Physical Examination in Dermatology
Transcript of 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
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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
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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$le root
Herpes zoster
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DERA!OAL
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DERA!OAL
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$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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