Explaining a cutaneous sign of systemic disease — OSCE

Communication and structured-discussion OSCE on explaining to a family that a child's skin sign may reflect an underlying internal disease, covering the recognise, investigate and refer framework, the targeted work-up the lesion dictates, the rationale for blood tests and specialist referral, and the reassurance that the skin often improves as the systemic disease comes under control.

osce communication diagnosis systemic-link referral4 min readVerification in progress

Prompt

A 10-year-old girl presents with an intensely itchy, symmetric eruption of grouped vesicles and crusts over the elbows, knees and buttocks, present for four months, with poor sleep from the itch. The family asks what the rash is, whether it is just an allergy, and why the doctor wants blood tests and a gut biopsy for a skin problem. The candidate must explain that the rash is dermatitis herpetiformis, the cutaneous face of coeliac disease, the rationale for the coeliac serology and duodenal biopsy, the gluten-free diet and dapsone management, and the long-term plan.

Candidate instructions (8-minute station)

You are the paediatric registrar in the clinic. A 10-year-old girl has an intensely itchy, symmetric eruption of grouped vesicles and crusts over the elbows, knees and buttocks, present for four months, with poor sleep from the itch. The family asks what the rash is, whether it is just an allergy, and why the doctor wants blood tests and a gut biopsy for a skin problem. ^[6]

Your tasks are: ^[6]

Explain the diagnosis of dermatitis herpetiformis in plain, reassuring language, including that it is not a simple allergy but the skin sign of an immune reaction to gluten. ^[6]
Explain why coeliac blood tests and a small-bowel biopsy are needed for a skin problem, and what they are looking for. ^[5]
Explain the treatment — a strict gluten-free diet and dapsone for rapid itch control — and the safety checks for dapsone. ^[5]
Set the expectation for the long term, including why treating the gut matters even when the gut is silent. ^[5]

You are not expected to perform the biopsy or start dapsone without the specialist — those decisions are made with the gastroenterologist and dermatologist. ^[6]

References2Show

[5]Al-Toma A; Volta U; Auricchio R; Castillejo G; et al European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J, 2019.PMID 31210940
[6]Nguyen CN; Kim SJ Dermatitis Herpetiformis: An Update on Diagnosis, Disease Monitoring, and Management. Medicina (Kaunas), 2021.PMID 34441049

Explaining a cutaneous sign of systemic disease — OSCE

osce communication diagnosis systemic-link referral4 min readVerification in progress

Candidate instructions (8-minute station)

Your tasks are: ^[6]

Explain the diagnosis of dermatitis herpetiformis in plain, reassuring language, including that it is not a simple allergy but the skin sign of an immune reaction to gluten. ^[6]

Explain why coeliac blood tests and a small-bowel biopsy are needed for a skin problem, and what they are looking for. ^[5]

Explain the treatment — a strict gluten-free diet and dapsone for rapid itch control — and the safety checks for dapsone. ^[5]

Set the expectation for the long term, including why treating the gut matters even when the gut is silent. ^[5]

You are not expected to perform the biopsy or start dapsone without the specialist — those decisions are made with the gastroenterologist and dermatologist. ^[6]

References2Show

[5]Al-Toma A; Volta U; Auricchio R; Castillejo G; et al European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J, 2019.PMID 31210940
[6]Nguyen CN; Kim SJ Dermatitis Herpetiformis: An Update on Diagnosis, Disease Monitoring, and Management. Medicina (Kaunas), 2021.PMID 34441049