DERMATOLOGY: CORE CURRICULUM

  1. GENERAL TOPICS

(a)The trainee should know the indications for referral to a dermatologist and recognise his/her own limitations.

(b)The trainee is expected to be able to recognise and manage common dermatoses and skin malignancies in the out-patient clinic (see below).

(c)Counselling/Preventive Medicine.

  1. the role of dermatology nurses
  2. the use of emollients
  3. care of the hands
  4. protection against the sun
  5. liaison with fellow professionals e.g. the paediatric nurse and dietician in the management of children with atopic eczema, the health visitor in the management of scabies.

(d)In-patients/Day Care.

  1. psoriasis, eczema and erythroderma
  2. cellulitis
  3. leg ulcer – venous and arterial, use of Doppler
  4. pemphigus and bullous pemphigoid.

(e)The trainee should be aware of the psychological impact of skin disease.

2.SKIN DISEASES

The trainee should obtain a working knowledge of these common and/or important skin diseases:

Infections and infestations

  1. fungal and yeast infections: Candida, pityriasis versicolor, tinea
  2. bacterial infections: impetigo, cellulitis
  3. viral infections: herpes simplex and zoster, molluscum contagiosum, viral warts, viral exanthem, pityriasis rosea
  4. infestations: scabies, lice, insect bites.

Eczema (dermatitis)

  1. atopic (children and adults)
  2. contact (irritant and allergic) including hand dermatitis; pompholyx
  3. seborrhoeic, discoid, asteatotic, stasis.

Psoriasis

  1. chronic plaque, guttate, flexural, scalp
  2. palmo-plantar pustulosis

Psychosomatic

  1. dermatitis artefacta
  2. acne excoriee
  3. dysmorphophobia.

Other Conditions

  1. leg ulcers
  2. prurigo / pruritus
  3. acne, rosacea
  4. alopecia, hirsutes, vitiligo
  5. blistering diseases, erythema multiforme, drug eruptions, photosensitivity
  6. genital dermatoses including lichen sclerosus
  7. granuloma annulare
  8. urticaria, vasculitis, erythema nodosum
  9. lichen planus, discoid lupus erythematosus.

Skin Tumours

(a)Benign

  1. melanocytic naevus (mole)
  2. dermatofibroma, seborrhoeic wart, keratoacanthoma
  3. epidermal/pilar cyst
  4. pyogenic granuloma, spider naevus, haemangioma.

(b)Premalignant

  • solar keratosis, Bowen’s disease.

(c)Malignant

  • basal cell cancer, squamous cell cancer, malignant melanoma.

Dermatological Emergencies

The trainee should discuss the management of the following problems:

  1. disseminated herpes simplex
  2. angio-oedema and anaphylaxis
  3. acute contact dermatitis and erythroderma
  4. toxic epidermal necrolysis
  5. pustular psoriasis.

3.PRACTICAL SKILLS

Out-patient Procedures

  1. skin scrape for mycology/scabies
  2. intralesional injection of corticosteroid (acne cyst, keloid)
  3. examination with Woods Light.

Skin Surgery

Procedures should be performed under supervision two or three times.

  1. skin biopsy (punch)
  2. shave biopsy
  3. curettage and cautery
  4. excision and closure
  5. cryosurgery.

Management of Leg Ulcers

  1. choice of dressings
  2. use of Doppler for measuring the ankle-brachial systolic resting pressure index
  3. compression bandaging
  4. paste bandages
  5. indications for patch testing.

4.TREATMENTS

Effective treatments are available at low cost for most skin problems.

Topical treatments

The trainee should understand the principles of topical treatment including:

  1. choice of base, eg. Cream versus ointment versus lotion
  2. quantity to prescribe
  3. how to apply
  4. use of occlusion, eg. Tar bandages, hydrocolloid dressings.

The trainee should be familiar with the use of:

  1. emollients
  2. topical corticosteroids
  3. tar, dithranol, calcipotriol
  4. scalp treatments (keratolytics)
  5. topical antibiotics/antiseptics
  6. potassium permanganate soaks
  7. topical retinoids.

Oral Treatments

The trainee should have discussed the indications for the following oral medications:

  1. corticosteroids
  2. azathioprine
  3. methotrexate
  4. dapsone
  5. retinoids
  6. cyclosporin.

Ultravoilet Light

The trainee should understand the indications for:

  1. UVB (phototherapy)
  2. PUVA (photochemotherapy).

Patch Testing

The trainee should understand the indications for patch testing. The trainee should have an opportunity to see patch tests applied and read.

Adapted from

Cleveland VTS