Skin Assessment and Consultation
This domain tests structured observation: can you classify a skin, separate type from condition, spot what must be referred, and record a baseline that later justifies your treatment choices?
Classification tools the exam expects
- Fitzpatrick I–VI: burn and tan response to UV. It predicts photodamage and post-inflammatory hyperpigmentation risk - not sensitivity, not oiliness.
- Glogau I–IV: photoageing severity, from early wrinkles to widespread actinic change.
- Baumann: four dimensions - dry/oily, sensitive/resistant, pigmented/non-pigmented, wrinkled/tight.
- Acne description: comedonal, papulopustular, nodulocystic; grade and refer nodulocystic.
Type versus condition
Type is genetic and stable (oiliness, pore size, tendency to sensitivity). Condition is temporary and treatable (dehydration, irritation, post-summer pigmentation). "Dehydrated oily skin" is coherent; "oily and dry skin type" usually is not.
Objective assessment
Magnifying lamp for texture and vessels; Wood's lamp - coral-red fluorescence suggests porphyrin-producing Cutibacterium acnes, epidermal pigment enhances contrast, dermal pigment looks dull, dehydration shows as fine whitish flaking. Palpation, comedone count, and photographs with consistent lighting and consent.
Screening before you touch the skin
Isotretinoin (commonly defer resurfacing for six months after the last dose, per product guidance), pregnancy or breastfeeding, photosensitising medication, anticoagulants, active herpes labialis, keloid history, recent waxing, laser or retinoid use, uncontrolled eczema or rosacea, and any lesion that fails the ABCDE test (asymmetry, border, colour, diameter, evolution) or that bleeds, crusts or does not heal.
Worked example
A 34-year-old, Fitzpatrick III, oily T-zone, cheeks tight after cleansing, wants "brightening". Reasoning: oily type with a dehydrated condition; the tightness is barrier-related, so scrubs and high-strength acids would worsen it. Plan: gentle non-comedogenic cleanser, humectant plus niacinamide serum, daily SPF 50, review in four weeks, defer peels until hydration is restored.
Traps that cost marks
- Using Fitzpatrick as a sensitivity score.
- Advising oily clients to skip moisturiser.
- Applying heat and stimulating massage to undiagnosed rosacea.
- Recording findings in your head rather than on a signed consultation form.