Dermatological Complaints

Introduction

Unlike internal medicine, most dermatological complaints presenting in a community pharmacy can be seen (and felt).

This presents the community pharmacist an excellent opportunity to base the differential diagnosis by

Questioning

• Where did the problem first appear?
• Are there any other symptoms? Itch and/or pain?
• Family and household contact history
• The patient's thoughts on the cause of the problem

Physical examination

• It is worth remembering that many patients will be embarrassed by the appearance of the skin conditions.
• Examples of notable findings include:
• Dry, flaky scalp with reddened areas may indicate dandruff, psoriasis or dermatitis.
• White patches on the tongue or throughout the mouth can indicate oral candidiasis ("thrush").
• Xanthomas are deposits of cholesterol in the skin of patients who have very high cholesterol levels and indicate a need for referral.
• Nails that are very thick, lifting up from the nail bed or are discoloured can be a sign of a fungal infection.
• Bluish or purplish discolouration of the lips or finger, also known as cyanosis, is a sign of hypoxia.

Resources

Apart from general community pharmacy references, few useful resources on dermatological conditions include:

• American Academy of Dermatology Association
  
• British Association of Dermatologists
  
• Dermatology Made Easy, 2022
  
• DermNet NZ
  
• Fitzpatrick’s Dermatology, 2019
  
• Habif’s Clinical Dermatology, 2021
  

Tips

Dermatology is a medical field which relies heavily on visual examination.

• Hence, to familiar with a skin condition (instead of reading through the plain words description), it may be a good idea to Google image the skin condition.

Inspection should be performed in a well-lit room with either natural light or the ability to use a penlight to determine how raised a lesion is.

• Fluorescent light tends to make lesions appear flat.

When performing palpation, gloves are important both for patient comfort and practitioner safety.