GEM - Curriculum statement 15.10 Skin Problems

Knowledge Base for the nMRCGP

Curriculum Statement 15.10 Skin problems including trauma

Symptoms:

Key issues in the diagnosis of skin problems will be eliciting of the appropriate signs and symptoms and subsequent investigation and/or referral of people presenting with:

• Rashes
  • rash reference from GPnotebook
• Hair loss
  • hair loss section from GPnotebook
• A disorder of their nails
  • nail disorders section from GPnotebook
• Itch (also known as pruritus)
  • itch section from GPnotebook
• Pigmented skin lesions
  • pigmented naevi section from GPnotebook
• Signs of infections of the skin
• Bruising or purpura
  • bruising section from GPnotebook
  • petichiae section from GPnotebook
• Lumps in and under the skin
• Photosensitivity and the red face
  • photosensitivy section from GPnotebook
  • red cheeks section from GPnotebook

Common and/or important conditions:

• eczema
  • eczema section from GPnotebook
• Psoriasis
  • psoriasis section from GPnotebook
• Generalised pruritus
  • pruritus section from GPnotebook
• Urticaria and vasculitis
  • urticaria section from GPnotebook
  • vasculitis section from GPnotebook
• Acne and rosacea
  • acne vulgaris section from GPnotebook
  • acne rosacea section from GPnotebook
• Infections (bacterial, viral and fungal)
  • skin infections section from GPnotebook
• Infestations including scabies and head lice
  • head lice section from GPnotebook
  • scabies section from GPnotebook
• Leg ulcers and lymphoedema
  • leg ulcer section from GPnotebook
  • lymphoedema section from GPnotebook
• Skin tumours (benign and malignant)
  • skin tumours section from GPnotebook
• Disorders of hair and nails
  • nail disorders section from GPnotebook
  • hair loss section from GPnotebook
  • hirsutism section from GPnotebook
  • hypertrichosis section from GPnotebook
• Drug eruptions
  • drug-induced skin disorders section from GPnotebook
• Other less common conditions such as the bullous disorders, lichen planus, vitiligo, photosensitivity, pemphigus, pemphigoid, discoid lupus, granuloma annulare and lichen sclerosus
  • blistering section from GPnotebook
  • lichen planus section from GPnotebook
  • vitiligo section from GPnotebook
  • photosensitivy section from GPnotebook
  • pemphigus section from GPnotebook
  • pemphigoid section from GPnotebook
  • discoid lupus section from GPnotebook
  • granuloma annulare section from GPnotebook
  • lichen sclerosus section from GPnotebook

Investigation:

• Ability to take specimens for mycology from skin, hair and nail
• Basic interpretation of histology reports
• Skin biopsy.

Treatment:

• Those commonly used in primary care (including an awareness of appropriate quantities to be prescribed and how to apply them)
• Principles of protective care (sun care, occupational health and hand care)
• An awareness of specialised treatments, such as retinoids, ciclosporin, phototherapy and methotrexate
  • retinoids in the treatment of psoriasis reference from GPnotebook
  • isotretinoin section from GPnotebook
  • phototherapy in psoriasis section from GPnotebook
• The indications for, and the skills to perform, curettage, cautery and cryosurgery.

Emergency care:

• Acute treatment of people presenting with skin problems or symptoms thought to be due to skin problems and appropriate referral if necessary. Including:
  • angioedema and anaphylaxis
    • hereditary angioedema section from GPnotebook
    • anaphylaxis section from GPnotebook
  • meningococcal sepsis
    • meningococcal section from GPnotebook
  • disseminated herpes simplex
    • herpes simplex section from GPnotebook
    • eczema herpeticum reference from GPnotebook
  • erythroderma
    • erythroderma section from GPnotebook
  • pustular psoriasis
    • pustular psoriasis section from GPnotebook
  • severe nodulo-cystic acne
    • acne vulgaris section from GPnotebook
  • toxic epidermal necrolysis
    • toxic epidermal necrolysis section from GPnotebook
  • Stevens-Johnson syndrome
    • Stevens-Johnson syndrome section from GPnotebook
  • necrotising fasciitis
    • necrotising fasciitis section from GPnotebook

Prevention:

• This will involve the following risk factors:
  • Sun exposure
  • Fixed factors: family history and genetics
  • Occupation and care of the hands.

Genetics:

• Describe how genetic factors influence the inheritance of common diseases such as psoriasis and atopic eczema