EXAMINATION OF SKIN

1. SKIN LESIONS
DR KOMAL JADHAV
PG SCHOLAR
DEPT OF AGADATANTRA

2. AGE
 INFANTS
Atopic dermatitis
 ADULTS
 OLD AGE
Senile pruritis

3. HISTORY
 Drug intake
 Administration of vaccine, sera, blood components…
 Contact agents like poison, toxic plant, cosmetics, insect
bite, poisonous animals
 Household contact is suggestive of infective disorder like
viral infection, scabies.

4. MENSTRUAL HISTORY
 In case of hirsutism – when there is androgen excess,
libido is increased and menstrual cycles become irregular
and scanty.

5. FAMILY HISTORY
 Eczema, atopic dermatitis, autoimmune disorder, vitiligo,
psoriasis

6. DISTRIBUTION OF SKIN LESIONS
 WRIST – Scabies
 EXTENSAR PART OF ELBOW, KNEE – Psoriasis
 FINGER WEBS – Scabies, atopic dermatitis

7.  SYMETRICAL – Systemic disease
 ASYMETRIC – Local infection

8. EXAMINATION OF SKIN
 It includes
 Inspection
 Palpation
 History
 Clinical TESTS
 Laboratory Tests

9. PRIMARY SKIN LESIONS
MACULES
 Flat, nonpalpable areas of colour
change of skin.
 May be erythematous, hypo or
hyperpigmented
 May be of any shape
 Border- regular or irregular
 Ex : moles, lentigines, freckles, café-
au- lait spots, vitiligo, Mongolian
blue spot and port wine stain

10. MOLE
 A pigmentary nevus

11. FRECKLES
 Small, < 0.5cm, discrete brown macules
that appear on the sun exposed areas of
skin.
 The condition is inherited as an
autosomal dominant trait in light
skinned red-haired people.
 Commonly seen on the face, back, upper
shoulders, sparing the mucous
membrens.

12. LENTIGINES
 Small, < 0.5cm, single or multiple brown to
black, variegated or uniformly colored
macules over the skin or mucosae.
 They are darker in colour than freckles and
are not affected by sunlight.
 They may be associated with LEOPARD
syndrome, FACES syndrome, sotos
syndrome, LAMB syndrome, NAME
syndrome and peutz–jeghers syndrome.

13. PAPULE
 Circumscribed raised skin lesions of
<1 cm in diameter.
 They may be dome- shaped, flat-
topped, conical, umblicated or
verrucous.
 Ex : mollusum contigiosum, warts,
miliary rubra

14. PAPILLOMA
 It is a pedunculated lesion projecting from skin.

15. NODULES
 Elevated skin lesions > 1cm in diameter.
 They may be located in epidermis, dermis
or subcutaneous tissues.
 Ex : epidermoid cysts, fibromas and
neurofibromas.

16. TUMOR
 Large nodule, generally > 2 cm in
diameter.
 They may be benign or malignant
and primary or metastatic.

17. PLAQUES
 Well circumscribed, broad based dicoid
lesions of altered skin texture often
formed by coalescence of the number
of papules.
 The diameter or size of the lesions is
greater than its height of elevation.
 It may be flat, elevated or depressed.
 Ex : psoriasis

18. TARGET LESION
 Annular patch or plaque with centra
vesicle or pigmentation and a halo of
erythema.

19. WHEALS
 They are transient, raised, edematous
skin lesion with irregular edges.
 The lesions are erythematous with a
central pallor.
 Intense itching is usually present.
 Show characteristics of urticaria and
insect bites.

20. VESICLES
 Elevated, fluid-containing lesions.
 Blisters of <1cm in diameter.
 Ex : chickenpox, herpes simplex or
zoster, contact dermatitis.

21. BULLAE
 Vesicles > 1cm diameter.
 They may be intraepidermal,
subepidermal.
 Ex : epidermolysis bullosa,
staphylococcal scaled skin syndrome.

22. CYSTS
 The circumscribed tumor containing
semisolid or fluid.
 E x : epidermal cysts that may occur
after puberty on the face and upper
back, dermoid, sebaceous cyst,
brachial cyst.

23. PUSTULES
 The elevated, well circumscribed lesions
containing prurulent material or pus .
 Unlike the transparent dew drop
appearance of vesicles, the postules may
be turbid or opaque and white or yellow in
color.
 Ex : folliculitis, pyoderma.

24. CALLUS
 Localized hyperplasia of horny
layer on the palm or sole due to
presser.

25. COMEDONS
 These are characteristic skin lesions of acne
due to dark horny keratin and sebaceous plug
which are distributed on the face and upper
back.
 Open comedons or black heads are 2-5mm
flesh colored papules with black centers
 The closed comedons or white heads are 1-
3mm flesh colored papules with a pinpoint
opening.

26. PETECHIE
 Pinhead sized macules of extravasated
blood.
 They cannot be blanched on pressure.

27. PURPURA/ ECCHYMOSIS
 The leakage of blood in the skin.
 Unlike erythematous macules, purpura cannot be
blanched by pressure with a finger or with a glass
side or a transperant plastic spatula.
 PETECHIAE - Small, pinpoint, <3mm.
 ECCHYMOSIS- larger areas of extravasation of
blood in the skin.
 Ecchymatic skin patches may be flat or raised above
the surface when there is associated with vasculitis,
Henoch – schonlein purpura and collagen vascular
or connective tissue disoreders.

28. HEMATOMA
 Swelling with or without fluctuation
due to gross bleeding under the skin.

29. TELANGIECTASIA
 Dilatation of superficial blood vessels
which can be blanched by pressure.

30. BURROWS
 They are linear, curved or seepentine
elevations or tunnels in the superficial skin
produced by the adult female mite as she
travels through the stratum corneum.
 There is the black dot at the leading edge of
the tunnel due to the lodgement of mite.
 Typically located in the interdigital areas of
palm and soles.

31. SECONDARY SKIN LESIONS
 Produced due to changes caused by scratching, touching,
secondary infection and because of local and systemic
effect of medications.

32. SCALES
 Desquamation or shedding of excess of
normal and abnormal horny layer of
skin.

33. CRUSTS
 Formed by drying of blood, serum and any
exudate overlying the diseased skin.
 They are often present in impetigo- in which
they appear horny colored and in weeping
eczematous lesion.

34. EXCORIATIONS
 Develop as a result of linear loss of skin
secondary to self – induced scratching
and rubbing.
 Ex : contact dermatitis, atopic dermatitis,
insect bites.

35. EROSIONS
 Partial loss of epidermis which heals without
scarring.

36. ULCERS
 Occur due to deeper loss of the skin
involving both epidermis and a variable
depth of dermis or subcutaneous tissue.
 They may result from infection, vascular
insufficiency or burns.

37. ESCHAR
 It is necrotic skin lesion covered with a
black crest.

38. FISSURES
 Linear clefts which are located deep in
the epidermal layer in thickened or
chronically inflamed skin.

39. LICHENIFICATION
 Thickening and hyperpigmentation of skin
which exaggeration of skin markings due
to chronic rubbing because of allergic or
infective skin lesions

40. ATROPHY
 Loss or thinning of the epidermis or dermis.
 Epidermal atrophy is characterized by
wrinkling of the skin with telengiectases.
 In dermal or subcutaneous atrophy, the skin
is depressed.

41. ECZEMATOUS SKIN LESIONS
 Inflammatory skin lesions which have
indistic margins with erythema and
vesiculation in the acute phase.
 Scaling, crusting and lichenification
may be seen as the disorder progresses.

42. STRIAE
 A trophic pink or white linear skin lesions over
the abdomen and buttocks due to alterations in
the connective tissue because of sudden
changes in the girth as a result of obesity,
pregnancy and ascites.

43. HYPERKERATOSIS
 Thickening of stratum corneum.
 The presence of thick rough scales over
skin lesions is a good clinical marker of
hyperkeratosis.

44. SCAR
 Healing occurs by replacement with fibrous
tissue.
 When formation of scar is excessive, it is called
keloid.

45. THANK YOU