Clinical medicine rotations
Dermatology
Dermatology is the care of the skin, hair and nails. A psychiatrist uses it at awareness level: skin conditions are strongly affected by stress, several psychiatric drugs cause serious rashes, and some psychiatric conditions present with skin damage.
Depth by stage, Pre-U → Consultant (details)
What is it?
Dermatology covers eczema, psoriasis, acne, skin infections, skin cancers and drug reactions. Students learn to describe skin lesions accurately and recognise common and dangerous conditions.
It is a short posting. Students see how visible skin disease affects self-esteem and social life.
Psychodermatology, the overlap of skin and mind, is a recognised area: stress can trigger psoriasis or eczema, and some people pick at or damage their skin because of psychological conditions.
Why does a psychiatrist need it?
Lamotrigine and carbamazepine can cause life-threatening rashes such as Stevens-Johnson syndrome; carbamazepine risk is linked with the HLA-B*1502 gene, common in people of Asian ancestry including Malaysians. Lithium can worsen psoriasis and acne. Skin picking, trichotillomania and delusional infestation present to dermatologists first.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalAwareLearns skin structure and immunology basics.
- ClinicalUnderstandsDescribes skin lesions and recognises common skin diseases.
- HousemanshipAwareRecognises drug rashes and skin infections on general wards.
- Medical officerAwareRetains basic recognition skills.
- Psych traineeUnderstandsUnderstands serious drug rashes, HLA-B*1502 testing and psychodermatology conditions.
- Specialist / consultantUnderstandsApplies this when prescribing and in liaison work.
What are the key topics?
Skin basics
- Describing lesions
- Eczema and psoriasis
- Acne
- Skin infections and infestations
- Skin cancers
Drug reactions
- Stevens-Johnson syndrome and toxic epidermal necrolysis
- DRESS syndrome
- HLA-B*1502 and carbamazepine
- Lithium and skin
Psychodermatology
- Skin picking (excoriation) disorder
- Trichotillomania
- Delusional infestation
- Stress and skin disease flares
- Body dysmorphic concerns about skin
How is it learned and assessed?
- Short clinical posting with clinics
- Photo-based and OSCE assessments
- Assessed in a minor specialties block in many universities
Typical textbooks and resources
- Clinical Dermatology (Weller, Hunter and Mann) — student text
- Oxford Handbook of Medical Dermatology — practical reference
- Psychodermatology texts and review articles for later reading
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Can stress cause skin problems?
Stress can trigger or worsen conditions such as eczema and psoriasis. Some people also damage their skin through picking or hair pulling, which are recognised psychiatric conditions.
Why must a psychiatrist know about skin rashes?
Some medicines used in psychiatry, such as carbamazepine and lamotrigine, can rarely cause dangerous rashes. Psychiatrists must recognise early signs and know about genetic testing before prescribing in some cases.