2. Diagnosis of Skin Diseases

8/18/2019 2. Diagnosis of Skin Diseases

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Diagnosis ofSkin Diseases


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History and PhysicalExamination

• 90% of skin diseases can be properly diagnosed withmeticulous history and proper physical examination.

• In the history the chief complaint, onset, progression,

associated symptoms, drug history, past medicalhistory, personal history, family history, race, systemreview are all important.

• The prinicipal steps in physical examination arepalpation and inspection.


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Skin Lesions

• lassi!ed as "#I$#&' ()*+#& (-I+)(I*+(.


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Primary Skin Lesions

$acule

"atch

"apule

+odule

Tumor"la/ue

esicle

"ustule

1ullae

2heal Telangiectasia

bscess

"etechiae, purpura ' ecchymosis


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Macule

• 3at, coloredlesion, 45cm indiameter, not

raised above thesurface ofsurrounding skin

• 6reckle 7 prototype

of pigmentedmacule


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Macule


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patch

• large8:cmdiametr;3at lesionwith a color

di


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Papule

• small, solidlesion, 40.> cmin diameter, raised

above the surfaceof surrounding skin' hence palpable

• )g? white head in

acne


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Papule


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Nodule

• large 8 5 cm ;,!rm lesion raisedabove the surface

of surrounding skin.• i


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Tumor

• solid,raisedgrowth :cm indiameter


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Plaque

• large 5cm, 3attoppedAplateau likeraised lesion, edges

may either bedistinct 8 inpsoriasis ; orgradually blend

with surroundingskin 8 inec=ematousdermatitis;

• iameter greater


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esicle

• are small papule,3uid !lled lesion,45cm in diameter,

raised above theplane ofsurrounding skin.6luid is often visible

and the lesion aretranslucent

• esicles in llergicontact ermatitis


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Pustule

• vesicle !lled withleukocytes ' pus45cm

• The presence ofpustule does notnecessarily signifythe the existance of

infection


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!"scess

• localisedcollection of pus ina cavity, more than

5 cm in diameter


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"ulla

• 3uid !lled ,raised, often atranslucent lesion

5cm in diameterand it is the largerform of vesicles.


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#heal

• raised,erythematous,edematous,

papule A pla/ue,usuallyrepresenting shortBlived vasodilatation

andvasopermeability

• )g? utricaria


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telangiectasia

• dilated super!cialblood vessel like

C".


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Petechiae$ purpura %ecchymosis

• "etechiae 7 pinheadBsi=ed macules of extravascular blood in the dermis.

• "etechiae are 3at.

• The larger ones are referred to as purpura

• If bleeding involves deeper structures then it iscalled ecchymosis


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&urro'

• linear or cuvillinear papule, caused byburrowing scabies mite


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(omedones

• plug of keratin and sebum wedged in dilatedpilosebaceous ori!ce.


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Secondary Skin Lesions

(cale

rust

)xcoriation

)rosion6issure

(inus

(car

trophy(triae

icheni!cation


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Scale

• 3ake arising fromstratum corneumdAt excessive

accumulation.• )g? psoriasis


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(rust

• ried exudate ofbody 3uids 8blood Aserous 3uid;

•2hich might beeither yellow8 serous crust ;

red 8hemorrhagiccrust ;


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)lcer

• n area of skinfrom which thewhole of epidermis

' atleast the upperpart of dermis hasbeen lost


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Excoriation

• inear, angularerosions that maybe covered by crust

and are caused byscratching.


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Erosion

• rea of skindenuded8removed;by complete or

partial loss ofepidermis.

• +o associated lossof dermis


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*issure

• slitB shaped deepulcer

• )g? irritant

dermatitis of hands


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Sinus

• cavity or channelthat permits theescape of pus or

3uid


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Scar

• change in theskin secondary totrauma or

in3ammation• (ites may be

erythematous,hypopigmented or

hyperpigmenteddepending upontheir ageAcharacter.


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Scar


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!trophy

n ac/uired loss ofsubstance .

In skin, this mayappear as a depression

with intact epidermis8 loss of dermal Asubdermal tissues ;

*r appear as sites of

shiny, delicate,wrinkled lesions8 epidermal atrophy ;


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Striae

• streak like,linear , atrophic,pink, purple or

white lesion dAtchanges inconnective tissue

• )g? cushings

syndrome,pregnancy induced


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Licheni+cation

• distinctivethickening of skinthat is

characteri=ed byaccenuated skinBfold markings.


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Primary Skin Lesions

Macule: 3at area of altered colour or texture 8less than 0.> cm;

Patch: large macule 8more than : cm in diameter; Papule: elevated solid lesion 8less than 0.> cm;

Nodule: elevated solid lesion 8more than 0.> cm, diameter@thickness;

Plaque: elevated area of skin of more than : cm indiameter8diameter the thickness;.

Vesicle: 3uid !lled papule 8less than 0.> cm;

Bulla: larger blister 8more than 0.> cm; TD$*#B larger bullae or nodule8more than :cm;

Pustule: collection of free pus

Abscess: locali=ed collection of pus in a cavity 8more than 5 cm;

Petechia, Ecchymosis, Purpura

Telangiectasia


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Secondary Skin Lesions

Scale: 3ake from the horny layer rust: dried serum, exudates or tissue 3uid

!lcer: whole of the epidermis and part of dermis lost

E"coriation: linear erosion or ulcer produced by

scratching Erosion: partial loss of the epidermis

#issure: slit in the skin

Sinus: channel that permits escape of pus or 3uid

Scar: result of healing, normal structure replaced by!brous tissue

Atrophy: thinning of skin.


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!rrangement of Skin Lesions

• iscreteAseparate

• EroupedAcoalese

• inear

•

rcuate• ircinate

• Eyrate


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Distri"ution of Skin Lesions

• (ymmetry, asymmetry

• 6lexural, extensor

• )xposed, overed

•

"hoto• (ebaceous

• ermatomalA(egmental

• cral, entral

•

"alms and soles


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Special Techniques

5. ). "ercutaneous Testing

. $ite )xamination

J. -*K )xamination

L. T=ank (mear


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Principles of Treatment

• rugs for skin diseases could be given topicaly,oraly, parentraly or intralesionaly.

• Topical therapy is the milestone

• onsidering the active ingradient coupled with thevehicle is important.

• Topical preparations are classi!ed based on thevehicle.


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•reams

•*intments•otions

•(hampoos•"astes

•Eels


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Topical Steroids

• The most commonly used topical preparations

• Improper use has led to signi!cant side e


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Principles of using topicalsteroids

• onHt use for uncertain diagnosis and cosmeticreason

• 6irst treat concomittent infection

• Dse the mildest steroid possible

• onHt apply potent steroids to the baby skin, faceand intertreginous areas

• onHt apply potent steroids more than two weeks.


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Side E,ects of Steroids

• ocal• 1alnching

• trophy

• cne form eruptions

• Infections• Elaucoma

• ataract

• (ystemic side e

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2. Diagnosis of Skin Diseases

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