BASICS IN DERMATOLOGY
Transcript of BASICS IN DERMATOLOGY
![Page 1: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/1.jpg)
BASICS IN DERMATOLOGY
ERNESTO GONZALEZ, M.D.
PROFESSOR OF DERMATOLOGY
HARVARD MEDICAL SCHOOL
![Page 2: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/2.jpg)
BASICS IN DERMATOLOGY
DISCLAIMERNO
CONFLICT OF INTERESTS
NO
FINANCIAL SUPPORT
![Page 3: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/3.jpg)
PHYSICAL DIAGNOSIS
◼ HISTORY
◼ PHYSICAL EXAMINATION
VISUAL
PALPATION
◼ INTUITION: PATTERN RECOGNITION
![Page 4: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/4.jpg)
PHYSICAL EXAMINATION
CARDINAL FEATURES
◼ TYPE OF LESION
◼ SHAPE OF INDIVIDUAL LESION
◼ ARRANGEMENT OF MULTIPLE LESIONS
◼ DISTRIBUTION
![Page 5: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/5.jpg)
PHYSICAL EXAMINATION
MACULE
◼ CIRCUMSCRIBED, FLAT LESION WITH
ABNORMAL COLOR
WHITE / BLACK / GRAY / BLUE / BROWN / RED
◼ NO TEXTURAL CHANGES
◼ NO ELEVATION OR DEPRESSION
◼ TOOL: SIDE LIGHTING
![Page 6: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/6.jpg)
![Page 7: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/7.jpg)
PHYSICAL EXAMINATION
PAPULE
SOLID, ELEVATED LESION LESS THAN ONE CENTIMETER IN SIZE
◼ VARIABLE SHAPES
DOME-SHAPED, FLAT TOPPED, UMBILICATED, ACUMINATE, FOLLICULAR
◼ USUALLY DENOTES INFILTRATION OR HYPERPLASIA
◼ TOOL: SIDE LIGHTING, PALPATION
![Page 8: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/8.jpg)
PHYSICAL EXAMINATION
NODULE
SOLID, PALPABLE, ROUND TO ELLIPSOIDAL LESION LARGER
THAN A PAPULE◼ CAN INVOLVE ALL LAYERS OF SKIN
◼ CAN REPRESENT COALESCING OF PAPULES
◼ USUALLY DENOTES INFILTRATION OR HYPERPLASIA
◼ TOOL: VISUAL, PALPATION
![Page 9: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/9.jpg)
![Page 10: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/10.jpg)
![Page 11: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/11.jpg)
PHYSICAL EXAMINATION
TUMOR
SOLID OR SOFT LARGER MASS
◼ CAN BE BENIGN OR MALIGNANT
◼ TOOL: VISUAL, PALPATION
![Page 12: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/12.jpg)
![Page 13: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/13.jpg)
PHYSICAL EXAMINATION
PLAQUE
LARGE, FLAT-TOPPED ELEVATION
◼ CAN INVOLVE ALL LAYERS OF SKIN
◼ VARIABLE SKIN SURFACE AND PALPABILITY
◼ CAN REPRESENT COALESCING PAPULES
◼ “PATCH” = PLAQUE WITH SCALE
◼ TOOL: SIDE LIGHTING, PALPATION
![Page 14: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/14.jpg)
![Page 15: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/15.jpg)
PHYSICAL EXAMINATION
WHEAL
ROUND OR FLAT-TOPPED COMPRESSIBLE, TRANSIENT
ELEVATION
◼ ONLY DERMIS INVOLVED
◼ IMPLIES EDEMA, NO INFILTRATE
◼ URTICARIA, HIVES
◼ TOOL: PALPATION
![Page 16: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/16.jpg)
![Page 17: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/17.jpg)
PHYSICAL EXAMINATION
VESICLE
CIRCUMSCRIBED ELEVATION OF SMALL DIAMETER WITH NON-
PURULENT FLUID◼ 0.5 CENTIMETER OR LESS
◼ CAN INVOLVE THE EPIDERMIS (FLACCID) OR DERMIS (TENSE) FLUID CAN VARY IN COLOR
AND CONSISTENCY
◼ TOOL: SIDE LIGHTING, PALPATION
![Page 18: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/18.jpg)
![Page 19: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/19.jpg)
PHYSICAL EXAMINATION
BULLA
CIRCUMSCRIBED ELEVATION OF LARGER DIAMETER WITH NON-
PURULENT FLUID◼ CAN INVOLVE EPIDERMIS (FLACCID) OR
DERMIS (TENSE)
◼ FLUID CAN VARY IN COLOR AND CONSISTENCY
◼ TOOL: PALPATION
![Page 20: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/20.jpg)
![Page 21: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/21.jpg)
![Page 22: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/22.jpg)
PHYSICAL EXAMINATION
PUSTULE
CIRCUMSCRIBED ELEVATION WITH
PURULENT FLUID OF ANY
DIAMETER
◼ VARIABLE SHAPES
◼ TOOL: SIDE LIGHTING
![Page 23: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/23.jpg)
![Page 24: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/24.jpg)
PHYSICAL EXAMINATION
CYST
ENCAPSULATED RESILIENT LESION
CONTAINING LIQUID OR
SEMISOLID MATERIAL
◼ USUALLY DOME SHAPED
◼ MAY HAVE AN EXTRUSION POINT
◼ VARIABLE SIZE
◼ TOOL: PALPATION BETWEEN FINGERS
![Page 25: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/25.jpg)
![Page 26: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/26.jpg)
PHYSICAL EXAMINATION
EROSION
CIRCUMSCRIBED, DEPRESSED, MOIST LESION
◼ AFFECTS EPIDERMAL LAYER ONLY
◼ ASSOCIATED WITH BLEEDING OR
CRUSTING
◼ NO SCARRING
◼ TOOL: VISUAL, PALPATION, REMOVAL OF CRUST
![Page 27: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/27.jpg)
PHYSICAL EXAMINATION
ULCER
CIRCUMSCRIBED, DEPRESSED
LESION WITH DESTRUCTION OF
EPIDERMIS AND OTHER LAYERS
◼ ASSOCIATED WITH BLEEDING, CRUSTING AND
ADHESIONS
◼ SCARRING A CONSEQUENCE
◼ TOOL: PALPATION, DEBRIDEMENT
![Page 28: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/28.jpg)
PHYSICAL EXAMINATION
SCAR
PARCHMENT-LIKE, NON-VIABLE
TISSUE REPLACING AN ULCER OR
SURGICAL TRAUMA
◼ DEPRESSED (ATROPHIC)
◼ ELEVATED (HYPERTROPHIC)
◼ TOOL: PALPATION
![Page 29: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/29.jpg)
PHYSICAL EXAMINATION
SCAR
PARCHMENT-LIKE, NON-VIABLE
TISSUE REPLACING AN ULCER OR
SURGICAL TRAUMA
◼ DEPRESSED (ATROPHIC)
◼ ELEVATED (HYPERTROPHIC)
◼ TOOL: PALPATION
![Page 30: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/30.jpg)
![Page 31: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/31.jpg)
![Page 32: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/32.jpg)
PHYSICAL EXAMINATION
ATROPHY
DEGENERATION OR THINNING
OF
ALL OR SOME LAYERS OF SKIN
![Page 33: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/33.jpg)
![Page 34: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/34.jpg)
![Page 35: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/35.jpg)
PHYSICAL EXAMINATIONMODIFIERS/SECONDARY
◼ SCALE
◼ CRUST
◼ EXUDATION
◼ MACERATION
◼ LICHENIFICATION
◼ EXCORIATION
◼ EROSION
◼ FISSURE
◼ VEGETATION
◼ COLOR
![Page 36: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/36.jpg)
![Page 37: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/37.jpg)
![Page 38: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/38.jpg)
![Page 39: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/39.jpg)
![Page 40: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/40.jpg)
![Page 41: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/41.jpg)
![Page 42: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/42.jpg)
![Page 43: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/43.jpg)
![Page 44: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/44.jpg)
PHYSICAL EXAMINATION
CONFIGURATIONS
◼ ANNULAR
◼ ARCIFORM
◼ POLYCYCLIC
◼ IRIS (TARGETOID)
◼ LINEAR
◼ SERPIGINOUS
◼ HERPETIFORM
◼ ZOSTERIFORM
◼ RETIFORM
◼ GROUPED
◼ CORYMBIFORM
![Page 45: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/45.jpg)
![Page 46: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/46.jpg)
![Page 47: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/47.jpg)
![Page 48: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/48.jpg)
![Page 49: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/49.jpg)
![Page 50: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/50.jpg)
![Page 51: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/51.jpg)
![Page 52: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/52.jpg)
![Page 53: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/53.jpg)
PHYSICAL EXAMINATION
PATTERN RECOGNITION
◼ TYPE OF PRIMARY LESION(S)
◼ MODIFIER(S)
◼ CONFIGURATION(S)
◼ DISTRIBUTION
![Page 54: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/54.jpg)
PHYSICAL EXAMINATION
PATTERN RECOGNITION (SAMPLE)
PSORIASIS VULGARISTYPE OF LESION: PLAQUE
MODIFIER: SCALES
CONFIGURATION:
GROUPED/GEOGRAPHIC
DISTRIBUTION: ELBOWS, KNEES, SCALP
![Page 55: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/55.jpg)
![Page 56: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/56.jpg)
![Page 57: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/57.jpg)
PHYSICAL EXAMINATION
PATTERN RECOGNITION
URTICARIATYPE OF LESION:
MODIFIER:
CONFIGURATION:
DISTRIBUTION:
![Page 58: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/58.jpg)
![Page 59: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/59.jpg)
PHYSICAL EXAMINATION
PATTERN RECOGNITION
LICHEN STRIATUSTYPE OF LESION:
MODIFIER:
CONFIGURATION:
DISTRIBUTION:
![Page 60: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/60.jpg)
![Page 61: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/61.jpg)
PHYSICAL EXAMINATION
PATTERN RECOGNITION
HERPES ZOSTERTYPE OF LESION:
MODIFIER:
CONFIGURATION:
DISTRIBUTION:
![Page 62: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/62.jpg)
![Page 63: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/63.jpg)
PHYSICAL EXAMINATION
PATTERN RECOGNITION
GRANULOMA ANNULARETYPE OF LESION:
MODIFIER:
CONFIGURATION:
DISTRIBUTION:
![Page 64: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/64.jpg)
![Page 65: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/65.jpg)
![Page 66: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/66.jpg)
PHYSICAL EXAMINATION
PATTERN RECOGNITION
TINEA VERSICOLORTYPE OF LESION:
MODIFIER:
CONFIGURATION:
DISTRIBUTION:
![Page 67: BASICS IN DERMATOLOGY](https://reader031.fdocuments.net/reader031/viewer/2022020621/61ea0d893e69ba10b45aed78/html5/thumbnails/67.jpg)