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■ - AH ANDBOOOKF C LINICSAILG NISN B LACKA NDB ROWNS KIN- MUKWMET,NA DMEPOT ,NU VRM N ER FIRST EDITION � ---�0 � -··�S Gte orges UniveorfLs ointdyo n www.blackandbrownskin.co.uk INTRODUCTION There ism orea ndm orlei teroantt hunere ee fdo mre disccahlo tooal dsd retshse equaalniddtv iye irtysa gendiano rdteoer n sutrheaf tu tduorcet coarensf fecttrievaetl y thed iveprospeu laitnthie oUnKT .h eC OVID-p1a9n dehmaihsci ghlihgohwt ed marginaalnidps aerdt icBuMlEca ormlmyu nihtaivpeeos o rheearl touhtc omeIsf. medicdioensen odte colointcisuz rer icanud ltuemas cthu detnort esc ogsniigsanens d symptoomnds a rksekrit no ntehse wriebl eld elaiynds i agnoorms iissd iagnosis (Gis&h eLno kuga2m0a1g9Ae)sw . e lalso ffeirmianggoe fcs o ndiotinbo lnasac nkd brown fsrkeiqnusoe mnittlitynte edxb to okwseh avael sloo okaetld a nguaangde descritphtaootfr tases ns utmhepe a tiieswnh ti te. GMC-E QUALITDYI,V ERSITY "Thper incoifep qlueasld iitvye,ra snidft atyir re atmeenmtb eadrdieeno d u r coreet hisctaaln daanrdrd esq uiretmheantt sdm oucstmtoe reistnm edical educaatnidto rna iInmipnlge.m etnhtsiitsnr ga itasec goyn tritboiu mtpiroonv ing standoafcr adrsfe oa rlp la tibeynr tasi saiwnagr enoefs esox upre ctaantdi ons makisnugr e: ·Doctaorreesq uiptpoe dt redaitv etrohsfpei a ttyia enndste sr viucseeisrn s the pUoKp ulaitriroens,po efwc hteirtvehe et yr ain ·Doctaorraesb lteou steh ediirv ebrascek groaunnded xsp eriteodn ecleisv er innovcaatritevh eca atrn e spotnod d tihvee nreseedo sft hepiart i.e.n.t s" 2 www.blackandbrownskin.co.uk AUTHOR&S A CKNOWLEDGEMENTS CO-AUTHORS MaloMnuek wenMdeed,iS ctauld ent DrP etTearm oCnlyi,n Lieccatlu rer MargToutr nSeern,iL oerc turer CONTRIBUTORS & ACKNOWLEDGMENTS Mantyh antkoas lt lh owsheoh elpweidtt hhSe t udenpta-rSttnaeafrnfsd h ip thee vdelopomfte hnhitas n dbWoeoa kr.pe a rtitchualnatkrofl:uy l ·Student Experience Action Group (SEAG) ·P aramFeadciuc(l DtayPv aer Crh,rB iask er) ·S tG eorgAef'rsi can-SCoacriiebtbyean ·C linSikciTalella s(m D RrN agj,aD rH KhaDnr, S SivakSu mGarreaenn,, Dr DrJ MogfoPrS di,v aDnra than, Dr N Farrell) ·e LearUnni(inLtgu Wkoeo dmh,Sa heeKtaavli a) ·D rT ariMsaanid ishona IMAGES Wea reg ratteotf huolws heoa lwleodu st ou se itmhaegiferots rh hiasn dobkAo.l l rigrhetsse rbvyte hidem aogwen ers. RECOMMENDERDE SOURCES: BriAtsissohc ioafDt eiromna itsoatlh soa:gdn bofookmr e disctauld aennjdtu sn ior doctors https://www.bad.org.uk/librarayn-dmbeodoika%/2d0ofcourments/Dermatology%20H %20medical%20students%202nd%20Edition%202014%20Final2(2).pdf OladoRke utan lA .t loafPs a ediHaItIVrn ifce ction http://openbooks.uct.ac.za/hivatlas/index.php/hivatlas/catalog/book/3 DermNNeZht t ts:/p/edrmnetnz.org/ BroSwkni Mna tthetrtsp s://www.instagram.com/ brownskinmatters 3 www.blackandbrownskin.co.uk www.blackandbrownskin.co.uk BASICS PALMAR PALLOR SOURCEIm:ag e from Crawley Jet al. Malaria in Children. The Lancet. 2010; 375. https://www.semanticscholar.org/paper/Malaria-in-children-Crawley-Chu/ e6a3b573e38d72c0f85f2e41e4aa0974a17a17db/figure/2 (accessed 11/03/20) WHAT IISTP: al lor refers to the pale appearance of skin due to reduced oxyhaemoglobin levels. This may occur in anaemia or shock. HOWI TI SI DENTIFIPaElloDr m:a y be identified by asking the patient to turn their palms to face the ceiling (supination). In particular there is reduced darkness in the palmar creases. It is useful to compare the patient's palms with your own or that of an accompanying family member (e.g. parent or sibling). Sensitivity and specificity is not particularly high so clinical correlation is advised. 4 www.blackandbrownskin.co.uk BASICS CONJUNCTIVAL PALLOR SOURCEI m:a ge from Breman J, Holloway C. Malaria surveillance counts. The American Journal of Tropical Medicine and Hygiene. 2007. https://www.semanticscholar.org/paper/Malaria-surveillance-counts.-Breman- Holloway/807bdf8d5a5193d7f3a1c6ffde41f570355a1dd1/figure/5 (accessed 11 /03/20) WHAT IISTA: s with the palms, pallor refers to the pale appearance of skin due to reduced oxyhaemoglobin levels. This may occur in anaemia or shock. HOWI TI SI DENTIFIPaElloDr m:a y be identified by pulling down (or asking the patient to pull down) the lower eyelid. The palpebral conjunctiva is usually a health pink due to the blood supply of the vascular bed. In anaemia it will appear a pale pink or white (regardless of skin colour) 5 www.blackandbrownskin.co.uk BASICS CENTRAL CYANOSIS SOURCEIm:ag e (used under CC licence CC BY-SA 4.0) from Singhai A et al. Methemoglobinaemia. Journal of Dr. NTR University of Health Sciences. 2013. http://www.jdrntruhs.org/viewimage.asp?img=JNTRUnivHealthSci 2013 2 2 154 112359 f1 .jpg (accessed 11 /03/20) https://creativecommons.org/licenses/by-sa/4.0/ WHATI TI SC:ya nosis refers to a blue or grey discolouration of the skin and mucous membranes due to high levels of deoxygenated haemoglobin. This is caused by hypoxaemia (low arterial oxygen). Note that this is distinct from hypoxia which refers to inadequate oxygenation of tissues. HOWI TI SI DENTIFIThEe Dab:ilit y to detect cyanosis on visual inspection depends on "dermal thickness, cutaneous pigmentation, and the state of the cutaneous capillaries". It is therefore best to look for cyanosis where the epidermis is thin and the vascular supply is abundant such as the lips or more importantly the oral mucous membranes (buccal, sublingual). This is known as central cyanosis. Cyanosis detected in the hands and feet is known as peripheral cyanosis. Peripheral cyanosis may occur with or without central cyanosis, and is more difficult to detect in dark skin. 6 www.blackandbrownskin.co.uk BASICS CENTRAL CYANOSIS SOURCEIm:ag e (used under CC licence CC BY-SA 4.0) from Singhai A et al. Methemoglobinaemia. Journal of Dr. NTRU niversity of Health Sciences. 2013. http://www.jdrntruhs.org/viewimage.asp?img=JNTRUnivHealthSci_2013_2_2_154_112359_f2.jpg (accessed 11/0 3/20) https://creativecommons.org/licenses/by-sa/4.0/ WHAT ITI SN:o rmoxaemia refers to having a normal concentration of arterial oxygen HOWI TI SI DENTIFIPleEaDse: no te the difference between the same patient pre- and post-oxygen therapy. Post-oxygen therapy the patient's tongue and lips have a healthy pink colour due to correction of arterial oxygen and subsequent tissue oxygenation. The facial skin now appears it's usual colour, not the "ashen" (pale grey/blue) tone associated with cyanosis. DESCRIPTIAODNAPST EDF ROMM:c Mullen S, Patrick W. The American Journal of Medicine. Cyanosis. 2013. https://doi.org/10.1016/j.amjmed.2012.11.004 (accessed 11/0 3/20) 7 www.blackandbrownskin.co.uk BASICS ERYTHEMA SOURCE : Image (used under CC licence CC BY-SA 4.0) from Atlas of Paediatric HIV Infection. Oladokun R et al https://openbooks.uct.ac.za/uct/catalog/view/hivatlas/23/655-2 https://creativecommons.org/licenses/by-sa/4.0/ WHATI TI SE:ry thema refers to the red appearance of skin associated with inflammation and infection. HOWI TI SI DENTIFIIn EtheD f:irs t image (folliculitis) you will note the red/purple hue immediately surrounding the pustules. The patient's regular skin tone is best appreciated in the area directly in between the two pustules (mid-shin). Detection of erythema in the second picture is aided by the swelling which pulls the skin tight and gives it a smooth and shiny appearance with a burgundy undertone. 8 www.blackandbrownskin.co.uk BASICS SWELLING (OEDEMA) SOURCEIm:a g(eu esd wpietrhm ission- CopyCreingtLhirtce e CnNlcueema brearn:c e 4785430529f1rm5o M9a)t thCee wtas l . Sidciksleeia nccs heelil dlh oBoMdJ.2.0 143;4 8 https://www.bmj.com/content/348/sbmj.g115 (access1/e10d 3 /20) WHAT IISTO: e demreaf etross w eldluiteno eg x cefslsuT hidio.sc cuirnasn umboefcr o nditions includihnega faritl uarelerl,ga yn tdr auma. HOWI TI SI DENTIFISwEeDl:l cianbneg o bserwvheedrb eo dtisys uaepsp elaarr tghearn normHaela.far ilutr mea yr esiunsl wto lalneknl& el esg sY.o mua ys eep itwthierne agn i ndentation remaaifntspe rre sstihanefg f eacrtee(ads ompea tiweinhltalsv m ea rkiendd entaaltoitnhogen isr soclki nOee)d.e moaft hnee cakn adi rwwaiyrlsel s iunbl rte atdhiifnfgi acnucdlh taireasc teristic gurglingJ/osistnwrtei ldilontiri hsn.i g m agiaesr esoufdla ctt yl(iitnifsl amomfta htdeii goicnta su)s ed bya s icklec eclrli Nsoitste.h tahthe a nadnsdf ingaeprpse" apru fafnytd"h s ek iints a auntsd h iInty . ivsi ltt ahaantry i nogrjs e welalrreeer myo vbeedf osrwee lbleicnogm seesv ere. 9 www.blackandbrownskin.co.uk