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PHYSICAL

EXAMINATION IN
DERMATOLOGY
CLIENT ASSESSMENT

EXAMINATION OF THE SKIN, HAIR,
NAIL, AND MUCOUS MEMBRANE

GENERAL PHYSICAL EXAMINATION
RELATED TO SKIN DISEASES

DESCRIPTION OF THE PHYSICAL
EXAMINATION IN DERMATOLOGY
CLIENT ASSESMENT
1. Notice the initial clinical impression.
2. Give the patient an adequate explanation
about the physical examination.
3. The patient is placed in an adequate
illumination, prefer under natural light or
bright overhead fluorescent lighting.
4. Ask the patient to take off his/her clothes.


EXAMINATION OF THE
SKIN, HAIR, NAIL AND
MUCOUS MEMBRANE
EXAMINATION OF THE SKIN
Distribution of lesion
Location of lesion
Characteristic of lesion
Type of lesion :
Primary lesion
Secondary lesion
Specific lesion

DISTRIBUTION OF LESION

LOCALIZED

Restricted to a limited region or to one spot
Basal cell carcinoma
REGIONAL

Prurigo nodularis
Affecting a certain region or regions
GENERALIZED
Varicella
Spread throughout the body
or affecting many parts
of the body
UNIVERSAL


Involvement of the
entire skin

Eritroderma lina
Erythroderma
Characteristic pattern of
distribution of lesion
SIMMETRY
Atopic dermatitis
On each side of plane of the body
ASIMMETRY
Not symmetry
Cellulitis
BILATERAL
Having two sides or pertaining to both sides
Psoriasis vulgaris
UNILATERAL
Affecting one side of the body
Epidermal nevus
DERMATOMAL
The area of skin
supplied with afferent
nerves fibres by
a single posterior
spindle root
Herpes zoster
LOCATION OF LESION

FLEXURAL


Pertaining to
or affecting
a flexure
Atopic dermatitis
EXTENSOR

Eczema
Pertaining to
or affecting
an extensor
INTERTRIGINOUS
Occuring on apposed skin surface, such as the
axillae, creases of the neck, intergluteal fold,
groin, between the toes, and beneath
pendulous breast
INTERTRIGINOUS
Erythrasma

Candidiasis interdigitalis
Axillae Between the toes
GLABROUS
Smooth and bare area
Seborrheic dermatitis Tinea corporis
PALMS


Palm :
The flexor surface of
the hand
Pityriasis rubra pilaris
SOLES


Sole :
The bottom of the
foot
Irritant contact dermatitis
EXPOSED AREA
The area that exposure to sunlight, such as the
dorsa of the hands and arms, the neck, and face.
Polymorphous light eruption
CHARACTERISTIC OF
LESION

The number of lesions
Soliter
Multiple
SOLITER



Only one lesion
Epidermal cyst
MULTIPLE



More than one lesion
Neurofibromatosis
Discrete or confluence ?
DISCRETE
Made up of separated parts or characterized by
lesions which do not become blended
Molluscum contagiosum
CONFLUENCE
Becoming merged; not discrete
Tinea corporis Pustular psoriasis
Shape and arrangement
of lesions
- Irregular - herpetiform
- Annular - zosteriform
- Linear - serpiginous
- Round - corymbiform
- Oval - polycyclic
- Iris
- Umbilicated
Irregular
Haemangioma
ANNULAR

A ring-shaped
arrangement of a number
of lesions form a
complete circle
Tinea corporis
Tinea corporis
LINEAR


A linear shape of
a single lesion
Koebner phenomenon in psoriasis
ROUND



Ball-shaped
Tinea corporis
OVAL
Egg-shaped
Herald patch in Pityriasis rosea
IRIS
An erythematous annular macule or papule with a
purplish or dusky, papular or vesicular center

Erythema multiforme

UMBILICATED



Marked with depressed
areas resembling
the umbilicus
Molluscum contagiosum
HERPETIFORM
Cluster or groups of vesicles
Herpes simplex virus infection
ZOSTERIFORM
Vesicles or bullae that occur in
a bandlike pattern following a dermatome
Herpes zoster
SERPIGINOUS
A snake-like arrangement of lesions
Cutaneous larva migrans
Scrophuloderma
CORYMBIFORM
A group of arrangement that consist of a central
cluster of lesions beyond which are scattered
individual lesions
Intertriginous candidiasis
Intertriginous candidosis
POLYCYCLIC
Lesions composed of
several intersecting portion of circles
Tinea corporis
The size of lesions
Milier
Guttate
Nummular

MILIER
Minute lesions resembling millet seeds
Miliaria crystallina
GUTTATE
A small round lesions,
like drops
Guttate psoriasis
NUMMULAR
A large round lesions, like a coin
Nummular eczema
The border of lesions


- Well-defined
- Ill-defined
WELL-DEFINED
With marked border
Tinea fascialis
ILL-DEFINED
With unmarked border
Pityriasis alba
TYPES OF SKIN LESIONS

1. primary skin lesion
2. secondary skin lesion
3. specific skin lesion
PRIMARY SKIN LESIONS
MACULE

A circumscribed, flat (without elevation or
depression) lesion differs from the
surrounding skin because of its color
1. Hyperpigmentation
2. Hypopigmentation
3. Depigmentation
4. Erythematous
5. Petechiae
6. Purpura
7. Ecchymoses

Hyperpigmentation macule
Melasma Solar lentigo
Hypopigmentation macule
Pityriasis versicolor
Depigmentation macule
Vitiligo
Erythematous macule
Vascular abnormalities, capillary dilatation
Erythema multiforme
Purpura



Extravasated
red blood cells.

Vasculitis
Small, pinpoint purpuric spots
often seen in thrombocytopenic states
Petechiae
Ecchimoses



Larger, bruise-like
purpuric lesions.

PAPULE
A solid, elevated and circumscribed lesion, varying
in size (pinhead to 1 cm) projects above the
plane of the surrounding skin.

Lichen planus
PLAQUE
A broad papule or
confluence of papules,
1 cm or more
in diameter flat, but
may be centrally
depressed.
The center of a plaque
may be normal skin.

Plaque type psoriasis
TUMOR

A soft or firm and freely
movable or fixed masses
of various sizes and
shapes.
The term is used to imply
enlargement of the tissues
by normal or pathological
material or cells that form
a mass inflammatory or
non-inflammatory, benign
or malignant process.

Keratoacanthoma
WHEAL

A rounded or flat-topped
papule or plaque
evanescent, edematous,
disappearing within
hours, usually pink to
red, and surrounded by
pink areola
Urticaria and Angioedema of the eyes
VESICLE
A circumscribed,
fluid-containing,
epidermal
elevation, 1-10 mm
in size

Varicella
BULLAE

A rounded or irregularly
shaped blisters
containing serous or
seropurulent fluid
differ from vesicles only
in size, being larger than
1 cm.

Bullous pemphigoid
PUSTULE
A circumscribed,
raised lesion
contains a purulent
exudates.
Pus, composed of
leukocytes with or
without cellular
debris, may contain
bacteria or sterile.

Folliculitis
CYST


A sac that contains liquid
or semisolid material
(fluid, cells, and cell
products)

Steatocystoma multiplex
ABSCESS

A localized collection of pus in a cavity formed by
disintegration or necrosis of tissue
Furuncle
SINUS


A tract leading from a
suppurative cavity to the
skin surface, or between
cystic or abscess cavities


Scrofuloderma
SECONDARY SKIN
LESIONS
SCALE

A dry or greasy
laminated masses of
keratin that caused by
abnormal shedding or
accumulation of stratum
corneum in perceptible
flakes.

Psoriasis vulgaris
Psoriasiform scale
Pityriasiform scale
CRUST

Dried serum, pus, or blood,
usually mixed with epithelial
and sometimes bacterial
debris.
Crust
Crust
EROSION


Loss of all or portions
of the epidermis alone.
It may or may not
become crusted, but it
heals without a scar.

Pemphigus vulgaris
EXCORIATION

A punctate or linear
abrasion produced by
mechanical means,
usually involving only
the epidermis but not
uncommonly reaching
the papillary layer of the
dermis.

FISSURE
A linear cleft or crack through the epidermis,
or into the dermis
ULCER

Rounded or irregularly
shaped excavations that
result from complete loss
of the epidermis plus
some portion of the
dermis.

Plantar ulcer
SCAR

Composed of new
connective tissue that
replaced lost substances
in the dermis or deeper
parts as a results of
injury or disease, as part
of the normal preparative
process.
Keloid
Atrophy
LICHENIFICATION


An area of skin to appear
as thickened plaques
with accentuated skin
markings. The lesions
may resemble tree bark.

Lichen simplex chronicus
SCLEROSIS


A circumscribed or
diffuse hardening or
induration in the skin
It is detected more
easily by palpation
than by inspection.
Systemic sclerosis
SPECIFIC SKIN LESIONS
COMEDO
A plug of keratin and sebum in a dilated
pilosebaceous orifice

Acne Vulgaris
White head
Black head
TELEANGIECTASES

Permanent dilatations of
capillaries that may or
may not dissapear with
application of pressure.
They form nonpulsatile,
fine, bright red lines or
netlike patterns on the
skin.

CANALICULI (BURROW)


A small tunnel in the
skin that houses a
metazoal parasite, such
as the scabies acarus.

Larva migrans
MILIA

A tiny white cyst containing lamellated keratin.

Milia
EXAMINATION OF THE NAILS
ONICHODISTROPHY
Irritant contact dermatitis
SPLINTER HAEMORRHAGE
Psoriasis vulgaris
PITTING NAIL
Psoriasis vulgaris
SUBUNGUAL DEBRIS
Tinea unguium
ONICHOLYSIS
Psoriasis vulgaris
EXAMINATION OF THE HAIR
ALOPECIA AREATA
ALOPECIA TOTALIS
TELOGEN EFFLUVIUM
EXAMINATION OF THE
MUCOUS MEMBRANES
ORAL CANDIDIASIS
STOMATITIS
GEOGRAPHIC TONGUE
Psoriasis
GENERAL
PHYSICAL EXAMINATION
RELATED TO
PRESENT SKIN ILLNESS
LYMPHADENOPATHY
A. Tuberculous chancre on the thigh
B. Regional lymphadenopathy
C. A positive tuberculin test
Tuberculosis
cutis
A
B
C
JOINT
Psoriatic arthritis
on metacarpophalangeal joint
DESCRIPTION OF
PHYSICAL EXAMINATION IN
DERMATOLOGY
Dermatological status :
Distribution :
Location : .
Characteristic : .
Type of lesion :
General status :
Hair, nail, mucous membrane and
other organ : .


Distribution : Regional
Location :
Both of elbows, extensor
surface of arms, lower
back, buttock, and both
of thighs
Characteristic :
Multiple, confluents,
irregular, 2 x 1 cm to
30 x 20 cm, well-defined,
elevated from surrounding
skin, dry.
Type of lesion :
Erythematous plaque with
thick white scales
Dermatological status :
General status :
Nails : Oily spot
Splinter haemorrhage
Pitting nail

Diagnosis : Psoriasis vulgaris
Dermatological status :
Distribution : regional
Location : cheeks
Characteristic : Multiple, mostly confluents, round and oval, 0,5 x
0,5 cm to 3 x 2 cm, well-defined, elevated from
surrounding skin, dry.
Type of lesions :
Erythematous macules and papules, pustules, crusts and comedones

Diagnosis : Acne vulgaris

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