on learning the principles ( for Tinea capitis: systemic antifungals, for common Warts: topical wart paints, Psoriasis: topical Vit D). Students are encouraged to look at web sites where there is especially pictures of dermatological conditions they may have not had chance to see in the clinic. Some suggested sites are given below: www.bad.org.uk www.aad.org www.dermnetnz.org http://tray.dermatology.uiowa.edu http://dermatlas.med.jhmi.edu

NEXT IS THE OUTLINE DESCRIPTION: 1. STRUCTURE and FUNCTION. HISTORY AND EXAMINATION IN DERMATOLOGYand DIAGNOSTIC APPROACH:

BASIC STRUCTURE OF SKIN: i. Epidermis: cell types, cell layers and main features. Cell cohesion and desquamtion. ii. BMZ. iii. DERMIS: fibers, ground substance, cells, neuro/vascular/lymphatics, skin appendages. SKIN IMMUNOLOGY: i. Skin immune system and hypersensitivity reactions. HISTORY, CLINICAL EXAMINATION i. History: dermatologic history ii. Dermatologic examination: 1. types of lesions: primary and secondary 2. shape of lesions: colour, surface , margin 3. Arrangement 4. Distribution . SPECIAL DIAGNOSTIC TOOLS: Wood's light, Diascopy, patch test, Immunofluorescence, Tzanck smear, KOH .

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Approach to patients with Red Non-scaly Rash: Students should know the main disorders in this group including: Vasculitis and Reactive Erythemas (Urticaria, Erythema Multiforme and Erythema Nodosum). The main clinical presentations, causes and principles of management should be known.(+++) Other causes of Red non-scaly rashes should also be discussed especially Drugs ( clinical presentation patterns, main groups of Drugs causing such reactions) and infections (common viral causes of rashes mentioned with main clinical features. Also Bacterial conditions especially Staph. Aureus 4s and toxic shock syndromes.(+) Investigations Complications. Principles of treatment Approach to patients with Red Scaly Rash (Papulosquamous Conditions): Conditions that should be discussed here include: Eczema, Psoriasis, Lichen Planus, Pityriasis Rosea and Fungal infections. Various types of eczema discussed (Atopic, Irritant Contact, Allergic contact, Discoid, Seborrhoeic) , main complications of eczema discussed (especially infections: Staph aureus and Herpes virus, psycho-social complications, cost, complications related to therapy: steroids-related, immunosuppression and others) Psoriasis: main clinical variants (Common type, Guttate, flextural, Pustular, Erythrodermic, scalp and nail psoriasis), main complications ( Psoriatic arthritis, metabolic syndrome, psychosocial, drug-related), principles of treatment (Mild by topical agents, Moderate by Phototherapy, severe by systemic agents including Methotrexate, Retinoids, Ciclosporin and Biological agents/ Anti TNF-a). main side effects related to drugs should be known. Lichen Planus: main clinical features (5 Ps), special features vs other scaly rashes (color, striae, distribution, resolution, complications), complications (hair, nails, mucous memebranes) and principles of therapy. Pityriasis Rosea: main special features , course and treatment. Fungal infections: mainly considered when scaly rash is unilateral. Clinical types according to site: T.corporis (body), T. Cruris (Groin), T.Pedis (Feet), T.Capitis (scalp), diagnosis and treatment .

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Bacterial and Viral,and Fungal infections: i. Staphylococcal: Impetigo, Ecthyma, Folliulitis and Boils. Recurrent Staph infections. ii. Streptococcal: Erysipelas/Cellulitis Viral: i. Herpes virus infections types 1, 2 , 3. ii. Human Papilloma virus: warts Fungal infections: Tineas: T. capitis, corporis, cruris, pedis.

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REACTIVE ERYTHEMA AND VASCULITIS: REACTIVE ERYTHEMAS: i. Urticaria, Erythema multiforme, Erythema Nodosum: aetiology, clinical features, complications, investigations and treatment. VASCULITIS: small vessel vasculitis (Cutaneous vasculitis) aetiology, features, complications, investigations and treatment.

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DISORDERS OF PIGMENTATION: Hyperpigmentation: causes, features, investigations and treatment. Emaphasis on(PiGM 2EN TED): Post-inflammatory pigmentation, Genetic freckles and lentigines, medical causes (renal disease, liver disease, hemochromatosis, B12 deficiency, lymphomas), Malignant conditions (Melanomas, lymphomas), Naevi, Traumatic or frictional, Exogenous (Tattoos..), Drugs. - Hypopigmentation (APiGMENTED):Auto immune(Vitiligo), Posi-inflammatory, Genetic (albinism), .Causes, features, investigations and treatment. ACNE and ROSACEA: - Pathogenesis - Clinical features - Complications - Treatment BULLOUS DISORDERS: - As: Genetic and Acquired causes: - Genetic causes for Bullae: especially Epidermolysis Bullosa, Ichthyosis. - Acquired causes: Immune causes (Pemphigus Vulgaris and Bullous Pemphigoid: aetiology, features, complications, investigations and treatment), other causes of Bullae should

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also be briefly known including: infections, drugs, traumatic/frictional, diabetic bulla, insect bites and edema blisters. 9. HAIR AND NAIL DISORDERS: Hair disorders: i. Hair loss: localised VS Diffuse loss: causes, investigations, management. ii. Hirsutism: definition, causes, management Nail disorders: onychomycosis, paronychia and nail involvement in common dermatoses: Psoriasis, Lichen Planus.

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PRURITUS: Dermatological causes of pruritus: scabies, Lice and others: eczema, psoriasis,. - Underlying medical causes for Pruritus and the importance for investigating patients with pruritus for such medical conditions. Treatments used for pruritus. -