Skin and integument conditions

Rationale

Skin disorders (including rashes, tumours and ulcers) are among the most common reasons for seeking medical attention from primary care physicians and specialists such as dermatologists. Integument conditions (including hair and nails) are also common. These disorders can be due to local diseases or may indicate an underlying systemic condition. Patients who are affected can present with psychological distress.

Causal Conditions

(list not exhaustive)

1. Rashes
   1. Macular
   2. Papular
   3. Vesiculobullous
   4. Pustular
2. Tumours
   1. Benign
   2. Premalignant
   3. Malignant (e.g., melanoma)
3. Ulcers
   1. Vascular
   2. Infectious
   3. Autoimmune
   4. Pressure ulceration
   5. Tumours
   6. Toxic
4. Nail presentations
   1. Local nail problems
   2. Associated with an underlying condition
5. Hair presentations
   1. Alopecia
      1. Scarring
      2. Non-scarring
   2. Hirsutism
   3. Hypertrichosis

Key Objectives

Given a patient with a skin or an integument condition, the candidate will diagnose the cause, severity and complications, and will initiate an appropriate management plan. In particular, it is important to determine whether a condition is benign, malignant or associated with an underlying systemic condition.

Enabling Objectives

Given a patient with a skin or an integument condition, the candidate will

1. list and interpret critical clinical findings, including those derived from
   1. an appropriate history (e.g., drug and medical history);
   2. a general physical examination and an assessment of the skin characteristics (e.g., morphology and distribution);
2. list and interpret critical investigations, including
   1. those which differentiate benign from more serious disorders (e.g., biopsy, fungal scraping);
   2. further investigations, as required (e.g., diagnostic imaging or laboratory tests);
3. construct an effective management plan, including
   1. prescribe an appropriate topical and/or systemic therapy;
   2. refer if appropriate;
   3. offer counselling and education, including prevention of future skin conditions (e.g., sun exposure).