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Today is my first day of my internship posting in dermatology. What should I be prepared of and... Or should I go prepared today?

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Today is my first day of my internship posting in dermatology. What should I be prepared of and... Or should I go prepared today?

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dermatology education AND clinical rotation

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dermatology clinical rotation medical student preparation skin examination documentation

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Yes, go prepared today, but do not feel you need to know all of dermatology beforehand. On day one, being punctual, observant, respectful with patients, and willing to learn matters more than recalling rare diagnoses.

Carry

  • White coat or clean professional attire, ID, stethoscope if expected
  • Small notebook or notes app and pen
  • Hand sanitizer
  • Your hospital/internship logbook if applicable
  • Water and a light snack if your posting runs long

Revise briefly before you leave

Focus on how to describe a skin lesion rather than trying to memorize every disease:
  1. Primary morphology: macule/patch, papule/plaque, nodule, vesicle/bulla, pustule, wheal.
  2. Secondary changes: scale, crust, excoriation, erosion, ulcer, fissure, lichenification, scar.
  3. Distribution: localized/generalized, symmetrical/asymmetrical, flexural/extensor, acral, dermatomal, sun-exposed, mucosal, scalp, nails, palms and soles.
  4. Key history: onset and progression; itch, pain or burning; contacts and new products/drugs; prior treatments; similar illness in family or contacts; fever or systemic symptoms.
Dermatologic diagnosis relies heavily on careful inspection and palpation, plus the lesion’s site and distribution. Identifying the primary lesion is especially important because scratching, infection, and prior treatment can alter its appearance. Andrews’ Diseases of the Skin: Clinical Dermatology, p. 23.

In clinic, learn this routine

When you see a patient, silently structure the case as:
Who is affected + what is the lesion + where is it distributed + how long + symptoms + relevant triggers/treatments.
Example: “A 22-year-old with intensely pruritic, scaly erythematous plaques on both flexural elbows for 3 months, with a history of atopy.”

Common things you may encounter

  • Acne, eczema/dermatitis, fungal infections, scabies
  • Psoriasis, urticaria, pigmentary disorders
  • Hair loss and nail disorders
  • Bacterial/viral skin infections
  • Drug eruptions and skin lesions requiring biopsy or dermoscopy

First-day etiquette

  • Introduce yourself and ask permission before examining or exposing any body area.
  • Maintain privacy and draping, especially for breast, genital, or full-skin examinations.
  • Never photograph a lesion without explicit consent and your unit’s approved process.
  • Do not diagnose confidently in front of a patient if unsure. Say: “I’ll discuss this with my senior.”
  • Watch how your consultants document morphology and distribution. That is one of the fastest ways to learn.
  • Ask at the start: “What should interns do during clinic, procedures, and ward rounds?”
Your aim today is simple: learn the clinic flow, observe 10 to 15 cases carefully, and write down unfamiliar terms or diagnoses to review tonight. The AAD basic curriculum can be a useful structured resource once you know what your department emphasizes.

Teach me general cases in indian population

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dermatology India outpatient AND prevalence

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India dermatology outpatient common conditions fungal infections scabies acne public health guideline

For an Indian dermatology OPD, start with a practical “high-frequency cases” approach. You are likely to see infectious and inflammatory dermatoses repeatedly, along with acne, pigmentary complaints, hair disorders, and drug reactions. The exact case mix differs by region, season, and whether the clinic is government or private.
  1. Itchy infections/infestations: dermatophytosis (tinea), scabies, pediculosis, candidiasis
  2. Eczemas: atopic dermatitis, contact dermatitis, seborrheic dermatitis, hand/foot eczema
  3. Papulosquamous disease: psoriasis, lichen planus, pityriasis rosea
  4. Acne, hair and nail OPD: acne, melasma, acne marks, androgenetic alopecia, alopecia areata, nail fungal disease
  5. Pigmentary disease: vitiligo, post-inflammatory hyperpigmentation, melasma
  6. Safety cases not to miss: drug eruptions, cellulitis/necrotizing infection, herpes zoster, leprosy with neuritis or reaction, blistering disorders
A useful first principle: describe the primary lesion, then distribution, symptoms, duration, triggers, and prior medication use. In dermatology, careful physical examination and lesion distribution usually drive diagnosis; primary lesions may be altered by scratching, infection, or treatment. Andrews’ Diseases of the Skin: Clinical Dermatology, p. 23. In Indian OPDs, specifically ask about over-the-counter combination creams, topical steroid use, family members with itch, shared clothing/towels, heat/sweating, and contact allergens such as hair dye, cosmetics, footwear, or occupational exposure.
Which group should we do first?
Asking for Preferences

Choose the cases you want to learn first, using short OPD-style presentations with diagnosis, examination, tests, and initial management.

Your credits are exhausted. You can purchase a top-up or subscribe to a plan to continue using Orris. If you're already subscribed, your daily credits will reset tomorrow.Yes, go prepared today, but do not feel you need to know all of dermatology beforehand. On day one, being punctual, observant, respectful with patients, and willing to learn matters more than recalling rare diagnoses.

Carry

  • White coat or clean professional attire, ID, stethoscope if expected
  • Small notebook or notes app and pen
  • Hand sanitizer
  • Your hospital/internship logbook if applicable
  • Water and a light snack if your posting runs long

Revise briefly before you leave

Focus on how to describe a skin lesion rather than trying to memorize every disease:
  1. Primary morphology: macule/patch, papule/plaque, nodule, vesicle/bulla, pustule, wheal.
  2. Secondary changes: scale, crust, excoriation, erosion, ulcer, fissure, lichenification, scar.
  3. Distribution: localized/generalized, symmetrical/asymmetrical, flexural/extensor, acral, dermatomal, sun-exposed, mucosal, scalp, nails, palms and soles.
  4. Key history: onset and progression; itch, pain or burning; contacts and new products/drugs; prior treatments; similar illness in family or contacts; fever or systemic symptoms.
Dermatologic diagnosis relies heavily on careful inspection and palpation, plus the lesion’s site and distribution. Identifying the primary lesion is especially important because scratching, infection, and prior treatment can alter its appearance. Andrews’ Diseases of the Skin: Clinical Dermatology, p. 23.

In clinic, learn this routine

When you see a patient, silently structure the case as:
Who is affected + what is the lesion + where is it distributed + how long + symptoms + relevant triggers/treatments.
Example: “A 22-year-old with intensely pruritic, scaly erythematous plaques on both flexural elbows for 3 months, with a history of atopy.”

Common things you may encounter

  • Acne, eczema/dermatitis, fungal infections, scabies
  • Psoriasis, urticaria, pigmentary disorders
  • Hair loss and nail disorders
  • Bacterial/viral skin infections
  • Drug eruptions and skin lesions requiring biopsy or dermoscopy

First-day etiquette

  • Introduce yourself and ask permission before examining or exposing any body area.
  • Maintain privacy and draping, especially for breast, genital, or full-skin examinations.
  • Never photograph a lesion without explicit consent and your unit’s approved process.
  • Do not diagnose confidently in front of a patient if unsure. Say: “I’ll discuss this with my senior.”
  • Watch how your consultants document morphology and distribution. That is one of the fastest ways to learn.
  • Ask at the start: “What should interns do during clinic, procedures, and ward rounds?”
Your aim today is simple: learn the clinic flow, observe 10 to 15 cases carefully, and write down unfamiliar terms or diagnoses to review tonight. The AAD basic curriculum can be a useful structured resource once you know what your department emphasizes.For an Indian dermatology OPD, start with a practical “high-frequency cases” approach. You are likely to see infectious and inflammatory dermatoses repeatedly, along with acne, pigmentary complaints, hair disorders, and drug reactions. The exact case mix differs by region, season, and whether the clinic is government or private.
  1. Itchy infections/infestations: dermatophytosis (tinea), scabies, pediculosis, candidiasis
  2. Eczemas: atopic dermatitis, contact dermatitis, seborrheic dermatitis, hand/foot eczema
  3. Papulosquamous disease: psoriasis, lichen planus, pityriasis rosea
  4. Acne, hair and nail OPD: acne, melasma, acne marks, androgenetic alopecia, alopecia areata, nail fungal disease
  5. Pigmentary disease: vitiligo, post-inflammatory hyperpigmentation, melasma
  6. Safety cases not to miss: drug eruptions, cellulitis/necrotizing infection, herpes zoster, leprosy with neuritis or reaction, blistering disorders
A useful first principle: describe the primary lesion, then distribution, symptoms, duration, triggers, and prior medication use. In dermatology, careful physical examination and lesion distribution usually drive diagnosis; primary lesions may be altered by scratching, infection, or treatment. Andrews’ Diseases of the Skin: Clinical Dermatology, p. 23. In Indian OPDs, specifically ask about over-the-counter combination creams, topical steroid use, family members with itch, shared clothing/towels, heat/sweating, and contact allergens such as hair dye, cosmetics, footwear, or occupational exposure.
Which group should we do first?Start with the most common OPD pattern in India: itching cases. Learn these first because they appear daily.

1. Tinea corporis/cruris - “fungal infection”

Typical complaint: Itchy red/brown circular rash in groin, buttocks, abdomen, or body, worse with sweating.
Examination
  • Annular plaque with a scaly, active raised edge
  • Central clearing may be present
  • Look carefully at groin, feet, nails, scalp, and family members may have similar lesions
  • Ask specifically: “Any mixed cream or steroid cream used?” Steroid-modified tinea may lose its classic ring shape and become extensive.
Ask
  • Duration, itch, sweating, tight clothing
  • Similar complaints in household
  • Previous creams or oral medicines
  • Diabetes, immunosuppression, recurrent infection
Basic test: KOH mount from the active scaly edge, if diagnosis is uncertain or recurrent.
Intern takeaway: Do not label every itchy groin rash as fungal infection. Consider candidiasis, erythrasma, psoriasis, contact dermatitis, and intertrigo.

2. Scabies

Typical complaint: Severe itching, especially at night, often affecting multiple family members.
Examination
  • Small papules, excoriations, burrows
  • Common sites: finger webs, wrists, axillae, waist, buttocks, genitalia
  • In infants: palms, soles, scalp, and face may also be affected
  • Look for secondary bacterial infection: pustules, crusting, pain, fever.
Ask
  • “Does anyone at home have itching?”
  • Night-time worsening?
  • Recent treatment and whether all close contacts were treated simultaneously?
Intern takeaway: Treatment fails if household contacts are not treated and bedding/clothes are not managed according to local advice. Post-scabetic itch may continue for weeks even after mites are eradicated.

3. Eczema/contact dermatitis

Typical complaint: Itchy, dry, red or hyperpigmented patches, often recurrent.
Examination
  • Acute: erythema, edema, vesicles, ooze, crust
  • Chronic: dry scale, fissures, lichenification, hyperpigmentation
  • Distribution gives clues:
    • Hands: soaps, detergents, wet work, occupation
    • Feet: footwear allergy
    • Face/scalp: cosmetics, hair dye, fragrance, seborrheic dermatitis
    • Flexures: atopic dermatitis
Ask
  • New cosmetic, soap, hair dye, occupational exposure, footwear, jewellery, topical product
  • Atopy: asthma, allergic rhinitis, childhood eczema
  • Steroid creams and fairness creams
Intern takeaway: In darker skin tones, inflammation may look violaceous, dusky brown, or grey rather than bright red. Feel for warmth, scale, thickening, and examine the borders.

4. Acne vulgaris

Typical complaint: Pimples, oily face, marks, scars.
Examination
  • Comedones are the key: open blackheads and closed whiteheads
  • Papules, pustules, nodules, cysts
  • Assess scars and post-inflammatory hyperpigmentation
  • Check chest and back as well.
Ask
  • Onset, menstrual irregularity/hirsutism in women, medications, supplements, cosmetics, manipulation/picking
  • Emotional effect and previous treatment
Intern takeaway: Acne is not just a cosmetic complaint. Identify nodulocystic acne, scarring acne, and possible PCOS features early for senior review.

5. Psoriasis

Typical complaint: Recurrent scaly plaques, commonly on elbows, knees, scalp, lower back.
Examination
  • Well-demarcated erythematous or darker plaques with dry silvery-white scale
  • In Indian skin, redness can be less obvious and lesions may look violaceous or hyperpigmented
  • Examine scalp, nails, palms/soles, and intergluteal cleft
  • Nail pitting, onycholysis, and subungual hyperkeratosis support the diagnosis.
Ask
  • Joint pain, morning stiffness, swollen digits, heel pain
  • Family history, recent infection, new drugs, stress
  • Previous topical steroid use
Intern takeaway: Always ask about joints. Psoriatic arthritis can be missed.

6. Vitiligo

Typical complaint: White patches, often with significant social distress.
Examination
  • Well-defined depigmented macules or patches
  • Examine lips, fingertips, eyelids, genital area, hair within patches
  • Wood’s lamp may help distinguish depigmentation from hypopigmentation.
Ask
  • Progression, family history, thyroid symptoms, autoimmune disease
  • Trauma-related new lesions, such as at pressure sites
  • Emotional impact, stigma, school/work difficulties
Intern takeaway: Do not casually promise a cure. Assess extent, activity, and psychosocial burden; distinguish vitiligo from pityriasis versicolor, post-inflammatory hypopigmentation, and chemical leukoderma.

7. Melasma and post-acne pigmentation

Typical complaint: Facial darkening or “acne marks.”
Examination
  • Melasma: symmetric brown to grey-brown patches on cheeks, forehead, upper lip
  • PIH: dark macules where prior acne, eczema, injury, or infection occurred
Ask
  • Sun exposure, pregnancy, hormonal medicines, cosmetics, photosensitivity
  • Skin-care products and steroid-containing “fairness” creams
Intern takeaway: Sun protection and stopping irritant or steroid-containing products are often as important as the prescription.

8. Hair loss

Common OPD presentations:
  • Androgenetic alopecia: patterned thinning, widening part in women, frontotemporal/vertex loss in men
  • Telogen effluvium: diffuse shedding after fever, dengue/COVID, childbirth, weight loss, stress, thyroid disease, anemia
  • Alopecia areata: sudden smooth round patches, exclamation-mark hairs
Ask
  • Sudden versus gradual onset, shedding versus thinning
  • Recent fever/illness, delivery, diet/weight loss, medications
  • Menstrual history, thyroid symptoms, family history
  • Scalp itch/scaling or painful patches
Intern takeaway: Examine scalp for scale, inflammation, scarring, broken hairs, and nail changes. Scarring alopecia or rapidly progressive loss warrants prompt senior assessment.

9. Leprosy - never miss in India

Think of it with:
  • Hypopigmented, coppery, or erythematous patch with sensory loss
  • Peripheral nerve thickening/tenderness
  • Weakness, clawing, foot drop, recurrent burns or ulcers
Do every time you suspect it
  • Test light touch, pain, and temperature over the patch
  • Palpate relevant peripheral nerves
  • Check motor function and eyes
  • Look for reaction states: painful swollen lesions, neuritis, fever, edema, new weakness
Intern takeaway: New nerve pain, loss of function, or acute neuritis needs urgent senior review because nerve damage can become permanent.

10. Red flags for immediate senior review

  • Fever with widespread rash, skin pain, mucosal erosions, blisters, or epidermal peeling: possible severe drug reaction
  • Rapidly spreading painful redness, edema, bullae, or systemic toxicity: severe skin/soft tissue infection
  • Eye involvement in herpes zoster or severe drug eruption
  • Extensive blistering disorder
  • Purpura with fever or systemic illness
  • Erythroderma: generalized redness/scaling with systemic risk
  • Leprosy with acute neuritis or new weakness

Daily OPD checklist

For every lesion, document:
Morphology + colour + surface + size + site/distribution + symptoms + duration + previous treatment.
Example:
“Multiple annular, scaly, pruritic plaques with active peripheral margins over bilateral groins and thighs for 2 months; history of topical combination cream use.”
Learn this language first. It will make your case presentations much stronger than memorizing drug names.
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