An Approach to Dx Ix & Rx

1. Solitary lesion or multiple lesions

• Solitary --> consider using dermatoscope for pigmented and non-pigmented lesions

2. Multiple

• Distribution
• Pruritic or not?
• Painful or not?

3. Time scale

• Acute
• Sub-acute
• Chronic

4. Similar in past?

5. Primary or secondary skin condition

• e.g. eczema with secondary Staph. infection

6. Main feature

• Red scaly
• => epidermis affected
• Red non-scaly
• => dermis affected
• Blisters
• Pustules

7. Muco-cutaneous symptoms


8. Contact?

9. General condition

• Presenting complaint
• Systematic enquiry
• PHx
• Symptoms
• RS - URTI/LRTI
• GI - infection; inflammation
• GU - UTI; STI
• NS - headache
• Pysch - stress; mood disorder
• Other
• Medications
• OTC preparations
• Vaccinations
• Diet
• Weight
• Examination
• Scalp
• Oral cavity
• Axilla
• Groin
• Palms & soles
• Lymph nodes
• neck
• axilla
• groin
• epitrochlea

10. Febrile?

11. Ix

• Clinical
• Wood's lamp
• Magnifier
• Dermoscope
• Lab
• Swab
• mcs
• PCR
• Throat ?Strep.
• Scrape
• KOH micro
• Bxi
• +/- DIF
• +/- special stains
• Exc
• +/- DIF
• +/- special stains
• Special stains
• Standard
• H&E
• Consider other or additional stain in inflammatory and neoplastic disease
• Bacteria
• Gram (gram -ve difficult to demonstrate)
• Ziehl-Neilson (most mycobacteria (ZN or AFB)
• Cutaneous lymphoma
• cytogenetics
• Fungi
• Periodic acid-Schiff (PAS)
• 
  
• DIF
• IgG; IgA; IgM; C3
• Blood/serology
• Blood
• FBC
• LFTs
• UCEs
• F.BSL & lipids
• Serology
• CRP
• RF
• ANA
• Complement
• IDIF
• IgE
• RAST
• Strep.
• FTA-ABS
• Hep B/C
• HIV
• QuantiFERON

11. Rx

• Reduce symptoms
• Reduce excessive moisture
• Hydrate dry skin
• Prevent recurrence
• Cure
• Palliate
• Rx secondary condition/s (incl. infection)
• General skin care
• Clothing
• 100% not always best as may contain allergens
• may be finished with formaldehyde resin
• Consider
• 100% cotton or linen that wrinkles easily
• 100% polyester
• 100% wool
• 100% silk
• 100% denim
• Silver Shield/4H gloves
• Soap alternative
• Dermaveen Shower & Bath Oil
• Emollient
• Dermeze ung
• Aqueous cream
• Shampoo
• Don't use everyday if skin dry
• Hypo-allergenic
• Head & Shoulders Clean Balance
• Selsun
• Sebitar/Sebirinse
• Topical

• Rx
• PBS
• Private
• Compound
• OTC
• Systemic
• antibiotics
• c.steroids
• Ig
• Vaccine
• Address psychological issues