AAFP Core Educational Guidelines
Conditions of the Skin: Recommended Core Educational Guidelines for Family Practice Residents
Am Fam Physician. 1999 Sep 15;60(4):1258-1264.
This document has been endorsed by the American Academy of Family Physicians and developed in cooperation with the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of Teachers of Family Medicine. These revised guidelines represent suggestions and comments from the Committee on Interdisciplinary Dermatologic Education of the American Academy of Dermatology.
The specialty of family practice is interested in dermatologic care, with an emphasis on comprehensive and continuing care. Each family physician should be aware of the impact of skin problems on a patient and the family and should be willing to perform and capable of performing preventive and therapeutic roles in these cases. The appearance of skin problems may have significant emotional impact on individuals and families. Significant preventive factors include emotional, environmental and occupational effects that may disturb the skin. Interaction with the family of any patient who has skin problems should be stressed in the education of the family physician. In addition, family physicians must be taught to be aware of the damage that can be done to the skin by inappropriate care.
While this outline specifies certain knowledge and skills basic to the diagnosis and management of patients with skin disorders, the family physician should understand that additional areas of knowledge and skills may be essential to the appropriate care of a given patient. Therefore, these guidelines are not intended to limit the family physician's effort to acquire other important dermatologic knowledge and skills.
It is expected that the family physician will become proficient in the diagnosis and treatment of patients with many kinds of skin diseases. The family physician may find it appropriate to seek consultation from a dermatologist and to actively engage in the co-management of the patient. In some cases, referral to a dermatologist for management is indicated.
Basic components of dermatology
Normal anatomy, development and physiology
Arrangement, distribution, type and pattern of lesions
Type of lesion: primary/secondary; macular/papular/vesicular/nodular; tumor
Specific lesion sites
Systemic evaluation (if indicated)
Common dermatologic problems
Seborrhea and dandruff
Miliaria (prickly heat)
Other pruritic conditions
Dry skin (asteatosis)
Secondary systemic disease
Lichen simplex chronicus (localized neurodermatitis)
Chigger and other insect bites
Boil (e.g., furuncle, pustule, folliculitis, abscess, carbuncle, ecthyma)
Superficial fungal infections
Deep fungal infections
Rocky Mountain spotted fever
Complexion and cosmetic problems
Bites and stings
Verruca (common, plantar, anogenital, flat)
Corn and callus
Skin tag (acrochordon)
Mole, nevus (intradermal, junctional, compound, halo, blue, congenital)
Other, such as fibroma, leiomyoma
Squamous cell carcinoma in situ (Bowen's disease)
Disseminated superficial actinic porokeratosis
Giant congenital nevus
Dysplastic nevus syndrome
Basal cell carcinoma
Squamous cell carcinoma
Major clinical categories
Prognostic and therapeutic guidelines
Metastases to the skin
Cutaneous manifestations of systemic disease, including human immunodeficiency virus infection and syphilis
Occupational skin disease
Androgenic (male pattern)
Traction alopecia and trichotillomania
Discoid lupus erythematosus
Ingrown hair (pseudofolliculitis)
Virilizing causes of hirsutism
Texture alterations (hair dystrophy)
Disturbances associated with other dermatoses
Disturbances associated with systemic illness
Periungual and subungual conditions
Squamous cell carcinoma
Mucous membrane lesions
Oral hairy leukoplakia
Black hairy tongue
Performance of history and physical examination with differential diagnosis
Acquisition, examination and interpretation of laboratory specimens
Skin testing techniques and interpretation
Use of mechanical devices (i.e., Wood's light)
Systemic evaluation (if indicated)
Description of distribution and character of lesions
Routine skin care
Avoidance of environmental causes
Appropriate use of over-the-counter lotions
Use of photographs to document progress
Use of scales/indexes to grade disease severity
Use of consultations and referrals
Cauterization of skin lesions
Electrodesiccation and curettage
Excision of skin lesions
Intralesional injection of corticosteroids
Incision and drainage
Treatment of ingrown toenails
Principles of ultraviolet light therapy
The development of core cognitive knowledge and appropriate skill in the care of the skin, hair and nails should require experience in a structured educational component of a family practice residency program. There must be written goals and educational objectives. This component need not be a “block rotation,” but the educational experience must be appropriately identified and structured. Most of this experience will be in an out-patient setting with qualified physician teachers and consultants.
Residents will obtain substantial additional dermatologic experience throughout the three years of their involvement in the family practice center. Family practice residents should be instructed regarding timely and appropriate consultation with, and/or referral to a dermatologist.
Residents should be taught the difference between acquisition of consultations and the referral of patients to another specialist for management and ultimate return to the referring family physician. In addition, residents should be instructed regarding the interdependence of family practice and other specialties and the appropriate referral of patients both from the family physician to the dermatologist and from the dermatologist to the family physician.
Habif TP. Clinical Dermatology: a color guide to diagnosis and therapy. 3d ed. St. Louis: Mosby, 1996.
Sams WM Jr, Lynch PJ, eds. Principles and practice of dermatology. 2d ed. New York: Churchill Livingston, 1996.
Sauer GC. Manual of skin diseases. 7th ed. Philadelphia: Lippincott, 1996.
Copyright © 1999 by the American Academy of Family Physicians.
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