Vitebsk State Medical University Practical Dermatology Methodical recommendations Adaskevich UP, Valles - Kazlouskaya VV, Katina MA VSMU Publishing 2006 616.5 удк-б-1^«адл»-2о -6Sl«Sr83p3»+4£*łp30 А28 Reviewers: professor Myadeletz OD, head of the department of histology, cytology and embryology in VSMU: professor Upatov Gl, head of the department of internal diseases in VSMU Adaskevich IIP, Valles-Kazlouskaya VV, Katina МЛ. A28 Practical dermatology: methodical recommendations / Adaskevich UP, Valles-Kazlouskaya VV, Katina MA. - Vitebsk: VSMU, 2006,- 135 p. Methodical recommendations “Practical dermatology” were designed for the international students and based on the typical program in dermatology. Recommendations include tests, clinical tasks and practical skills in dermatology that arc used as during practical classes as at the examination. УДК 616.5:37.022.=20 ББК 55.83p30+55.81 p30 C Adaskev ich UP, Valles-Ka/.louskaya VV, Katina MA. 2006 OVitebsk State Medical University. 2006 Content 1. Practical skills.......................................................................................................5 > 1.1. Observation of the patient's skin (scheme of the case history).........................5 1.2. The determination of skin moislness, greasiness, dryness and turgor.......... 12 1.3. Dermographism determination.........................................................................12 1.4. A method of the arrangement of dropping and compressive allergic skin tests and their interpretation......................................................................................................... 13 1.5. Patients examination under Wood lamp.............................................................14 I 6. Balzer's test with tincture of iodine..................................................................15 1.7. Microscopical examination in dermatomycosis................................................ 15 1.8. The method of footwear disinfection in fungous disease of the feet............... 16 1.9. Carrying out of Jadassohn's test in dermatitis herpetifotmis (Diiring’s derma­ tosis) '.................................................................. 16 1.10. Symptom of Nikolsky in pemphigus...............................................................17 1.11 Taking of smear-prints and their staining by Romanovsky-Himza method for detection of acantolytic cells in pemphigus......... ..........................................................17 1.12. Besnier-Mcschersky symptom, dame’s heel sign and «butterfly» symptom in Lupus erythematosus............................................................................................................. 18 1.13. «Apple jelly» and «button probe» symptoms in lupus vulgaris.................... 18 1.14. The detection of psoriatic phenomenon (stearic spot, terminal film, punctuate hemorrhage)...........................................................................................................................19 1.15. Getting of Wickham's net in lichen planus.................................... 19 1.16 The method of material taking for preparing slides for detection of Tre­ ponema pallidum....................................................................................................................19 1.17. l he method of microscopic examination on trichomonas and gonococ­ cus 20 1.18. Skill of gathering epidanamnesis in patients suffering from venereological diseases..............................................................................................................................22 1.19. A twinglass probe (Thompson's probe) as a procedure using during the ex­ amination of a patient with uretritis.................................................................................22 1.20. Disinfection of hands and tools during working with a patient, being in­ fected with syphilis, gonorrhea and other sex transmitted infections............................... 22 1.21. The method of individual prophylaxis of venereological diseases............23 1.22. Filling in an extreme notification and necessary documentation to a patient, infected with venereological disease or infectious skin disease........................................24 2. Tests.......................................................... i...................................................... 25 3. Clinical tasks..................................................................................................121 4 1. PRACTICAL SKILLS 1. OBSERVATION OF THE PATIENT S SKIN (SCHEME OF THE CASE HISTORY) The examination of the patient's skin has some peculiarities. There are some circumstances necessary for the examination: good lighting, an ade­ quate light torch, a spatula, a magnifying glass and a transparent glass slide for diascopy. It is better to perform the examination at the day light, but if it is not possible, the light must be intensive enough. The temperature in the observa­ tion room must be 22-23° C because low temperature may cause spasms of blood vessels and high temperature may lead to their dilatation that will change the skin color. The general impression of the patient is very important, especially of his general health, pallor, intellectual assessment, queer personality etc. Make sure that the patient is completely undressed. The examination of the face and exposed extremities does not constitute a full assessment. Pa­ tients may be unaware of lesions or problems in areas that are inaccessible to them (back, feet). Carefully examine skinfolds (axillary, under breasts). Be certain to remove shoes and socks to inspect the bottom of feet and the space between toes. Nails, hair, mucous membranes also should be carefully ob­ served. Case history consists of several parts: Personal data of the patient Name, Age, Address, Profession, Duration of the stationary treatment, The clinical diagnosis. Complaints of the patient Dermatological patients usually complain of rash that may be followed by subjective sensations such as itching, burning, tingling, pairi, etc. The rash itself may be a complaint as it causes cosmetological problems. Some pa­ tients have general complaints such as malaise, dizziness, high temperature. Itch is one of the most frequent complaint. It may be the sign of many dermatological and systemic diseases. It can be localized and generalized. The location of itch in different parts of the body is typical for different skin diseases: for example, itch of the scalp may be a sign of seborrhoeic dermati­ tis, seborrhoeic eczema, psoriasis; in the eyelids - of allergic reaction to some allergens from the environment; in the palms - of scabies, dyshidrotic ec­ zema; in the feet - of tinea, eczema. There are many reasons for the general­ ized itch. Usually patients with dry skin suffer from itch. Dry skin can be caused by age, some skin diseases - eczema, atopic dermatitis, and ich­ thyosis. For some skin diseases itch is the main clinical sign: scabies, pedicu­ losis, atopic dermatitis, lichen planus, herpetiformic dermatosis Duhring, tox- iderma, urticaria, prurigo, lichen simplex. It can be seen in 40% of patients with psoriasis. Generalized itch can be a symptom not only of skin diseases but a clinical sign of other pathologies: infectious diseases, endocrine disor­ ders (diabetus mellitus - mostly located in the groin region; hyper and hypo­ thyroidism - because of the dry skin); disorders of the liver (cholestasis, cir­ rhosis); disorders of kidneys (80% in the kidney insufficiency); hematologi­ cal diseases (Hodgkin’s disease - 30%; mycosis fungous; leukemia; mielo- matosis); autoimmune diseases («Sicca syndrome» in systemic lupus erythe­ matous); neurological diseases (cancer of brain; multiple sclerosis); psychiat­ ric diseases; drug induced conditions (chlorpromazine, testosterone, aspirin). The character of itch is also important. For example, in scabies itch is more severe at night; patients with lichen planus suffer from severe itch that may be exhausting. There are obvious signs that are present in the skin of patients who suffer from itch - scrachmarks, excoriations, polish nails, lichenification. It is important in differential diagnosis of itch caused by psychological prob­ lems. Burning of the skin is seen in eczema, rosacea, etc. Pain is a more rare complaint but it is alsoseen in patients with deep ulcers and vasculitis. Some­ times the loss of sensation is observed (scleroderma, leprosy). The students have to be able to analyze all the complaints, to define the more important ones and to compare them to the severity of rash in the skin. Anamnesis morbi During this part the main questions should be asked: when did the dis­ ease begin? Did the patient have similar disease previously? In what part of the body did the lesions begin? How did they spread? During what period did they spread? Can the patient determine what factors provoke the disease? Did the patient become any treatment before? What treatment did he have? Does anybody of the family have skin diseases? 6 Anamnesis vitae Anamnesis vitae includes data about race, geographical factors (espe­ cially for immigrants), occupation, sports, hobbies, social background, ethnic tradition (dietary habits), past medical history: allergy to medication, hay fe­ ver, asthma, past major illness or operation. Social and occupational history has information about patient's travelling abroad, his hobbies and details of the type of work, substances in contact, etc. Status present Status present is described according to