How can I get a history of skin diseases from patients and perform physical examinations? Here you can easily learn.

1. Approach to the
DIAGNOSIS
of
DERMATOLOGICAL
DISEASE
Prepared and edited by: Associate prof. Dr. Khushhal Farooqi
2020
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2. ‘The patient is the doctor’s best tex
Dermatologic diagnosis depends on
the examiner’s skill in skin
inspection.
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3. • Exposure and lighting
• Patient must be properly gowned
• Extra lighting
• Always encourage the patient to undress completely; no peekaboo
• Develop a systematic approach and use it for every skin examination.
• Gently use your fingers to glide across the skin- your touch can
• One should do hand hygiene prior to and after touching the patient.
How to perform a skin examination
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5. HISTORY OF CUTANEOUS DISORDERS
• A PROBLEM-FOCUSED HISTORY is sufficient for
most common skin disorders.
• If, the patient has systemic complaints, or if
diseases such as lupus erythematous or vasculitis
are suspected, a DETAILED OR COMPREHENSIVE
HISTORY may be needed.
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7. FITZPATRICK'S
COLOR ATLAS AND SYNOPSIS OF
CLINICAL DERMATOLOGY
EIGHTH EDITION 2017
PHYSICAL EXAMIN
Appearance
• Uncomfortable,
• toxic
• well.
Vital Sign
• Pulse,
• Temperature
• Respiration
Skin: learning to red
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8. ‫پاره‬‫ل‬ ‫يص‬‫شخ‬‫ت‬ ‫د‬ ‫يو‬‫غ‬‫انرو‬ ‫د‬ ‫تکی‬‫س‬‫پو‬ ‫د‬Prerequisites
1. Types of skin lesions
2. Colour
3. Margination
4. Consistency
5. Shape
6. ARRANGEMENT
7. DISTRIBUTION
TYPES OF SKIN LESIONS‫پيژندل‬ ‫تورو‬ ‫الفبا‬ ‫د‬ ‫لکه‬ ‫دی‬ ‫داسی‬
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18. Shaping Letters Into Words: Further Characterization of Identified Lesions
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20. Forming Sentences and Understanding the Text
Confluence Yes or no
Number Single or multiple lesions.
Arrangement Multiple lesions may be
(1) Grouped:
• herpetifonn,
• arciform,
• annular,
• reticulated (net-shaped),
• linear,
• Serpiginous (snakelike)
or
(2) Disseminated: scattered discrete lesions.
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23. Our Skin Is Covered With Invisible Stripes
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26. PRELIMINARY HISTORY
This initial history is composed of two parts that correlate
with the
• Chief complaint and
• The history of the present illness
in the standard history format.
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27. CHIEF COMPLAINT
• In eliciting the chief complaint, one can
often learn much by asking an open-ended
question, such as, “What is your skin
problem?”
• This is followed by four general questions
regarding the history of the present illness.
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28. HISTORY OF THE PRESENT ILLNESS
• Onset and Evolution
o “When did it start?
o Has it gotten better or worse?”
For most skin conditions, this is important information.
• Symptoms
o “Does it bother you?”
o “Does it itch?”.
• Treatment to Date
“I’ve already tried that and it didn’t work!”
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29. REVIEW OF SYMPTOMS
This should be done as Indicated by the clinical
situation, with particular attention to possible
connections between signs and disease of other
organ systems (e.g., rheumatic complaints,
myalgias, arthralgias, Raynaud phenomenon).
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30. Review of Systems (ROS)
A s k a b o u t
• Fever, chills,
• Fatigue,
• Weight changes,
• Lymphadenopathy,
• Joint pains,
• Wheezing, rhinitis,
• Menstrual history,
• Birth control methods,
• Depression, and anxiety.
• Additional ROS questions can be asked based on the patient’s chief complaint.
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31. EXAMINATION TOOLS
1. Potassium hydroxide mount
2. Culture
3. Biopsy
• The gold standard for precise diagnosis of many skin conditions remains tissue
biopsy. The two most commonly employed techniques are shave biopsy and punch
biopsy.
4. Magnification with hand lens.
5. Wood lamp (ultraviolet long-wave light) is valuable in the diagnosis of
certain skin and hair diseases and of porphyria. With the Wood lamp
(365 nm),
6. Diascopy
7. Dermoscopy , Digital dermoscopy
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