Senior-clinician companion to introductory Dermatology notes. Educational use only.
A Word From Your Senior
Skin disease is visible, but visibility can create false confidence. Good dermatology begins with precise morphology, distribution, time course, symptoms, exposures, medicines, mucosal findings, and systemic state.
Examine the Whole Pattern
Describe primary lesions before secondary change: macule, papule, plaque, nodule, vesicle, bulla, pustule, wheal, or other morphology. Record colour using objective language, surface, border, arrangement, distribution, symmetry, and involvement of scalp, nails, mucosae, palms, and soles when relevant.
Skin findings appear differently across skin tones. Erythema may be less visually obvious; palpation, warmth, swelling, tenderness, symptoms, and comparison matter. Educational images must represent diverse skin tones.
Common Does Not Mean Harmless
Acne reflects follicular plugging, sebum, inflammation, and microbial interaction; management considers severity, scarring, pregnancy potential, psychological impact, and treatment risk. "Rash" is not a diagnosis. Consider inflammatory, infectious, drug-related, autoimmune, vascular, neoplastic, infestation, and systemic causes.
Bedside Case
A patient develops a widespread painful eruption, fever, mucosal erosions, and skin tenderness after a new medicine. Stop non-essential suspect drugs under senior guidance, assess airway and systemic involvement, urgently escalate for possible severe cutaneous adverse reaction, provide supportive care, and document precise drug timing. Do not send the patient home with "allergy tablets."
Accuracy Guardrails
- Non-blanching rash with systemic illness requires urgent assessment.
- Rapidly progressive pain, toxicity, bullae, crepitus, or pain out of proportion may indicate deep infection.
- Topical steroids vary greatly in potency and site-specific risk.
- Do not treat undiagnosed facial or genital lesions repeatedly without review.
- Suspicious pigmented or non-healing lesions require appropriate dermoscopic or specialist assessment; simple rules support but do not replace judgment.
Trusted Starting References
- WHO skin-related neglected tropical diseases (opens in a new tab)
- British Association of Dermatologists guidelines (opens in a new tab)
- Current local severe-drug-reaction, skin-cancer, and antimicrobial guidance.