Curriculum standards

Knowledge guides

LG12: Medical dermatology

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

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Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.

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Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.

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Presentations

Acne excorie
Angioedema
Blisters
Eruption:
- blistering
- drug
- eczematous
- pustular
Erythematous papules / patches / plaques
Erythroderma
Facial flushing
Hair:
- excessive growth
- loss
Indurated plaques
Itch
Lesion of concern
Nail:
- bed inflammation
- discolouration
- plate changes
Pigmentary changes
Scarring
Skin:
- failure
- injury
Ulceration:
- mucous membranes
- oral
Urticaria

Conditions

Angioedema and urticaria
Connective tissue diseases and collagen vascular disorders:
- dermatomyositis
- lichen sclerosus
- localised forms of scleroderma
- lupus erythematosus
- morphoea
- panniculitis:
  - lobular
  - septal
- systemic sclerosis
- vasculitis
Contact dermatitis:
- allergic
- irritant
- non-eczematous contact dermatoses
- occupational skin dermatoses
- photoallergic and phototoxic
Cutaneous manifestations in the immunosuppressed host / graft-versus-host disease
Dermis disorders:
- eosinophilic disorders
- histiocytoses
- mastocytoses
- neutrophilic dermatoses
Genital and mucosal conditions
Immunobullous disease, including, but not limited to:
- bullous pemphigoid
- cicatricial pemphigoid
- linear IgA dermatoses
- pemphigus
Infiltration disorders:
- acneiform conditions
- disorders of cornification
- granulomatous processes:
  - lichenoid eruptions
Inflammatory dermatoses:
- dermatitis (all types)
- psoriasis
Pigmentation disorders, such as:
- vitiligo

Conditions – drug eruptions

Drug eruptions, such as:
- fixed drug eruption
- generalised drug eruption
- lichenoid
- severe cutaneous adverse reactions

Conditions – hair and nail

Alopecia:
- non-scarring
- scarring
Chromonychia
Congenital and inherited nail diseases
Cutaneous manifestations of internal malignancy
Hair loss, caused by drugs
Hirsutism
Hypertrichosis
Inflammatory conditions affecting the nails
Systemic conditions presenting with nail and hair symptoms
Vitamin deficiencies

Conditions – hypersensitivity reactions

Allergy / Sensitisation:
- environmental
- food
Scar:
- atrophic
- hypertrophic
- keloid

Conditions – skin of colour

Dermatological issues for patients with skin of colour, such as:
- follicular disorders, such as:
  - acne keloidalis nuchae
  - comedonal acne
- pigmentary disorders, such as:
  - melasma
  - pityriasis alba
  - vitiligo
Variants of conditions in skin of colour, such as:
- annular and hypertrophic lichen planus
- hypopigmented mycosis fungoides
- nummular and follicular dermatitis

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigation
consider the impact of illness and disease on patients and families, and their quality of life

Manage

provide evidence-based management
prescribe therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Presentations

Drug eruption in complex medical patients, such as those:
- in the intensive care unit
- who are oncology patients
- with immunodeficiency
Hair shaft changes

Conditions

Dermatological diseases:
- genital
Oral mucosal premalignant and malignant disease, such as mammary and extramammary Paget disease

Synthesise

recognise the clinical presentation
identify relevant epidemiology, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigation
consider the impact of illness and disease on patients and families, and their quality of life

Manage

provide evidence-based management
prescribe therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Genital and mucosal

Anatomy and physiology of normal female and male anogenital regions and mucous membranes
Anogenital region diseases, such as:
- dermatoses:
  - benign
  - malignant
- inflammatory diseases
- sexually transmitted infections (STIs)
- skin lesions:
  - benign
  - malignant

Hair and nail

Hair follicle:
- anatomy and development
- microscopic structure
Nail anatomy and biology

Inflammation

Cellular and molecular biology of inflammation, including:
- adhesion molecules
- arachidonic acid metabolism
- basophils and eosinophils
- complement system
- cytokines
- human leukocyte antigen system
- immunoglobulin structure and function
- polymorphonuclear leukocytes
Immunology in relationship to the skin
Pathology results, including relevant blood and serology tests related to autoimmune diseases and systemic diseases with cutaneous manifestations
Principles of:
- contact dermatitis
- different forms of urticaria
- drug allergy and patch testing
- wound healing and scar formation

Clinical assessment tools

Clinical assessment tools, such as:
- Dermatology Life Quality Index (DLQI)

Procedures

Botulinum toxin for hyperhidrosis
Iontophoresis
Triamcinolone injection

Investigations

Bacterial and viral swabs for culture and/or polymerase chain reaction (PCR)
Blood tests
Dermoscopy, including:
- digital dermoscopy
Hair sampling for histological analysis
Histopathology
Patch testing, including:
- ability to select appropriate batteries of allergens based on history and examination findings
- knowledge of:
  - Aotearoa New Zealand core series
  - Aotearoa New Zealand extended series
  - specific extended series
Photography
Phototesting, including:
- monochromator
- photopatch
- photoprovocation
Radiographic imaging
Scraping and nail clipping for mycology
Skin biopsy, including:
- immunohistochemistry
- immunofluorescence
Trichoscopy
Wood’s lamp

Management of a cutaneous disease in complex comorbid patients in intensive care

Genital and mucosal

Patient confidentiality issues

Immunodermatology

Psychological impact, both short- and long-term, of severe drug reactions and other dermatological diseases
Safety of desensitisation techniques
Techniques in desensitisation

Occupational dermatology

Allergen avoidance, advanced management of occupational dermatitis, and prevention of skin disease
Details of function of and occupational exposure to common allergens in extended patch test series, such as hairdressing battery
Medical reporting
Medicolegal aspects of contact dermatitis, including Accident Compensation Corporation (ACC) legislation and reporting
Workplace assessments

Psychodermatology

Clinical features, assessment, investigation, and management of primary psychiatric disease presenting as skin disease to dermatology
Clinical features, assessment, investigation, and management of primary skin disease presenting with psychosocial comorbidity
Dermatological manifestations of psychological problems
Drug- or toxin-induced psychiatric or psychological conditions
Features of:
- anxiety
- depression
- risk factors for suicide
Multidisciplinary approach to primary psychiatric disorders:
- psychiatric conditions that result in self-induced skin conditions, such as:
  - delusions of parasitosis
  - trichotillomania
Psychiatric differential diagnosis in skin disease
Psychophysiological disorders:
- skin problems that are not directly connected to the mind but react with emotional states, such as eczema and psoriasis
Psychosocial impact of dermatological disease, including, but not limited to:
- genital and mucosal dermatological disease
Secondary psychiatric conditions:
- associated with disfiguring skin disorders that can cause depression or social phobia, such as:
  - cystic acne
  - psoriasis

Skin of colour

Understand the differences required in treatment plans when treating skin of colour:
- increased risk of post-inflammatory hyperpigmentation and hypertrophic scarring
- recognise sociocultural barriers to:
  - accessing health care
  - interactions
  - treatment
- understanding that varied cultural practices may be undertaken by patients to treat skin conditions, including:
  - acupuncture
  - ayurvedic medicine
  - mirimiri
  - karakia / prayer
  - rongoa

PCH

Age- and patient-appropriate techniques for skin biopsies and other painful procedures
Age-appropriate assessment tools to assess quality of life
Association between childhood eczema and other atopic disorders, and the importance of developing immune tolerance
Differences in presentation of inflammatory skin disorders in children and adolescents compared to adults
Incidence and prevalence of inflammatory skin disorders in childhood and adolescence