The document discusses the components of a dermatological evaluation, which includes taking a thorough patient history and conducting a physical examination. A complete physical examination involves inspecting the entire skin and palpating any rashes or lesions. Key aspects of the physical exam are evaluating the morphology, configuration, distribution, color, and texture of skin lesions. Common primary skin lesions include macules, papules, nodules, plaques, vesicles, pustules, and urticaria. Secondary lesions and signs such as scales, crusts, erosions, and ulcers are also examined. Careful documentation of exam findings is important for accurately diagnosing skin conditions.

1. The
Integumentary
System
Diagnosis
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3. Components of Dermatological
Evaluation
• History (Subjective)
• Physical Examination (Objective)
• Diagnosis (Assessment)
• Plan
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• 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
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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.
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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
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8. ….
• Family History
– Psoriasis
– atopic dermatitis, allergic rhinitis, asthma
– skin cancer- particularly melanoma
• Social History:
– Occupation
– living state
• Review of Systems
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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
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10. Inspection and Palpation
• Morphology
• configuration
• Distribution
• Color
• Texture
• Particular clinical signs
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11. Classified as:
• Primary
-the original lesions
-identification is important for diagnose
• Secondary
-modified primary lesion
-involution, trauma, application of
medication
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Morphology

12. Distribution of the lesion:
– Symmetrical Vs asymmetrical
– exposed area Vs sun exposed area
– scalp region
– Hand
– extensor aspect Vs flexor aspect
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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
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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
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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.
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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).
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21. 3. Nodule: firm papule of >1cm or
lesions that extend into the dermis or
subcutaneous tissue.
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24. 4. Plaque: flat topped or rounded
palpable lesions > 1cm in diameter
and are elevated or depressed
compared to the skin surface
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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.
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30. 6. Pustule: vesicle that contains pus.
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32. 7. Urticaria: a.k.a wheal or hive is
characterized by elevated lesions
caused by localized edema.
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34. Secondary morphology
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35. 1. Scale: heaped-up accumulations of
horny epithelium.
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37. 2. Crust (scab): consists of dried serum,
blood, or pus
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38. 3. Erosion: open area of skin that
results from loss of part or all of the
epidermis
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39. 4. Ulcer: results from loss of the
epidermis and at least part of the
dermis.
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5. Excoriation
• Punctate or linear abrasion due to
scratching
• Usually involves only the epidermis
• Provides accesses to pyogenic organism

41. 6. Petechia: nonblanchable punctate
focus of hemorrhage.
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43. 7. Purpura: a larger area of
hemorrhage that may be palpable
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45. 8. Atrophy: thinning of the skin, which
may appear dry and wrinkled,
resembling cigarette paper
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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.
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50. 10. Telangiectasia: a focus of small,
permanently dilated blood vessels
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52. B. Configuration
1. Linear lesions take on the shape of a
straight line
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54. 2. Annular lesions are rings with central
clearing.
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56. 3. Nummular lesions are circular or coin-
shaped
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58. 4. Target (iris) lesions appear as rings with
central duskiness
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60. 5. Serpiginous lesions have linear, branched,
and curving element
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62. 6. Reticulated lesions have a lacy or
networked pattern
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64. 7. Herpetiform describes grouped papules or
vesicles
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66. 8. Zosteriform describes lesions clustered in
a dermatomal distribution
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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?
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69. D. Color
• Pigment (hypo, hyper, de-)
• Violet = Violaceous
• White = Alba
• Red = Erythema
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70. E. Texture
1. Verrucous lesions have an irregular,
pebbly, or rough surface
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72. 2. Lichenification is thickening of the skin
with accentuation of normal skin markings
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74. 3. Induration is deep thickening of the skin
that can result from edema, inflammation,
or infiltration by cancer.
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76. 4. Umbilicated lesions have a central
indentation
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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.
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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
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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
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81. Ixs……
• Mite examination-to identify burrow
• CBC, U/A, S/E, SEROLOGY
• Radiology examination
• Clinical Photography
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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
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83. Quiz
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84. Eg., multiple whitish scaly well demarcated plaques with
erythematous background over the dorsum of hand =
psoriasis
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