Dermatological history and examination


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Dermatological history and examination

  1. 1. Dermatological History and Examination Natapol Pumipuntu,DVM
  2. 2. Contents•• - History taking - Physical Examination - Differential Diagnosis - Diagnosis Test & Clinical pathology - Tentative Diagnosis & Definitive Diagnosis•
  3. 3. • Parasitic diseases• Bacterial skin diseases• Viral, Protozoal and Rickettsial skin disease• Fungal skin diseases• Hypersensitivities• Autoimmune dermatoses
  4. 4. • Endocrine dermatoses• Nutritional dermatoses• Neoplastic dermatoses• Psychogenic dermatoses• Congenital and hereditary dermatoses• Miscellaneous dermatoses
  5. 5. Parasitic diseases• Demodex canis• Sarcoptes scabiei• Otodectes cynotis• Cheyletiella spp.• Tick• Flea• Fly
  6. 6. Demodex canis
  7. 7. Sarcoptic mange
  8. 8. Otodectes cynotis
  9. 9. Bacterial skin diseases• Staphylococcus intermedius coagulase-positive & Gram-positive coccus
  10. 10. Bacterial skin diseases cont• Surface infections - pyotraumatimatic dermatitis Hotspot - fold pyoderma
  11. 11. Bacterial skin diseases cont• Superficial infections - impetigo - Superficial folliculitis
  12. 12. Bacterial skin diseases cont• Deep infections - Deep folliculitis - Deep pyoderma - cellulitis - mycobacterial infections
  13. 13. Viral, protozoal and Ricketsettsial skin diseases• Viral : canine distemper virus canine viral papillomatosis etc.• Protozoal : canine leishmaniasis etc.• Bacteria : Ehrlichia canis etc.
  14. 14. Fungal skin diseases• Fungi - Microsporum canis - Microsporum gypseam - Trichophyton mentagrophytes• Yeast - Malassezia patchydermatis
  15. 15. Hypersensitivites• Allergic contact dermatitis• Inhalant allergy• Adverse reaction to food• Drug eruption etc.
  16. 16. Autoimmune dermatoses• Lupus erythematosus• Pemphigus foliaceus• Pemphigoid syndrome• Alopecia areata• Discoid lupus erythematosus• Pemphigus vulgaris
  17. 17. Endocrine dermatoses • Hypothyroidisim • Hyperadrenocorticism • Gonadal hormones • Growth hormone etc.
  18. 18. Nutritional dermatoses • Protein/calorie deficiency • Essential fatty acid deficiency • Vitamin A deficiency • Vitamin E deficiency • Zinc deficiency
  19. 19. Neoplastic dermatoses • Tumors of epithelial origin : Papilloma, Basal cell tumor, Sebaceous gland tumor, Squamous cell carcinoma etc.
  20. 20. Neoplastic dermatoses cont • Tumors of mesenchymal origin : Fibroma, Fibrosarcoma, Lipoma, Liposacoma, Mast cell tumor etc.
  21. 21. Neoplastic dermatoses cont • Tumors of lymphohistiocytic origin : Histiocytosis, cutaneous lymphoma, Transmissible venereal tumor etc.
  22. 22. Psychogenic dermatoses• Lick dermatitis
  23. 23. Miscellaneous dermatoses• Congenital dermatoses• Hereditary dermatoses• Keratinization disorder• Metabolic dermatitis
  24. 24. HISTORY Physical Examination Treatment Differential Diagnosis Diagnosis Test & Clinical PathologyTentative Diagnosis or Difinitive Diagnosis
  25. 25. History Taking
  26. 26. •• CHIEF COMPLAINT•
  27. 27. • /•• …••• / /• /
  28. 28. •• /• … /• …
  29. 29. History• Breed• Age• Sex• Environment• Diet• Health status• History of disease• Response to previous treatments
  30. 30. Physical Examination
  31. 31. Physical Examination•
  32. 32. Physical Examination• - Bilaterally symmetric lesion - Asymmetric lesion
  33. 33. Physical Examination• - Single - Linear - Annular
  35. 35. Physical Examination• - Primary Lesions - Secondary Lesions
  36. 36. <<Primary Lesions>>• Macules & Patches - Discoloration of the skin - macules  less than 1 cm in diameter - patches  larger than 1 cm in diameter
  37. 37. ***The change is colour may result from pigment loss or excess, erythema or haemorrhage.
  38. 38. Papules & Plaques• A circumscribed, solid elevation of the skin• Papules  less than 1 cm in diameter often pink and red• Plaques  larger than 1 cm in diameter
  39. 39. Pustules• Circumscribed elevations of the superficial layers of the epidemis• Bacterial infection• The infiltrate will contain neutrophils, bacteria, debris and perhaps a few free keratinocytes
  40. 40. PUSTULE**The most important cause isStaphylococcus intermedius
  41. 41. Wheals• More or less well-defined elevations of the skin due to edema• Round, oval or plaque-like• Disappears within minutes or hours**angioedema *Localised mast cell degranulation within the skin
  42. 42. Vesicles & Bullae• A well-demarcated elevation of the superficial layers of the skin• Vesicles  less than 1 cm in diameter• Bullae  lager than 1 cm in diameter
  43. 43. Nodules• Circumscribed elevations of the skin that are larger than the 1 cm in diameter deeper skin layers
  44. 44. Tumors• Masses of neoplastic origin whether benign or malignant• May extend into the deeper subcutaneous tissue
  45. 45. Cysts• Cavities within the skin that are lined by epithelium
  46. 46. <<Secondary Lesions>>• Comedones - dilated hair follicle which contains a pigmented impaction of lipid and keratinaceous debris “BLACK HEAD”
  47. 47. Scale• Associated with the shedding of large rafts of keratinocytes accumulation of loose cornified fragment of the epidermis
  48. 48. Crust• Composed of dried exudate mixtd with debris on the skin surface serum/blood/pus
  49. 49. Exocoriation• Areas of epidermal damage caused by scratching, biting or rubbing
  50. 50. Ulceration• The integrity of the basal layer basement membrane is destroyed• The dermis is involved and healing is often by scar formation
  51. 51. Lichenification• A thickening of the epidermis with an accompanying hyperpigmentation in most instances elephant skin like
  52. 52. Hyperpigmentation• Usually a consequence of melanin excess Hypopigmentation• Loss of pigment
  53. 53. Scar• Occurs when the basal layers of the epidermis have been breached and the underlying dermis is damaged
  54. 54. &Problem list ?
  55. 55. Problem list?• Pruritus• Focal / generalized/symmetrical alopecia• Crust• Hyperpigmentation• Scale• Nodule• Patch• Plaque
  56. 56. Diagnostic Test• TrichogramIdentification of fur mites, adherent egg cases, fractured ends to the hair shaft** Trichograms are not a reliable method of diagnosing, or ruling out, ectoparasite infections
  57. 57. Method• Remove a small tuft of hair with fingers or forceps• Laid onto trasparent adhesive tape• Laid onto a glass slide• Microscopic examination
  58. 58. Adhesive tape stripping• Allows direct sampling of the coat or skin surface&hair• Observes squamous morphology, ectoparasites and micro-organisms
  59. 59. Method• A commercial, clear, adhesive tape is gently pressed onto the clipped skin surface removed stained with Diff Quick Laid across A glass slide Laid across a glass slide
  60. 60. Skin scraping• This procedure samples the surface, the epidermis and the upper dermis• Indication of Demodex spp., Sarcoptes scabiei and Cheyletiella spp.• Indication of dermatophytosis spores
  61. 61. Method• Parasites Clip hair Liquid paraffin is applied to the skin surface & slide Dragged across the tensed skin repeatedly by the blade Transfer accummulated sample to the slide
  62. 62. Method• Dermatophyte Clip hair 10%KOH applied to the skin surface & slide Dragged across the tensed skin repeatedly by the blade Transfer accummulated sample to the slide Heat fixing Stained with Lactophenol cotton blue or India ink
  63. 63. Wood’s light• Indication of Microsporum canis,Microsporum distortum, Microsporum audoinii, Trichophyton scnoenleinii• False positive : Pseudomonas spp., Corynebacterium spp., keratin, soap, petroleum and some drugs.
  64. 64. Wood lamp examination
  65. 65. Fungal culture• The scale and hair are inoculated onto a culture plate containing a medium
  66. 66. Otic sampling• Indication of Malassezia pachydermatis, bacteria and mites• Method the sample is collected with a cotton swab dry fixing staining
  67. 67. Impression cytology• Used to sample cells from the surface of erosions and ulcers or from the orifices of discharging fistulae• Medthod Pressing a cleaned glass slide against the lesion dry Staining with Diff Quick
  68. 68. Aspiration cytology• Used to sample cells from within lymph nodes, nodules and neplasms• Method Needle aspiration smear dry Staining with Diff Quick or special stain
  69. 69. Bacteria Culture• Indication of aerobic bacteriaMethodthe sample is collected with a cotton swab / aspiration
  70. 70. Intradermal skin testing • Demonstrate the presence of allergen- specific IgG on the mast cells at the site of the intradermal injection • Method
  71. 71. Punch biopsy• Obtain samples for histopathological examination• Method Select site Local anesthesia Push biopsy punch through the skin Remove sample & placed into 10% formaline
  72. 72. Treatment• - - -
  73. 73. • Topical treatment• Systemic therapy• Skin surgery