Physical Examination in Dermatology

7/24/2019 Physical Examination in Dermatology

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PHYSICAL EXAMINATIONIN DERMATOLOGY

Dermato-VenereologyDepartment


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CLIENT ASSESSMENT

EXAMINATION OF THE SKIN, HAIR,NAIL, AND MUCOUS MEMBRANE

GENERAL PHYSICAL EXAMINATIONRELATED TO SKIN DISEASES

DESCRIPTION OF THE PHYSICALEXAMINATION IN DERMATOLOGY


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CLIENT ASSESMENT

+, Not%!e te %n%t%al !l%n%!al %mpre))%on,

., G%(e te pat%ent an a$e/"atee0planat%on a1o"t te py)%!ale0am%nat%on,

2, Te pat%ent %) pla!e$ %n an a$e/"ate%ll"m%nat%on3 pre#er "n$er nat"ral l%gt

or 1r%gt o(erea$ 4"ore)!ent l%gt%ng,5, A)6 te pat%ent to ta6e o7 %)8er

!lote),


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EXAMINATION OF THE SKIN

D%)tr%1"t%on o# le)%on

Lo!at%on o# le)%on

Cara!ter%)t%! o# le)%on

Type o# le)%on 9 Pr%mary le)%on

Se!on$ary le)%on Spe!%:! le)%on


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LOCALIZED

Re)tr%!te$ to a l%m%te$ reg%on or to one )pot

Basal cell carcinoma


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REGIONAL

Prurigo nodulri!

Affecting a certain region or regions
http://162.129.70.33/images/Prurigo_nodularis_1_030523.jpg


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GENERALIZED

"ri#$ll

Spread throughout the body

or affecting many parts

of the body

(normal skin visible > 20%)


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UNIVERSAL

In(ol(ement o# te

ent%re 1o$y)"r#a!e

Eritroderma lina

Erythroderma


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Characteristic pattern ofdistribution of lesion


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SIE!R"

Atopic dermatitis

n each side of plane of the body
http://www.upmc.edu/dermatology/MedStudentInfo/introLecture/default.htm


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ASIE!R"

Not )ymmetry

Cellulitis


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#ILA!ERAL

Ha(%ng t;o )%$e) or perta%n%ng to 1ot )%$e)

Psoriasis vulgaris


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UNILA!ERAL

A7e!t%ng one )%$e o# te 1o$y

Epidermal nevus


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DERA!OAL

Te area o# )6%n

)"ppl%e$ ;%t a7erent

ner(e) :1re) 1y

a )%ngle po)ter%or)p%n$le root

Herpes zoster
http://162.129.70.33/images/shingles_1_010719.jpg


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DERA!OAL


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DERA!OAL


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$LE%URAL

Perta%n%ng to

or a7e!t%ng

a 4e0"re

Atopic dermatitis


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E%!ENSOR

Eczema

!ertaining to

or affectingan e"tensor


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IN!ER!RIGINOUS

O!!"r%ng on appo)e$ )6%n )"r#a!e3

)"! a) tea0%llae3 !rea)e) o# te ne!63%ntergl"teal #ol$3

gro%n3 1et;een te toe)3 an$ 1eneat

pen$"lo") 1rea)t


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IN!ER!RIGINOUS

ErythrasmaErythrasma

Candidiasis interdigitalisCandidiasis interdigitalis

A"illae #et$een the toes


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GLA#ROUS

Smoot an$ 1arearea

Seborrheic dermatitis Tinea corporis


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&ALS

Palm 9

Te 4e0or)"r#a!e o#

te an$

Pityriasis rubra pilaris


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SOLES

Sole 9

Te 1ottom

o# te #oot

Irritant contact dermatitis


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E%&OSED AREA

Te area tat e0po)"re to )"nl%gt3 )"! a) te$or)a o# te an$) an$ arm)3 te ne!63 an$

#a!e,

Polymorphous light eruption


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!he nu'ber of lesions

Sol%ter

M"lt%ple


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SOLI!ER

Only onele)%on

Epidermal cyst


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UL!I&LE

More tan onele)%on)

Neuroibromatosis


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D%)!rete or !on4"en!e e

%aricella


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&ULLAE'&LISTE#

A ro"n$e$ or %rreg"larly)ape$ 1l%)ter)

!onta%n%ng )ero") or

)erop"r"lent 4"%$

$%7er #rom (e)%!le) only

%n )%>e3 1e%ng largertan

F,B !m,

Bullous pemphigoid

!USTULE


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!USTULE

A !%r!"m)!r%1e$3ra%)e$ le)%on !onta%n) a p"r"lente0"$ate),

P")3 !ompo)e$ o#le"6o!yte) ;%t or;%to"t !ell"lar$e1r%)3 may

!onta%n 1a!ter%a or)ter%le,

*olliculitis


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C(ST

A )a!tat !onta%n)l%/"%$

or )em%)ol%$mater%al

@4"%$3 !ell)3 an$ !ell

pro$"!t)

Steatocystoma multiple$


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A&SCESS

A lo!al%>e$ !olle!t%on o# p") %n a !a(%ty #orme$ 1y$%)%ntegrat%on or ne!ro)%) o# t%))"e

*uruncle

SINUS


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SINUS

A tra!t lea$%ng #rom a

)"pp"rat%(e !a(%tyto te

)6%n )"r#a!e3 or1et;een

!y)t%! or a1)!e))!a(%t%e)

Scrouloderma


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SCALE


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SCALE

A $ry or grea)ylam%nate$ ma))e) o#

6erat%n tat !a")e$ 1y

a1normal )e$$%ng or

a!!"m"lat%on o#)trat"m

!orne"m %n per!ept%1le

4a6e),

Psoriasis vulgaris

!soriasiform scale

!ityriasiform scale


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!ityriasiform scale

C#UST


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C#UST

Dr%e$ )er"m3 p")3 or 1loo$3

")"ally m%0e$ ;%tep%tel%al

an$ )omet%me) 1a!ter%al

$e1r%),

*rust


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Crust


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E#OSION

Lo)) o# all orport%on) o# te

ep%$erm%) alone, It may or may not

1e!ome !r")te$

Heal) ;%to"t a

)!ar,

Pemphigus vulgaris


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EXCO#IATION

An a1ra)%onpro$"!e$ 1yme!an%!al mean)3")"aly !a")%ng lo))o# ep%$erm%)port%on 1"t not"n!ommonlyrea!%ng tepap%llary layer o#te $erm%),


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ULCE#

Ro"n$e$ or %rreg"larly

)ape$ e0!a(at%on)

tatre)"lte$ #rom

!omplete

lo)) o# te ep%$erm%)

pl") )ome port%on o#

te $erm%),

Plantar ulcer

FISSU#E


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FISSU#E

A l%near !le#t or !ra!6 tro"g teep%$erm%)3

or %nto te $erm%)


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SCA#

Compo)e$ o# ne;

!onne!t%(e t%))"e tat

repla!e$ lo)t )"1)tan!e)

%n te $erm%) or $eeperpart) a) a re)"lt) o#

%n&"ry or $%)ea)e3 a) part

o# te normal preparat%(e

pro!e)),

(eloid

At h


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Atrophy


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LICHENIFICATION

An area o# )6%n toappear a)t%!6ene$ pla/"e)

;%t a!!ent"ate$)6%n

mar6%ng), Te le)%on)

may re)em1le tree

1ar6,

&ichen simple$ chronicus


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SCLE#OSIS

A !%r!"m)!r%1e$ or$%7")e ar$en%ngor %n$"rat%on %nte )6%n

It %) $ete!te$ moreea)%ly 1y palpat%ontan 1y

%n)pe!t%on,

Systemic sclerosis


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COMEO


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COMEO

A pl"g o# 6erat%n an$ )e1"m %n a $%late$p%lo)e1a!eo") or%:!e

Acne %ulgaris


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+hite head


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#lack head

) C S S


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TELEAN)IECTASES

Permanent$%latat%on) o#!ap%llar%e) tat may

or may not $%))apear;%t appl%!at%on o#pre))"re,

Tey #ormnonp"l)at%le3 :ne31r%gt re$ l%ne) ornetl%6e pattern) onte )6%n,


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CANALICULI *&U##O$+

A )mall t"nnel %n te

)6%n tat o")e) a

meta>oal para)%te3)"!

a) te )!a1%e)a!ar"),

&arva migrans

MILIA% % % %


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A t%ny ;%te !y)t !onta%n%nglamellate$ 6erat%n,

!ilia


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ONIC)ODIS!RO&)"


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ONIC)ODIS!RO&)"

Irritant contact dermatitis

S&LIN!ER )AEORR)AGE


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S&LIN!ER )AEORR)AGE

Psoriasis vulgaris

&I!!ING


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&I!!ING

NAIL

Psoriasis vulgaris

SU#UNGUAL DE#RIS


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SU#UNGUAL DE#RIS

Tinea unguium

ONIC)OL"SIS


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O C O S S

Psoriasis vulgaris


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ALO&ECIA AREA!A


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ALO&ECIA AREA!A

ALO&ECIA !O!ALIS


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ALO&ECIA !O!ALIS

!ELOGEN E$$LUVIU


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!ELOGEN E$$LUVIU


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ORAL CANDIDIASIS


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ORAL CANDIDIASIS

S!OA!I!IS


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GEOGRA&)IC !ONGUE


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Psoriasis


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L"&)ADENO&A!)"


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A, -uberculous chancre on the thigh

#, .egional lymphadenopathy*, A positive tuberculin test

-uberculosis

cutisA

#*

-OIN!


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Psoriatic arthritis

on metacarpophalangeal +oint

DESCRI&!ION O$


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SC O O&)"SICAL E%AINA!ION IN

DERA!OLOG" Dermatolog%!al )tat") 9

D%)tr%1"t%on 9

Lo!at%on 9 ,, Cara!ter%)t%! 9 ,,

Type o# le)%on 9

General )tat") 9 Ha%r3 na%l3 m"!o") mem1rane an$

oter organ 9 ,,

/i t ib ti/istrib tion . i l.egional/ermatological status /ermatological status


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/istribution /istribution .egional.egional

1ocation 1ocation

#oth of elbo$s e"tensor#oth of elbo$s e"tensor surface of arms lo$ersurface of arms lo$er

back buttocks andback buttocks and

posterior of thighsposterior of thighs

*haracteristic *haracteristic

ultiple mostly confluentsultiple mostly confluents

irregular 2 " 3 cm toirregular 2 " 3 cm to

40 " 20 cm $ell5defined40 " 20 cm $ell5defined

elevated from surroundingelevated from surrounding

skin dryskin dry,,-ype of lesion -ype of lesion

Erythematous pla6ueErythematous pla6ue $ith$ith

thick $hite scalesthick $hite scales


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/ermatological status /istribution regional

1ocation cheeks *haracteristic ultiple mostly confluents round and oval 07 "

07 cm to 4 " 2 cm $ell5defined elevated fromsurrounding skin dry, -ype of lesions Erythematous macules and papules comedones pustules crusts

/iagnosis Acne vulgaris


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Physical Examination in Dermatology