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Dermatology - #23890


 

 
Jonathan C. Williams, MEd,DC, DABCI
1
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Discussion of the presentation, diagnosis, and treatment of dermatological conditions commonly encountered in chiropractic practice, including infections, tumors, allergic reactions, inflammatory conditions and skin injuries. Discussion as to how chiropractic doctors participate in the management of patients who have skin conditions.
Please select from the list on the right.

The Institution-wide learning goals define the common ground that unites the programs within the university. They are purposefully broad so that the various colleges and schools can continue to develop their unique identities through varying ways in which the goals are met.

  1. Effective Communication
    Graduates will demonstrate effective verbal, non-verbal, and written communication skills in a wide variety of contexts, including collaborative activities.
  2. Self Directed and Lifelong Learning
    Graduates will be aware of the limits of one’s personal knowledge and experience and have an intellectual interest in scholarly and creative endeavors. Graduates will actively set appropriate learning goals, pursue them, and apply the knowledge gained.
  3. Ethical Reasoning
    Graduates will demonstrate a willingness to recognize the values of others while maintaining one’s own integrity, and act ethically and professionally in all endeavors.
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  5. Service to the Community
    Graduates will understand and value the benefits of service to the community.
  6. Influence of Mind, Body and Spirit on Health
    Graduates will recognize the inter-relationship of the mind, body and spirit and the influence of extrinsic factors on an individual’s health.
  7. Critical Thought and Knowledge Acquisition
    Graduates will acquire, appraise and apply scientific information. Graduates will contextually organize and synthesize relevant information to address an issue or problem.
  8. Competence in one's Discipline
    Graduates will demonstrate competence of appropriate depth and scope for one's discipline.

Course Objectives
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  1. It is being assumed that most dermatological conditions will be diagnosed prior to seeing the chiropractor. With this assumption it is the goal of this course to provide natural, alternative, complementary and over-the-counter treatments that an be curative, palliative and soothing for the patient.
  2. There are certain conditions that the chiropractor should be competent to diagnose, provide treatment for, and recognize progression that requies more aggressive treatment and these include:
    • Acne vulgaris
    • Folliculitis
    • Contact dermatitis
    • Psoriasis
    • Sunburn
    • Burns: 1st, 2nd, 3rd degree
    • Impetigo
    • Tinea Pedis Crusis and Barbae
    • Rubella
    • Measles
    • Chicken Pox
    • Kyme Disease
    • Flea Bites
    • Herpes Zoster
    • Scabies
    • Lice
  3. The doctor of chiropractic should be competent to identify primary and secondary lesions and be prepared to draft a referral letter to a specialist describing the condition as either primary or secondary, wet or dry, color, location.
  4. The doctor of chiropractic should be competent to instruct their patients to maintain healthy skin.
  5. The doctor of chiropractic must recognize that visceral disease may have a dermatological expression, such as:
    • Pruritus or itching
    • Skin ulcers
    • Canker sores
    • Color changes
    • Hive-like rashes
    • Acne-like eruptions
    • Sweating
    • Pigment changes
Materials
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A. Required Text(s):
  1. Habif, T.P.: Skin Disease Diagnosis and treatment. 2nd Ed, 2005. Elsevier Mosby
  2. Dermatology Lecture Notes

B. Recommended Text(s):
  1. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 5th edition, 2005, by Wolff, Johnson & Suurmond
    University of Iowa Dermatologic Image Database: http://tray.dermatology.uiowa.edu
  2. University of Erlangen Image Database: http://www.dermis.net/bilddb/index_e.htm (accessible from the University of Iowa website)
  3. New Zealand Dermnet: http://www.dermnetnz.org

C. Required Materials for Lab:
Release Form allowing the use of assignments to be copied and forwarded to classmates and others.
Assignments
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The assigned reading includes the textbook, course lecture notes and handouts.
Three(3) papers: A)one (1) on dermatology treatments; B)one (1) on common dermatology conditions C) One (1) a referral letter
Attendance
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Attendance at lectures is expected with students being prepared to participate.
IT IS UNDERSTOOD THAT PERSONAL CIRCUMSTANCES MAY DICTATE THAT A STUDENT BE ABSENT FROM A CLASS SESSION. THE STUDENT WILL BE RESPONSIBLE FOR THE INFORMATION PRESENTED DURING THE MISSED CLASS SESSION AND BE ALLOWED TO MAKE UP NO MORE THAN ONE MISSED SESSION TEST IN ACCORDANCE WITH THE POLICIES SET FORTH IN THE NWHSU STUDENT HANDBOOK. WERE A STUDENT TO BE ABSENT FROM MORE THAN ONE CLASS SESSION, THEY WILL HAVE THE OPTION TO WITHDRAW FROM, OR TO RECEIVE A FAILING GRADE FOR THE COURSE.

NOTE: This course is now a blended format course involving lecture, small group research and presentation. The small group research project will culminate in the presentation of a paper on a treatment for a dermatological condition and a second paper describing a commonly seen dermatological condition. These papers will be formatted into a singular document and made available to the class for future reference.

Grading Criteria
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A. 1-30 point paper on treatment modalities. 1-60 point paper on dermatological conditions. 1 25 point referral letter
Use of course notes and the required text is permitted.

Guaranteed grades are as follows:

A = 100 - 94% of Total Possible Points
B = 93 - 88% of Total Possible Points
C = 87 - 82% of Total Possible Points
D = 81 - 76% of Total Possible Points
F = Failure to accrue at least 76% of the Total Possible Points
Course Competencies
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COGNITIVE DOMAIN


Students will be able to construct and follow a rational diagnostic process in evaluating patients who present with the following dermatologic related symptoms:

a. itching g. crusting
b. burning h. pigmentation
c. pain i. lichenification
d. weeping j. scaling
e. erythema k. cutaneous inflammation
f. pustulation  

Students will be familiar with the following general symptoms which may accompany dermatologic conditions, and be able to differentiate between primary and secondary lesions:
  1. Symptoms of underlying conditions when a dermatologic manifestation occurs secondary to a systemic illness
  2. fever
Students will be able to explain the clinical utility and indications for the following ancillary diagnostic procedures in dermatologic patients:
  1. KOH preparation
  2. Tzanck smear
  3. Wood's light
  4. Patch test
  5. Diascopy
  6. Culture
  7. Biopsy


Conditions:
Students will be able to make case management decisions regarding common dermatologic conditions based on their understanding of the following information regarding each condition. (See key on following page for description of codes).

Clinical Condition Etiol. & Epiderm

Pathophys

 Nat. History & course Exam & Dx Tx/Mgmt
Acne vulgaris 1 2 2 1,2,3 3,5,6
Rosacea 1 2 2 1,2,3 3,5,6
Folliculitis 1 2 2 1,2,3 3,5,6
Contact dermatitis 1 2 2 1,2,3 3,5,6
Atopic dermatitis/Infantalis 1 2 2 1,2,3 3,5,6
Lupus/Erythematosis 1 2 2 1,2,3 3,5,6
Xanthlomas 1 2 2 1,2,3 3,5,6
Seborrheic dermatitis 1 2 2 1,2,3 3,5,6
Psoriasis 1 2 2 1,2,3 3,5,6
Lipoma 1 2 2 1,2,3 3,5,6
Pityriasis rosea 1 2 2 1,2,3 3,5,6
Benign melanocytic nevus/Spider Angioma 1 2 2 1,2,3 3,5,6
Hemangioma 1 2 2 1,2,3 3,5,6
Keloid 1 2 2 1,2,3 3,5,6
Scleroderma 1 2 2 1,2,3 3,5,6
Epidermoid cyst 1 3 2 1,2,3 3,5,6
Seborrheic keratosis 1 3 2 1,2,3 3,5,6
Malignant melanoma 1 3 2 1,2,3 3,5,6
Basal cell carcinoma 1 2 2 1,2,3 3,5,6
Squamous cell carcinoma 1 2 2 1,2,3 3,5,6
Lichen planus 1 2 2 1,2,3 3,5,6
Reiter's Syndrome 1 2 2 1,2,3 3,5,6,7
Solar dermatoses-sunburn 1 2 2 1,2,3 1,2,3,5,6
Vitiligo 1 2 2 1,2,3 1,2,3,5,6
NeuroFibromatosis 1 2 2 1,2,3  
Thrombophlebitis 1 2 2 1,2,3 1,2,3,5,6,7
Impetigo 1 2 2 1,2,3 1,2,3,5,6,7
Abscess 1 2 2 1,2,3 1,2,3,5,6,7
Furuncle 1 2 2 1,2,3 1,2,3,5,6,7
Carbuncle 1 2 2 1,2,3 1,2,3,5,6,7
Acute Lymphangitis 1 2 2 1,2,3 1,2,3,5,6,7
Tinea, Pedis, Crusis, Barbac, Unquium 1 2 2 1,2,3 1,2,3,5,6,7
Lyme disease-erythema migrans 1 2 2 1,2,3 1,2,3,5,6,7
Rubella 1 2 2 1,2,3 1,2,3,5,6,7
Candidiasis 1 2 2 1,2,3 1,2,3,5,6,7
Measles 1 2 2 1,2,3 1,2,3,5,6,7
Chicken Pox 1 2 2 1,2,3 1,2,3,5,6,7
Flea Bites 1 2 2 1,2,3 1,2,3,5,6,7
Herpes simplex infection 1 2 2 1,2,3 1,2,3,5,6,7
Herpes zoster infection 1 2 2 1,2,3 1,2,3,5,6,7
Scabies 1 2 2 1,2,3 1,2,3,,5,6,7
Genital warts 1        
Gonorrhea 1        
Syphilis 1        
Chlamydia 1        
Ichtyosis 1     1,2,3 1,2,3,5,6,7

Elaboration of Coding Definitions Regarding the Conditions

The following codes refer to the depth of coverage for Etiology and Epidemiology, Pathophysiology, and Natural History and Course:

0 No coverage or content
1 Introduction, without test items
2 Moderate class discussion and/or handout material, with test items
3 Extensive discussion and/or handout material, with test items

For Exam and Diagnosis, the following numbers indicate which aspects of exam and diagnosis of each condition are taught in this course:

1 Presenting SX: Presenting symptoms related to condition are discussed.
2 History findings: Relevant personal and family history are discussed.
3 Exam findings: General physical exam findings are discussed.
4 Chiro. findings: Posture, subluxation, muscle tone and length, trigger pts.
5 Lab findings: Blood, urine, CSF...
6 Imaging findings: Normal, CT, CAT, MRI ...
7 Special test findings: eg sweat test for systic fibrosis, spirometry for asthma.

For Treatment/Management, the following numbers indicate which aspects of treatment and management of each condition are taught in this course:

1 Chiropractic: Adjustments, soft tissue techniques
2 PT: Physical therapy modalities of all types
3 Nutrition/Suppl: diet and supplement recommendations
4 Exercise: Stretching, strengthening, aerobic exercise recommendations
5 Lifestyle Mgmt: Stress reduction, smoking cessation, allergen avoidance....
6 Medical: Drugs, antibiotics, surgical procedures, radiotherapy...
7 Other: Acupressure/puncture, massage, homeopathic or herbal Rx.....
8 Guidelines: If published, do you refer to them regarding this condition?


PSYCHOMOTOR DOMAIN


Students will be able to conduct, in a patient presenting with a dermatologic condition, an appropriate physical examination using the following procedures:
  1. Observation of the skin lesions.
  2. Palpation (where appropriate) of skin lesions.
  3. Performance of the ancillary office diagnostic procedures, where indicated, including bacteriologic culture.
  4. Take appropriate precautions to avoid self infection when evaluating possibly infectious skin conditions.
Students will be able to select and properly employ the following treatments for dermatologic conditions:
  1. General lifestyle measures
  2. Nonprescription (over the counter) topical treatments
  3. Institute medical referral where indicated


AFFECTIVE DOMAIN


Students will demonstrate integrity, sensitivity, respect, courtesy, compassion and professionalism at all times, both in lectures and in general, and will be able to apply the history, physical examination and treatment techniques learned in this course to any patient while demonstrating those same qualities.
Weekly Calendar of Learning Objectives
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Week Dates Topics/Learning objectives
Week 1

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TO BE ANNOUNCED

Week 2

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TO BE ANNOUNCED
Week 3 --
Week 4

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Week 5 --
Week 6 --
Week 7 --
Week 8 --
Week 9 --
Week 10 --
Week 11 --
Week 12

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Week 13 --
Week 14 --
Week 15 --
Please Note
This schedule of lecture and lab topics and quizzes and exams may be changed during the course of the trimester as circumstances require. Whenever possible, such changes will be announced in class before the date and time in question. You are responsible for anything that transpires during lectures and labs, even when you are unable to attend. In the event that you miss a class session, make sure you check with a classmate about any announcements or schedule changes which may have been made. Makeup exams are allowed only according to the policies described in the current student handbook, which is available in the Student Affairs office.
Maintained by Northwestern College of Chiropractic
Last updated: 5 April, 2007
 

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