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Okay, So mining's in Asia. I'm enough one on Welcome to your central of dermatology. Essentially, this tool is going to go through, uh, clicking here. Um, the reasons why we started it. So basically, I think during med school, most of us, if we had done told you teaching it was probably some random zoom lectures. And if you like to me, I didn't really focused during seem lectures. So now, as an F one, when I come to do damn referrals, it's extremely awkward on I'm kind of clueless on Unless I'm saying the terms Red maculopapular rash. I don't really know what else I'm saying. So basically, it's gonna be a building block for further down toward you. Learning on what me and Charles want to do with my sleep is do a whole damn 20 Siris. Where will cover those of interesting topics? So syco don't told you the artificial intelligence, just any kind of condition. So this will kind of be in the building block for that, say contents next night. So I'm going to start with some skin functions and fax that quick reminder as to what the skin does. Looking at the growth anatomy and then we'll move on to taking a history hearing examination. And then keep part is how to communicate all your findings, which is what probably most of us don't when you know what to do next. So skin functions. In fact, so the largest organ in the body, it's 15% off human body weight on it's quite externally dynamic organ. So you're the constant turnover of cells on their cycle off renewal on regeneration is about 40 to 60 days, most probably meaning that, but half the dust at home is probably just your skin on. The reason I really like dermatology is because it just the skin reflects kind of the internal state of your organs kind of like a canvas. How I like to think about it s a couple of examples. Would damn pills would be the more obvious SLE butterfly rash. But then you have the more subtle information off subcutaneous fat, which you find with or a theme in a dose, um, commonly seen in involuntary valve disease next light so the skin is a multitude or function. So first we'll we'll talk about protection. So quite obviously it gives us protection to mechanical force is so the subcutaneous layer of fact literally acts of the shock absorber to trauma. Then we'll get quite literally, can ical barrier from microbes, chemicals and then another aspect of protection would be protection from you. The damage. So the pigment melon in which protects idea. And it's why, in reaction to light we can, because we're essentially increasing medicine in production. On then the skin also regulates your temperature. We've got arterials in our gum, is which responding to temperature through dilating and constricting on. We also have quite glands, which, when it's hot for just swept and then that means to conviction. Taking away that he ngf my body's me cool down on, then the skin also contributes team the tablet circulation. So carotene in sites in this game produce vitamin D and that contributes to calcium him the Stasis and then we also have the immune function from Langerhans cells which are done genetic cells in our skin on then something that you might not think about a lot is the skin helps us choose, watch absorb what is it creates. So obviously we secrete things like see them. But then also things like patches, so nicotine patches, estrogen patches. Our skin is essentially gateway of what's going in. What's getting out. Okay, Next lied. So skin thickness varies based on anatomical dication age off patient on effects of the patient. So the epidermis tends to be thickest in your palms and your soles around 1.5 millimeters on its thinnest on the island in the air, excited on the damn. It tends to be thickest on your back, and quite obviously, subcutaneous tissue is think is in places like abdomen and your buttocks. And generally the outline of skin thickness is it's more thin and Children, and then think is whilst you're reaching the thirties and forties, and then it thins out there after and generally, mail skin is about 20% thicker than female skin on this is because the college and content of males camber Jesus at a more constant right towards female skin when more affected by menstrual cycles were more affected by menopause. It's the relationship between estrogen and progestin, progesterone on college in content. So particularly after menopause. That's when the males tend to get more wrinkles thin up in the skin. In general. Um, so just kind of the background of white male skin is more thicker. Generally I next side. So we're here. We have a back to basics diet ground off the skin. We've got the epidemics, which is just five laser cells. Then we've got the German epidermal junction, which has the birth basement membrane. With that have the derma switches fit into T layers, superficial papillary and deep particular. And then we have subcutaneous tissue right at the bottom. Next line. So the epidemics is made off four major cell types. We put keratinocytes melanocyte slang hand cells on Merkel cells and they each other and function. But they synergistically work hasn't or going to perform all those functions we talked about earlier. Next light. So Claritin. The sites are the predominant cell type in our academics. They originate in the basal layer, a k. The straw thing. Besides, that's the deepest layer of the epidemics, and they are carotids producing cells. They're characters of the structural proteins found in our skin, hair and nails on. Essentially, they form that epidemic kind of water mechanical barrier we were talking about earlier on. They have a huge role in vitamin D synthesis so, essentially, when he leave, the light hits keratinocytes. It activates cholesterol precursors. And then we form vitamin D, and that feeds into the whole calcium homeostasis system we were talking about earlier. Next, right. So the next cell types talk about is manana site, so you can see whether our is you've got a little melanocyte sitting there in the basal cell off the basil cell layer of the epidemics, and sat between all the character insights on. The reason for this is because of the mechanisms of how pigment is produced on subsequently transfer to carotene insights. So manana sites are dendritic cells, so they make melanosome was, which are basically spherical canals which have the pigment melon, and in them on that stimulated by the light next light. So, interestingly, the difference in shade of skin is not caused by the number of Lantus that you have. It's the number of Milan A zones which ourselves produced. So in dermatology, we use the Fitzpatrick just getting phototoxic. Ailton assess someone's risk of developing skin capture on. That tends to depend on how, like tell her Doc, their skin color is so. I find it quite useful on referrals at the moment, as opposed to simply saying Okay, A Caucasian, male or Asian female, I tend to just say Okay, Truck aging female type 45 skin. I just find it makes it more of a structured referral Next life, and I made my own celebrity. It's Patrick Phototoxic scale so tight. One. You're thinking more. Taylor Swift. Pale skin tends to be blue eyes. Always burns doesn't turn type to you that he more dearly pearl. Still white skin but been more darker. Burns easily times poorly Type three or taking more thinking. Okay, I'm compassionate. He's got like brown skin, which turns after an initial burn type fall. You'll be thinking more than dairy, so moderate brown skin bugs minimally towns easily on, then tight. Five. With thinking more practice trick for Jonah. Start around. Skin rarely burns darkly. I'm probably somewhere between type Type five, and then type six. You're thinking really? Holler if there's if you don't win. A holler is she's a super model, but she has vitiligo s so she can pains about her skin conditions in the public light. So I just think that's quite cool. Having a model with the tiller. Go on. Yes. So she has type 16. Dark brown black skin. Never burns, Always tan Stockley. So next time you make a referral, just think about which celebrity your patient. Okay, next, next light, Say back to me on a slights. Um, I just think this is very interesting. So monogamous, like have these, man it seems that melon and Granules, which had transferred to neighboring carrot insights through a big A psychosis. So they're these long process is extended form the monocytes, which kind of urinate the's bulls of pigment to the keratinocytes. On that this person is cool pigment donation clean you to the next side. Um, and it's just a really beautiful person. I saw him created some marcos for the images. Um, so at the top are image A You can you can literally see this pigment full inside the character. The site, um, which have been freshly freshly undergone. Some bursitis is on image be. You can see a scanning electron, my cost be image capturing the pigment. Just about to go into the carrot in the site on Then at the you can see the explore extensions. I was talking about whether our is on e and F uh, just some simple Michael's. The photos showing again Milana zooms entering the cytoplasm off Claritin sites. Next light. So the next cycle, we're going to talk about our Langerhans cells. So these are mainly found on the strontium Spanos. Um, Andi, I'll get to the laser of the epidermis later in case anyone's forgotten on their antigenic presenting cells, which activate T cells and help allergen recognitions. Essentially, they play in to do the Amina surveillance roll the skin has, um on. They also are genetic cells like Lantus sites, but they're not connected to character in the sights because they don't you pick donation, essentially, as something I think is really interesting is that you the radiation actually decreases the number of longer hum cells we have on that partially explains the mechanism behind treatment for things like X men and psoriasis through proven I need to be like treatment kind of Jesus information and those disease processes. Next life on the Last cell will be talking about his medical cells so they contribute towards function of mechanic Reception on that whole nervous system on they contain specialized have endings for sensation on off note. You can have a where aggressive skin cancer called Merkel's are carcinoma, So you had classically find that in the head and neck of Caucasians A people with type one or type two skin for two types. Next light. Okay, so now I'm going to guarantee the epidemics and its structure. I don't know about you guys, but I might do this in your one year to your med school value. Remember any of it? But it's so interesting just to look back on up here again because it helps you kind of explain. The disease process is with skin, and I just think it's a good foundation to go through where I was, where building forward in the series. So all the cells we talk about, we talked about opposition to through the epidemics. Obviously, carrot in the sites are the predominant cell on essentially. How the epidemics works. Is is a constant migration of carrot in the sights, going from the top from the bottom to the top on gas. They moved up the machine, they flatten and they lose their nuclear, and they lose all their organelles. So eventually, by the time they reach the top up, the stratum corneum. They're just flat and dad cells, and that's how they form such a great barrier. Teo, The external environment on this whole process is called Characterization Onda. I mentioned earlier that the whole process takes about 40 to 60 days and most people, so it's kind of like a self renewing experience in which is nice to think about in the context off your own skin. Tell my skincare routine So you know, if you're using a new rational cream, it's not. You're gonna have overnight results. You need to give it around a month or so because off the way that epidemics works, say, next life. Okay, so we'll start with the strontium besylate, which is the deepest layer of the epidemics. It's located just above the dermis and about it's made up of about. It may have some cells in about 10% Um, and it's the first layer of Claritin the signs. So, like I said earlier, the cells divide. They flatten immature when they moved up on predominantly Carotids five and 14 are expressed here. Next, like um, the resemble this up is because you can't get this awful genetic condition called abdominal hallucis simplex Onda. It's essentially when you get carotids, you take a shins or four on 15 through genetic mutations in carriages four and 15 on. That leads to the skin being more sensitive and vulnerable to blistering on very minimal friction on it's inherited in an autism or dominant pattern on, you can get very severe forms, which present at birth with widespread Restoril and because it can also affect mucosal membranes. You also then thinking about how Children are feeding, how it's affecting the nutrition, so things like feeding issues and characteristically horse cries when they when they're when they're born. And that's because of blisters in the larynx. And as you can see, it's extremely painful. Um, next one, eso the next light so the next layer will be talking about is the strontium Spinatus Um, which is the one I mentioned earlier when we were talking about lying hand cells. So this is known as the pickles I lay at all on the reasons called Percocet. A day is because you get the spiny kind of processes and bridges between the Carotene Insight School. Dozens names on. They kind of help Teo have the characters like sticking together as they get flatter and as they move up on thickening in this layer is specifically called a camp Asus. That would be more relevant in from histology, um, and again, so Carotin one untended are primarily expressed in this layer on when mutated, they lied to you really horrible genetic condition called abdomen etiquette. The Asus, which is on the next light. So unlike, um e ds, which we mentioned earlier epidemic the ASIS, the mutations from from it and more sporadic on def not spread it, they're probably office or dominant, and it's like a B s. It's also got mean a widespread reddening scaling. So they're blistering, which come becomes a part of birth, and you also get some hyper carry cases with it. Um, and yet we'll come back to what Hyperkeratosis is later on. It's just I just I just want to put those two diseases in just a highlight. When you get an absolute breakdown of some of the core functions of these layers, it can lead to such a devastating picture. I just just to contextualize going through the histology. I think it's quite nice. Okay, next light say, um, on a chilly staining the started granulosa, Um is that kind of deep purple earlier? You can see that on the reason it's so reason it has that deep a shade is because they're all these dense carotid, highland and lamella Granules. So what these Granules do is they destroy their contents. They tend to have carriage in precursors and lipids inside thumb. So they discharged, um, somewhere between this layer on the layer were told about next, which is the strontium corneum, and that produces this beautiful qualified cell envelope. Um which kind of allows it contributes to the lipid barrier we were talking about earlier. And thickening and stretching specifically in this layer is called hyper granulosus. So you see that quite commonly in like, um, planus in histology um next light. And this is an intermediate there. It's called a strong family, said, um, and it's only found in palms and soles on. It's just that thing transparently you can see in the middle, and there's not much else to say about this later. It just that it is present Next one on, then the final nail we're gonna talk about is the stratum corneum So this is the terminal there of differentiation. It's got loads of intel, often interlocking dead starting Korean cells. On the way we describe this layer is a brick and mortar structure. To the bricks represent dead a nuclear carrot in the sights, which are placed in a whole kind of a rate of lipids and proteins, which were which we mentioned in the straw from granulosa on. The relevance of this is that in diseases like X men, you don't have asthma of a strong lipid barrier. So the lack of moisture tends to dry out, get a lot more, which is why you get more of an inflamed picture. It's something like Axman, Um, and thickening of this layer specifically is called hardly carry. Case is that just means increased thickness in the starting Korean on it can be a cause off, not too different things. So typically, things like chronic friction or chemical damage can only topic air cases. That's why these progressive soaps can create that picture. Okay, next light so quickly just to run through the D. J or the Derma epidural injections and is the interface between the stratum beside me on the damn it's on. It's kind of the core of a structural support between the two because it allows for epidemic renewal on your generation, which is happening above. But it also kind of keeps that contact between the deeper layers. And typically you get ripped bridges so you get down would protect addictions off the epidemics which lock into the dermis and kind of like, um a great um, yeah, actually, flattening off the d j enhances rank things Really interestingly. Yeah, So next light on, then finally, we're reaching the dumbest. So this today is superficial on the depo. Particular on the Germans is where all the adnexa are. Sweat glands, hair follicles on neurons, blood vessels. It's all happening here on the predominant sell, it appears fiberglass, which produce college in elastic fibers and glycosaminoglycans, say next light. So I just wanted to touch upon fiberglass on aging. So, like we said for fibroblast, make collagen, which in human skin type one is the main one in fetal. It's more type three on say, it's so I think I made a type of that, um, say the damage is baking made up college in of made up of college in an elastic fibers. I put a little diagram that you can kind of see all the college in structures lining up, and then you've got a lasting fibers with it yet, But he's pointing out on diet. Basically, this kind of matrix like structure gives skin that support, and that's from underpinning. What we know is healthy skin on. It gives us a bit of firmness. It gives us that elasticity, but from kind of early adulthood are collagen. Production reduces by about 1% per year, so kind of from your early twenties actually on. But I just wanted to touch upon supplement, say many of you ever have decided to take college in supplements were thinking about it actually is useful. So hydrolysized by active college in peptides have been shown to improve skin elasticity, hydration on be visible signs of kind of wrinkles on, and I've got just, like, just got a little diagram here just to show you kind of how deep wrinkling would work in the context off richest collagen and reduced last in on. You can see part of the age is going from 20 to 70 with the ring clean coming through so I just think that's just quite nice visual. Um, again, collagen production is affected by so many things, So one of them would be retinoid in vitamin A products which up regulate the production of college in on Also either radiation and down regulates collagen. And also, I wanted to talk to born hormonal changes. So the degrees the decreased production of college in after menopause just simply reflects the reduced estrogen. And progesterone is well on against steroids. We know that skin thinning is a side effect of steroids, and that's just because steroids down regulate collagen production, which is why you get atrophy is such a prominent side effect next night. Okay, another product of father passed functions are like a so meaning like hands, and the one that we all know is high on IC acid. So age is basically a patent, which means it absorbs moisture from whatever it surrounding. So that's what we associate with the plumpness and volume off a healthy, youthful skin on D topically for any of you that use the humble ordinary a check a serum topically. It's a great moisturizer. Um, you can put it on the estrogen corneum it. We'll give it some temporary pump nous. Um, but like I said, a cea a on all the glycosaminoglycans that maybe in the dumbest, which is why you get a chair. Use a lot of dermal fillers. So Juvederm it's basically a A on. The reason it's so effective is because you inject it straight into the damn is where it kind of belongs, and it gives it immediately. It gives you a skin, a bit of volume, and it gives it that feeling effect, which is why you can also see it and like, fillers here, you can see that kind of immediate just call you and that's from a A Okay, next time. Cool. So the papillary dumbest is the thin layer off the dumbest on it's composed of more thinner connective tissue on it. Has thesis really plexus with all the arterials that helped the temperature regulation on next light? And then we have the deeper part of the job. Ms, which has taken layers of college and fibers on it, supports the adnexa in the skin on next, So moving onto you how to do a damn surgical history, so simply start off by asking about presenting Asian. So just general questions. You know, when and where did the rash or lesion start to the nature of it at the site of it on. How long has it being there? Four. On as with any presentation, if they are able to let the patient to score of the lesion tea on, then you asked about any associated symptoms. So I think that's mainly for that. Are kind of key for dermatology, specifically so pain it's bleeding. Plus next, right Then you should ask about whether that there's any triggers. Alleviate is so you can call until we're kind of following more of a Socrates pattern. Like the pain. I just ask. You know what makes the lesion worse? What makes it better? For example, stress can trigger back psoriasis that you might have a patient, you know, planning the wedding. And they've now got new glasses. Rice is so clearly stress is clearly a big factor for them in this situation on. Then, ask about medications. What are they taking of the start? Anything new because that can kindly to make me to carry like picture, especially for something like and set, um, again, whether they've had any injury to any area of the body. As you know, even the system of scratch is worth asking the next life. And that's because I just wanted to touch upon injury responses there. There's some really interesting ways the skin reacts to very minor trauma. So the first one is the copay of phenomenon. I'm sure most of you heard of that. I feel like it comes up. A lot of pop comes up a lot on Pass Med. So the Copaxone phenomenon is just describing areas where you have new skin lesions, um, on your skin, where you didn't before in the context or pre existing skin disease. So plaques in psoriasis a little bit, or patches of hyper pigmentation in vitiligo. You kind of see maybe koebner phenomenon happening that whereas pathology is something similar but different pathology is more with generalized inflammatory tissue response to injury. So it kind of phones, populace and postural Z, so it's not specific to any preexisting disease. Commonly, you can kind of get this in something called pyoderma gangrenosum, which I think is interesting. So I put a picture of PG the top on. Then you've got hyperpigmentation patches of vertigo in the middle. And then you put your plaque in psoriasis, the bottom. So PG is essentially rapidly enlarging. Very painful ulcers on it is associated with inflammatory bowel disease, so just interesting. So there's like to kind of injury sponsors to look out for next light. Okay, so then go on toe, asking generally about the occupation in social history. So do they smoke. They drink. Do they do any recreational drugs? All of which can flare in, trigger certain conditions? And I'll come back to recreational drugs, Actually, um, and then ask about medications, allergies and tatsu. I mentioned idea and says, I'm kind of in Jesus' hard drugs. Like I said, kind of geese lesions in the skin on Then we have travel and recent contacts that Oscar they being anywhere recently. Have they seen anyone who's been on holiday recently? I'm just looking out for infestations or any tropical skin conditions. A Lyme disease, maybe, um, and then also ask about Kobe 19 vaccination history so vaccinations can flare. I'm trigger both existing anti new skin rashes to the vaccination dates and history, Um, is really important to note, especially in the current comment when and then finally asked about possible go history and do a quick systems review. So in terms of past medical history, I'm thinking more say, you know your atopic triad. You get people who have atrophic dermatitis but also more sensitive to kind of allergic rhinitis. And asthma is it's just worth asking what else they have on their persistent review. Ask about systemic symptoms of fever, weight loss on then, as always, ask about your secondary dermatological sites. So these are hair nails on because on them rooms as well as joints next light. Okay, say, I wanted to touch upon the recreational drugs side as well. So port. Interesting indeed, as this condition hold of him is old adulteration, cocaine vasculopathy on. Essentially, it's induced by cocaine use. So you get this ready for next, like prepare it, rush in patients who actually have to be ankle positive before and then they might take some cocaine, which is which has been contaminated with living muscle, which is a, um, I think it's a pet drug. I think if I'm wrong, I'm sorry. Um, and then you get this kind of picture, so I just think it's interesting. You know, it's it's always worth asking patients. If they smoke, do they drink? Do they do drugs as awkward? Is it maybe. Okay, next light. And then, lastly really, really important for your history. I know we all and ice at medical school, but just, you know, ask about how they are. You know, skin disease authority does not correlate with the sac a little impact. You can have someone with a mild form of excema, but you can end up so severely depressed on On the other hand, you might have someone who has a pyogenic granulomas in which we mentioned earlier Really horrible. Also, really not really ugly. But they could be fine the morning something moldings always see. But it doesn't matter. You just have to assess the emotional impact that this skin presentation is having on your patient. Um, on also because, you know, skin lesions relate to you know, your self concept, your self confidence, we'll move your body image. It is really important. And quite recently this year, there was a parliamentary report called mental health and skin disease. So this has been around from 2020 and it's essentially kind of trying to push for more like a dermatology clinics. At the moment, I think we have any six in the country. Um, and so, yeah, this was really recently discussed in Parliament. This's January, actually. So yeah, it is really important to say Just osk Um yeah, next light. Um and then I just want to touch from skin cancer. Specifics. So for skin cancer, specifically Oscar about the initial appearance on the evolution of the lesions, or has it changed? OSK If they are on any current treatments for skin cancer on, ask if they've had previous treatment. Will surgeries? Sometimes you know, having already being three surgery for skin cancer the next day, he might not be as effective, So it's worth asking on degeneration in terms of kind of a social context. Asked about the history of some Bernice of turning machines, they're holidays is we'll have they have any long periods where they've been living in a tropical climate and then, as always, ask about secondary damage surgical sites. So nails scout parent joints and then it, like I said, any previous history of skin council on family history, that's right. And again, just convert this bringing up a celebrity Fitzpatrick scale. Um, yeah, but I just wanted to touch on this again. Because even there I have said, you know, type one type two, type three. The lighter skin shades are more of a risk of skin cancer. Don't dismiss someone who may look like they have skin cancer with type flyable type six skin. Um, so it kind of richly pigmented skin candles have affected typically in a couple areas. So, yeah, don't dismiss a patient just because they don't have a lighter skin. Every one of us can get skin cancer next light. Okay, Now we're gonna be going to dump total examination, so we know a lot. The structure of the skin. We know what's made up to the histological level. We know how to do history now onto the examination. So there's four principles really easy. Inspect. Look that you look at the lesion, describe it on. I will provide us some tools on to how we do that. Because it's hard when you look at a rash. I I honestly don't know what to say other than red maculopapular rash on. Then people are paid. So look, we'll come to that and then do a quick, systemic check. Okay, so next side. So for inspection, start off with the general. Look at the skin. Look at the Fitzpatrick skin. A prototype. Look at the number and the location of lesions on. Look at the distribution and configurations. A configuration is just the outline of the lesions exploited. And then how to describe lesion that you see? So we using the Monix scam, so s is for the size or in the shape. So sorry. You know, you could say millimeters centimeters. Um, sees the color a is for associated second degree change, and I'll come back to you how to differentiate between a primary lesion in the second relation. Mm, It's warming, Falouji and margins on a I just added in there because we need to again assess do additional assessment for do additional assessments were pimping minted lesions next life. So pigmented lesions. Um, Oz me nerve is an AB CD approach to these, um, so a for asymmetry, usually with something that's more cats, like sides get really match each other. Borders tend to be more regular. They're different colors. Um, there are much of the lesion. If it's probably more than six millimeters, more likely to be much more cancerous, and he evolution. So as we as we went through earlier ast part of the skin cancer specifics in the history, you know, ask about the evolution of the lesion on. I think patients are quite good being able to tell, um, if it's kind of increase in size, I think a lot of patients know kind of a B C D approach, so they will kind of be able to answer all these questions. Uh, next life. Okay, describing the lesion. So prime religions are any on modified lesions direct from a disease process or birth. So I got two examples here. So we've got strawberry. My game is at the top, which people are born with, um and then secondary skin lesions are lesions which have evolved from the prime religion. So this convene from trauma, infection or medication What you're taking for that primary skin lesion? So example of this would be cross thing from scratch, constantly scratching your excema, um on infective a logic wheel on then my can if it cation off any epidemic. So the example have included in the bottom there is a turbine dermatitis, which has then been called with lichenification. So that would be your secondary skin lesion on top of that next light. Okay, here's the jeezy. Thought we've done the entire assessment. We've been through history. We don't examinations on Now. I'm gonna run through how to communicate your findings into your referral. I don't. We just never get taught how to do this in a proper structure. I feel like everything is sports porotic. So I just wanted to run through some key words to use in a structure for you to work through the next time you see a lesion, Um, I get cool next night. So the fasting to look at how to communicate morphology. So we'll start with prime relations. So flat lesions, arm actually or patches. So, um, actually, less than one centimeters on an example of this, Just the freckles. They're just mark yours on patches are over one centimeters. So example would be the telegraph patches, which you can see that you can see ah hyperpigmented patch off. And next light, it's and then solid red least the braves lesion. So these are not fluid. Feels so. We've got some papule for popular less than 0.5 centimeters on an example of this would be a million clocks are over there 0.5 centimeters and they have scaling. So obviously psoriasis is the first thing that pops into your mind when it comes to my scale. Clocks, no, jewels are more than 0.5 centimeters, but they have a more rounded, deeper component component to them. So example would be lost. Um, contagiosum and they're pearly nodule on, then interestingly, um, Abilify. Um, rash is just a huge mix of Machu ALS and PAP Yours on. They tend to be from drug reactions and bob reactions. Hey, next light on. Then there's clear raised, fluid filled lesions. So these are visa calls, or Billy. So visa cause less than 0.5 centimeters on a good example is contact dermatitis of the hand on bully are over 0.5 centimeters. For example, bullets pemphigoid or pemphigus vulgaris. Next light. So I did just want to talk in especially skin tests because I think the differentiation between bolus temper good and pemphigus vulgaris is quite confusing. So there's this test called the Nicole Skis Test. So it's positive when a natural pressure of unlisted skin you get sharing of the epidemics. So if you rub in a razor on the skin, you're gonna get sharing. It's positive in ST Pemphigus vulgaris or Estrace us. But it would be negative in something like bullets temp, a good which is more red, deeper disease process. Um and they're both auto means. Skin conditions next light so back to communication. Other lesions include postule so postural they are less than 0.5 centimeters and they are like physicals, but they have plus within them, four uncles are caused by staph infections around within a hair follicle on carbon calls. Artist Multiple for uncles, really, And wheels are transit rays. Lesions from derma, a demon See included some examples that you've got some wheels at the bottom on. Then we've got some folliculitis at the top. Um, she got lots of postural is they're building up on. This is actually really interesting. So this is a specific kind of folliculitis which get the nape of your neck and head. Um, yeah, and you can see all that information. What postural that and next, like on then couple more words for second religions. So excoriation is loss of epidemic following trauma. So, like I said, how second religions come from formulations of trauma is another way of causing a second religion. Social scratching lesions in X mark. You're gonna get some excoriated. You're gonna get an exploration picture. A fissure is an epidemic crack, often from dryness. So, you know, when you get some hyper carrot Asus in your feet, you tend to see that kind of joy picture with some cracks. Uh, next light. Okay, So, like, edification is defined as world find roughness of the skin, and it basically accentuates skill that skin lines. So you get that in things that chronic dermatitis, where is scaling is countries flakes off that top layer of strontium corneum You was getting flakes of dead skin coming off. Um, do you kind of see that in parks, in psoriasis on. You also get a thin clock in pityriasis bicycle s. I put Patricia's basically at the top there. You can see that kind of thin flocked coming off on. That's what different psoriasis weights. Very. Obviously you can see scaling that and thanks. And then lastly, uh, well, not lastly, there's more crossed. So crossed. It's just a rough surfaced. You 15 minutes of dried up, Stephen blood bacteria, dead cells from the top of the Crestor. Corny, um, which basically come three. Yeah. Yeah. So something is also question you can get the slides later. Um, so but I was like, So you get dried up fever blood bacteria which have come through and eroded epidemic so commonly from bass blessed up on the example of cute have included here is that classic honey colored picture in a target and Children embassy call that crossed basically call that honey colored crossed next life and then also unscarred. So the definition of it also is an excavation which Reese reaches the epidemics. I'm importantly, it also reaches the damn. It's so the reason ulcers heal with scarring is because you've hit the damage. Sir, we know that epidemics has that whole 40 to 60 day cycle off renewal on regeneration. But unfortunately, the damn it's doesn't have that. Which is why you get scarring after, um on scholars is just scarring is just need Barbas tissue after heating so you can get atrophic scholars. Whichever thin you could get hard for traffic scars should put the top there, which is basically hyperproliferative of the cells but within the wind boundary on. Then you can also get keloid scars, which go beyond the wound boundary on their bit more difficult to deal with, and they're kind of more firm will smooth and more more of a growth on. They tend to be quite uncomfortable. The patients next light, so the next step is palpating, so it's worth palpating. Any lesions or patients might have. So if you just kind of look at the surface or texture, is it? Rough is it's smooth, the of the lesions elevated or they depressed. So, for example, elevated lesions would be we mentioned earlier the wheels and are two carrier where you're getting the dumbbell a demon's. You can feel that on someone's skin elevated or if it's depressed. A common example be hypertrophic scarring, acne. So put an example of that. If you were to put your hand over that, you can you convict really feel depressed lesions. So that's just a nice thing to comment on Next light and then moving on with Palpations, um, say with the nodule or visa call or postural, have a look of the consistency. Nasacort Is it soft? Is there fluid inside that solid? And then look at whether what you're seeing? Is it moving is on its own? Or was it linked to any other structures on the generally have a feel of it. Is it Is it hot? Is it tender for the patient, which would indicate some sort of ineffective or inflammatory process going on? Um, and you can see the milia over there. You got tiny, tiny dots of carrot in hard character said he talks that that be quite hard on then. Molluscum contagiosum you'd have more puffs like picture. Um, yeah. And then I've just got a picture of a cutaneous carrot Carotid, carotid horn. I just thought that's cool. So if that would obviously be hard if you touch it, it, um, next slide. Okay, last but not least, always dear Systemic examination. So, as we've mentioned multiple times, dermatology is not just the skin. A dumb told you, you know, includes, um scalp hair, nails, genitalia. These are all sites to check on examination of systems as well. Just to check for any systemic disease there f any IBD thyroid disease commonly show up on your skin. Like I said, our skin is basically a canvas for what's going on inside, so you just have a check. It's always last hearing, um, next light, Um, and yet I just think nails are good to touch upon. So I don't think there's an animation that you just click, So you get pitting. So pitting is basically just want. Take depressions of the nail place. You get that sometimes with excimer so isis or alopecia areata, which we didn't cover today. But we will do it later. Talks next time and next. On closest is separation off the nail from the nail bed, which you can see it. The top left that so you can get that in psoriasis and, interestingly, chemotherapy as well. Next corner Nicaea is when you get spoon shaped cells. So it's really traffic, an iron deficiency anemia, and you got a really severe case over there in the middle of next life. And then, obviously I have to mention clubbing, Um, because coming is drilled into us the Imagine school, but obviously, you know it's part of dermatology. On passively you get it, you know COPD lung cancer IBD and graves disease, which are all things we also mentioned earlier when we're looking at skin lesions, so everything fits together very nicely on it helps create a better picture for you. Don't tell your referral next side just touching upon vascular lesions because I think they're quite confusing as well. So telangiectasia are small, superficial blood vessels on off know they blanch with pressure so you can't see them on a democracy scope. And if you get see them launching the mouth will be called. Something will be called Ask P say, specifically vessels, which branch on pressure next week. And then just a quickly differentiate some of the lesions we see in, um, kind of more vasculitic diseases. So petechiae are less than 0.5 centimeters on. There just extra visited red cells on their influence by gravity, so more they then more a result of platelet disorder. I've been in Kharkiv Correlation pathways. We kind of see that in I T. P. On the larger version would be popper, a soap opera is over 0.5 centimeters are not millimeters on, but if they are palpable, that indicates some sort of inflammation going on on this, Dina within the lesion on a chemo sees is a fancy term for bruising. And the reason we get that yellow color off a healing cruise is basically just the breakdown of hemoglobin into bilirubin. Next light. Okay, this is my favorite pneumonic. So I'm aware I've kind of bombarded everyone with loans of different structures on ways to go about assessing your patient from history examination on communication. But when you actually seeing a lesion, it's really hard to know. Immediately put all of that together without feeling like your brain is going to burst on again. Then you kind of slip into the habit of going Okay, this is a localized red rush. So last two cabs is a way off structuring a lot of faults you have going on in your brain. So l is for location. So you're looking at the lesions. Where is it? Is it localized is it's sun exposed. So, example of the sun experience lesion would be actinic keratosis is on the air. So I put a nice image that, um so it's just worth checking to. Scalp is some exposed areas. Is it so much call? Is it damaged? home. Also got a example Healthy, softer there. Which is more damage home or, um, E is for air A FEMA. So that's just brightness in and around leaders. Obviously, we all know that always comment on it s is for surface. So now we've already palpated the lesion our patients has. We have We can comment on that. So we know whether it's rough or crusted or scaly. So kind of rough lesion would be in an acne vulgaris. You can see the kind of rough sports they're, um, next light, and then tea is for the type of lesion. So primary or secondary, it might not always be obvious for the relation is primary secondary, So I wouldn't stress about trying to put that in a referral. C is full color. So is the lesion pigmented? If it is pigmented, you would have already done your A B c d e assessment on specific skin cancer questioning or is it hyperpigmented like the till ago? And A is for arrangement a k A configuration. So if you have more than one lesion, how are they arranged in relation to one another even really easily comment on that. So lesions might be generalized all over. They might be dermatomal. They might be a ring shaped on. I know we mentioned Dermatomal Aaliyah women to my location again. It's just another reminder of things to comment on. B is for Borders said the demarcation off religion on example, with the differentiation between cellulitis and Aricept lists. So our supplies has more of a demarcated border with cellulitis is more generalized on D s is for special sites. So how are their nails scalp genitalia? Because the memories how they affected you could just quickly comment on that in the end, Um, so I got last two caps. If you just go through that, you will be fine for your referral next life. And then I just wonder if we're really quickly run through some positive words for communicating. Say distribution so generalized is quite XL. Fix my artery all over the body. Widespread would be even more so even more extensive. Localize would be restricted to one area of the skin and then Flexeril is looking in your body fall so the neck, the popliteal regions, the antecubital fossa. So something like ex mail, which is more reflective disease, concede at the top there. That's more in the popliteal reason. Whereas if you're getting lesions more in Extensile region region Okay, for example, psoriasis is more extensile. Have a look at the knees, elbows, shrimp. So you can comment really easily on distribution on then, Obviously, pressure areas, especially for most of us. You're working inpatient wards. So many of our patients are going to be having ulcers on, you know, so say from bottle heels. So just have a look at pressure areas on then to communicate kind of maybe infection and not in the novel system. You can create easy, say damage. Um, and then a nice phrase communicating, um, lesions in more in areas more prone to skin Counselor would be for your sensitive. So I already shared afraid of kind of the year he he sees Yeah, next night and then how to communicate Theory of lesions with the street would be individual separated lesions confluent with the lesions which merged together. Uh, linear lesions obviously are in the line. Um, target lesions would be concentric rings. So, for example, ara three multiple conceal on the hands there. You call those type of lesions and you describe them as concentric rinse, and then another one to use is another or disco weeks. So you classically see that in the discourse relation off today Or corporate? Uh, next slide. Okay. Meaning, Kate in color. We mentioned our theme it before bread nous, which branches on pressure Purpura. So that's a red or purple car which doesn't really launched on pressure hyperpigmentation and deepened depigmentation would be areas of paleish skin. All areas which do not have any melatonin and hyperpigmentation would be areas of documents. I've got some hyperpigmentation in of the bottom that so that would be post inflammatory hyperpigmentation in someone who's actually just had some discoid X. Maybe you can see that there are new latest blood shapes. Um, yeah. Next one. Yeah, that's the end of my presentation.