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Is it Only Skin Deep? Dermatologic Evidence of Systemic Disease MAJ Amanda Cuda, MD 7 Sept 2011 Objectives • To review the dermatologic exam, including hair and nails • To learn dermatologic conditions and their systemic associations • To identify these same conditions and associations from photographs Dermatologic Exam • Break up into pairs: – Examine your partner’s hands and fingers only, include fingernails – Document exam using medical terms – Present exam to your partner Dermatologic Exam: Patient seated • Inspect the hair – Pattern of distribution and texture • • • • Inspect nail beds Inspect nails for clubbing, pitting Inspect skin of face and neck Inspect skin over back Dermatologic Exam: Patient lying • Inspect skin of chest • Inspect skin of abdomen • Inspect skin of lower extremities Systemic Conditions • Skin wellness = overall wellness • Many manifestations, many conditions Systemic Conditions • View photo of a skin manifestation • Write 3 descriptive exam findings • Identify systemic condition(s) Beau’s Lines Onycholysis Acanthosis Nigricans Café au Lait Spots Erythema Multiforme Telangiectasia Butterfly Rash Heliotrope rash Viral Exanthems Viral Exanthems con’t Purpura Which of these skin findings can be normal? A. Acanthosis nigricans B. Palpable purpura C. Heliotrope rash D. Café au Lait macule [Default] [MC Any] [MC All] Which of the following is not a cause of this nail finding? A. Diabetes Mellitus B. Psoriasis C. Thyrotoxicosis D. Trauma [Default] [MC Any] [MC All] All of the following are manifestations of an underlying vasculitis except: A. Acanthosis nigricans B. Erythema multiforme C. Purpura D. Telangiectasia [Default] [MC Any] [MC All] Possible cause of this nail finding? A. Kawasaki Disease B. Telogen Effluvium C. Scarlet Fever D. All of the above [Default] [MC Any] [MC All] Which of the following, pictured here, was known as Sixth Disease? A. Rubella B. Measles C. Roseola D. Scarlet Fever [Default] [MC Any] [MC All] Clinic Challenge • Derm exam, hair and nails included, • 1 patient/day for 1 week Conclusion • Reviewed dermatologic exam • Learned dermatologic conditions and their systemic associations • Identified these conditions on photo quiz Questions? References • DeGowin RL, Brown DD. DeGowin’s Diagnostic Examination, Seventh Edition. • Fitzpatrick TB, Johnson RA, Wolff K, Suurmond D. Color Atlas and Synopsis of Clinical Dermatology, Fourth Edition. • Habif TP etal. Skin Diseases Diagnosis and Treatment, Second edition. • www.dermnet.com • http://en.wikipedia.org/wiki • http://www.myfootshop.com/ • www.mdconsult.com • http://health.allrefer.com • http://www.clevelandclinicmeded.com • http://dermatlas.med.jhmi.edu • http://emedicine.medscape.com
