4. Dr ANNIS B
• 90% of skin diseases can be properly
diagnosed with meticulous history and
proper physical examination
• The principal steps in physical examination
are inspection and palpation
• Complete cutaneous examination should be
performed
5. Inspection of the entire skin
Palpation of rashes or localized lesion
-texture, consistency, thickness,
tenderness and temperature
Dr ANNIS B
6. History Components
• A dermatologic history is similar to
other fields of medicine and includes:
– Chief Complaint:
– History of Present Illness:
• Onset and evolution
• Symptom (itch, pain),
• details of spread
• original morphology
• precipitating and relieving factors such as
climate, sunlight etc.
Dr ANNIS B
7. Hx….
• Current Treatments
– topical including herbs & systemic
medication
• patient initiated or physician prescribed
– Patient's own perception on the cause of the problem.
• Past Medical History (PMH)
– Allergies
– Medications
Dr ANNIS B
8. ….
• Family History
– Psoriasis
– atopic dermatitis, allergic rhinitis, asthma
– skin cancer- particularly melanoma
• Social History:
– Occupation
– living state
• Review of Systems
Dr ANNIS B
9. Physical Examination
• Requirements
– undressed
– Good lighting
– Adequate privacy
– Light torch
– Spatula
– Magnifying glass and
– Transparent glass slide for diascopy
• Thorough examination of the whole body
• Examine the nails, hairs, and mucosa
• Inspection and palpation are principal
Dr ANNIS B
10. Inspection and Palpation
• Morphology
• configuration
• Distribution
• Color
• Texture
• Particular clinical signs
Dr ANNIS B
11. Classified as:
• Primary
-the original lesions
-identification is important for diagnose
• Secondary
-modified primary lesion
-involution, trauma, application of
medication
Dr ANNIS B
Morphology
12. Distribution of the lesion:
– Symmetrical Vs asymmetrical
– exposed area Vs sun exposed area
– scalp region
– Hand
– extensor aspect Vs flexor aspect
Dr ANNIS B
13. Arrangement and
configuration of the lesion
• Grouped
– insect bites, herpes simplex, common warts
• Annular
– granuloma annulare, mycosis fungoides, erythema annulare
centrifugum
• Linear pattern
– Koebner phenomenon, Psoriasis, lichen planus, plane wart,
morphoea, phytophotodermatitis
Dr ANNIS B
14. Morphology of lesion
• shape
– geometric shape, oval
• Colour
– pink, erythematous, skin colour, yellow
• Size
• margin
– sharpness of edge, well-defined, ill-defined
• surface
– dome-shaped, umbilicated, spike like
Dr ANNIS B
15. Primary lesions
1. Macule: flat, nonpalpable lesions <
1cm in diameter
Macules represent a change in color and are
not raised or depressed compared to the skin
surface.
A patch is a large macule.
Dr ANNIS B
18. 2. Papule: elevated lesions < 1cm in
diameter that can be felt or palpated.
• solid elevations with no visible fluid
• may be acuminate, rounded, conical,
flat topped, or umbilicated, and may
appear white (as in milium), red (as in
eczema), yellowish (as in xanthoma),
or black (as in melanoma).
Dr ANNIS B
27. 5. Vesicle: small, clear, fluid-filled
lesion of < 1cm in diameter. If they
are greater than 1cm in diameter, they
are called bulla or blister.
Dr ANNIS B
37. 2. Crust (scab): consists of dried serum,
blood, or pus
Dr ANNIS B
38. 3. Erosion: open area of skin that
results from loss of part or all of the
epidermis
Dr ANNIS B
39. 4. Ulcer: results from loss of the
epidermis and at least part of the
dermis.
Dr ANNIS B
40. Dr ANNIS B
5. Excoriation
• Punctate or linear abrasion due to
scratching
• Usually involves only the epidermis
• Provides accesses to pyogenic organism
47. 9. Scar: area of fibrosis that replaces
normal skin after injury. Some scars
become hypertrophic or thickened and
raised.
Keloid is hypertrophic scar that
extend beyond the original wound
margin.
Dr ANNIS B
68. C. Location and Distribution
1. Are lesions single or multiple?
2. Are particular body parts are affected
(palms or soles, scalp, mucosal
membranes, extensor, flexor)?
3. Is distribution random or patterned,
symmetric or asymmetric?
4. Are lesions on sun-exposed or protected
skin?
Dr ANNIS B
69. D. Color
• Pigment (hypo, hyper, de-)
• Violet = Violaceous
• White = Alba
• Red = Erythema
Dr ANNIS B
78. F. Particular Clinical Signs
1. Dermatographism is the appearance of an
urticarial wheal after focal pressure.
2. Darier's sign refers to rapid swelling of a lesion
when stroked.
3. Nikolsky's sign is epidermal shearing that occurs
with gentle lateral pressure on seemingly
uninvolved skin.
4. Auspitz sign is the appearance of pinpoint
bleeding after scale is removed from plaques.
5. Koebner phenomenon describes the
development of lesions within areas of trauma.
Dr ANNIS B
79. DERMATOLOY INVESTIGATION
• SKIN BIOPSY-
• WOOD’S LAMP EXAMINATION
ultraviolet light of 365 nm wavelength is obtained by
passing the beam through a wood’s filter composed of
nickel oxide containing glass
examination should be done in a dark room
microsporum canis-bright green
pityriasis versicolor-yellow
erythrasma-croral red
vitiligo-more white
Dr ANNIS B
80. Cont’d
• Patch test-tests type 4 hypersensitivity
reaction and it is confirmatory test for
allergic contact dermatitis
• Mycology examination
-Superficial fungi can be identified by
examination of the skin scraping, nail or hair.
The scales, nail or hair should be collected
onto a slide and a drop of 10 to 20 percent
KOH to dissolve the keratin
Dr ANNIS B
81. Ixs……
• Mite examination-to identify burrow
• CBC, U/A, S/E, SEROLOGY
• Radiology examination
• Clinical Photography
Dr ANNIS B
82. • Tangential shining of examination torch
to the skin lesions will enhance and
detect elevated skin lesions with ease
• Diascopy consists of pressing a
transparent slide or plastic spatula over
a skin lesion. It is useful to detect the
glassy yellow-brown appearance of
papules in sarcoidosis, tuberculosis and
other granuloma
Special Techniques
Dr ANNIS B
