Jules Lipoff - Dermatology Simplified: Outlines and Mnemonics
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This book is derived from notes taken during a dermatology residency and it represents a comprehensive yet condensed approach to a dermatology curriculum, listing every entity with only the most important and testable facts and mnemonics. There is an intimidating large amount of material for young dermatologists and other doctors with an interest in dermatology to learn, and this guide puts it all into a concise and manageable context. Further, introductions to the dermatology physical exam and dermatopathology, as well short guides describing the basics of medications, basic science, cosmetics, and surgery are included. The goal of this guide is not primarily to help with visual identification of diagnoses, but rather to help young dermatologists learn to create differential diagnoses and learn all the important facts for myriad diseases. Given its unique approach, this guide will serve new residents well in quickly adapting to a new field, and also, it will serve senior residents as quick review of all topics in preparation for in service and board examinations. In general, there are very few dermatology board review books of any kind and therefore this book will immediately have a market among dermatology students, residents, rotators, and faculty.
Jules Lipoff: author's other books
Who wrote Dermatology Simplified: Outlines and Mnemonics? Find out the surname, the name of the author of the book and a list of all author's works by series.
Jules Lipoff
Neelam A. Vashi
Mohammad Ali El-Darouti
Marcia Hogeling
Ernesto Bonifazi
Jennifer Cafardi
Michael J. Murphy (editor)
Herbert B. Allen
Misha Rosenbach
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Part I
Introduction
Introduction
Springer International Publishing Switzerland 2016
Jules Lipoff Dermatology Simplified 10.1007/978-3-319-19731-9_11. The Starter Kit
Jules Lipoff 1
(1)
Department of Dermatology, University of Pennsylvania, Penn Presbyterian Medical Center Medical Arts Building, Philadelphia, PA, USA
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Abstract
Mastering a complex field like dermatology can initially be intimidating. I recommend trusting your own past methods of studying while focusing on learning the essential building blocks of our field. You must be able to describe clinical dermatologic conditions and key features in dermatopathology. Then you are ready to construct a differential diagnosis.
Keywords
Approach to studying dermatology1.1 General Advice on Studying
1.1.1 How to Study
Everyone has his or her own strategy for learning dermatology. Dermatology residents are often assigned to read textbooks, study unknown dermatopathology slides, and participate in teaching rounds, conferences, and grand rounds! These present a large amount of information, but of course, much of this knowledge is quickly forgotten.
If I have one piece of advice for studying dermatology, it is this: do not reinvent the wheel. Stick with whatever has worked for you in the past.
More and more, we are focusing our energy on the boards. Both the in-training examination and the American Board of Dermatology Certifying Examination test obscure facts and details that are important to know. You may be surrounded by residents whose impressive knowledge base about dermatologic disease is quite intimidating. Do not be afraid! It is great to learn trivia and excel at roundsmanship, but anybody can memorize facts if given the time. The important thing is to learn how to think like a master clinician and approach each patient in a logical, systematic manner. While certain facts must be memorized, try to organize and understand the concepts that support this knowledge. The best physicians know the facts (e.g., what the treatment for a disease is), but also have a broad understanding of the reasoning behind this choice (e.g., the targeted pathophysiology and the mechanism of action of the treatment). Conceptual learning provides the bedrock for memorizing and retaining facts.
1.1.2 Logic of This Book
When confronted with the need to classify species in 1857, Charles Darwin wrote, It is good to have hair-splitters and lumpers. Those who make many species are the splitters, and those who make few are the lumpers. This line of thinking, the lumper-splitter dichotomy, is quite applicable to the categorization of dermatologic diseases.
A lumper believes there are many names for the same disease, perhaps because observers of that same disease are able to distinguish subtly different forms. It is simpler to learn a classification with fewer categories.
A splitter sees all the subtle differences and variations in disease processes and hopes to define optimal treatments by applying the scientific method to each separately categorized condition.
This book assigns merit to both the lumper and splitter worlds. There is value in lumping diseases into categories for the sake of easy learning and understanding, though admittedly sometimes this forces diseases into groups in which they may not cleanly fit.
On the other hand, splitting diseases by enumerating different names and distinctions permits more in depth learning about diseases in a broader category while defining distinctive features.
When I was a resident, I found that textbook readings, lectures, and other didactics blended together unpredictably, and often specific topics were taught in very different ways by each professor. There was also a large amount of important information that was not clearly presented in textbooks or manuals. In order to gain focus, I began to compile outlines and lists of everything I learned in an effort to unify various perspectives and points of view, and also to collect factoids and mnemonics so that I could study important material the same way every time. My notes reflect an organic mix of teachings during residency and as an attending dermatologist including information from lectures, textbooks, clinical articles, and personal experience. My goal is combine and organize this information in a systematic and logical way so that it is easier to learn. To simplify the presentation, I have not listed references. In the main outlines, I have focused on the important high yield and key conceptual points, yet still the information is comprehensive.
1.2 Describing Skin Conditions
Though it seems deceptively simple, learning to describe skin findings is a critically important skill. All physicians must learn to translate clinical observations into clear language to organize information and communicate effectively with colleagues.
A description should include the primary and secondary lesions, distribution, colors, configuration, nature of borders, and shape. If relevant, texture and patterns may provide diagnostic information.
- Remember: it is critically important to generate a complete differential diagnosis; this is far more important than getting the one right diagnosis. In theory, your description should allow a listener who has not seen the patient to develop a mental picture that would allow him or her to develop a comprehensive differential diagnosis.
- The description should lead to the differential, not the other way around. Often the first impression of diagnosis prompts the physician to describe features that match this initial impression (e.g., when we describe likely psoriatic lesions with silvery scale). This is a trap that limits the differential diagnosis.
- It is best to avoid descriptive terms that define themselves (e.g., verrucous, psoriasiform, acneiform, herpetiform). These terms also lead to closed-minded thinking. If you must use these terms (and we all do use them as a crutch), try to use them to supplement more descriptive terms.
Skin type: I to VI
- The Fitzpatrick skin phototype scale runs from I to VI, describing a patients complexion and sensitivity to sun exposure.
- Type I. Very white, fair, red/blonde hair/blue eyes (Irish). Always burns, never tans.
- Type II. White. Usually burns, rarely tans.
- Type III. White/olive skin. Sometimes burns, gradually tans.
- Type IV. Brown skin, rarely burns, tans easily (Mediterranean, Latino).
- Type V. Dark brown skin, very rarely burns (Middle eastern, Indian)
- Type VI. Black skin, never burns, always tans (African).
Distribution/Location
- Where are the skin lesions located? Generalized, bilateral/unilateral, sun exposed, intertriginous, extensor/flexural surfaces, acral (distal body such as hands and feet)?
- Make sure you know the difference between distribution and configuration.
Configuration
- How lesions are arranged? Confluent vs. discrete, scattered, clustered/grouped, geometric/linear, dermatomal, serpiginous, Blaschkoid, nevoid
- Certain shapes and configurations are almost always caused by external forces (e.g., geometric/linear) suggesting an outside job, such as contact dermatitis or Koebner phenomenon.
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