Professional Documents
Culture Documents
Patient
Dr. Ruth B. Medel, MD, FPDS
o Bluish
Turgor
Rapid assessment of tissue hydration
Lift a fold of skin and note ease with which it is moved
(mobility) & speed with which it returns to place (turgor)
Faster return means better hydration for the patient
Increase in turgor if it remains elevated
Hair
Facial, axillary & pubic hairs dependent on presence of sex
hormones, thus, affected by sex & age of patient
If with excessive hair, suggestive of endocrine disease
Alopecia areata - balding
Nails
May provide a clue to certain systemic disease
o Psoriasis vulgaris (oil spots, onycholysis, loosening of nail,
crumbling of nail, little pits on nails)
Renal disease Half & half nails (proximal white & distal
pink/brown)
Hemochromatosis
o Spoon nails (koilonychia)
Due to faulty iron metabolism
Pulmonary, cardiac, hepatic & GIT disease
o Clubbing (more common in cardiac diseases)
Four Cardinal Features
Type of Lesion
Primary or Secondary
E.g., macule, papule, nodule, vesicle
Shape and Arrangement of Lesions Provide Clues to the
Diagnosis
Linear
Phytodermatitis- plant dermatitis
Allergic reaction to plant particles usually seen in exposed
areas of gardeners/housewives
Iris/Target
bulls eye or iris lesions
Erythema on periphery and central portion (papule or vesicle)
of discoloration violet or purple color
Steven Johnsons Syndrome
Pathognomonic of erythema multiforme
Herpetiform
Herpes simplex virus
Annular / Ring like
Fungal infections
Tinea capitis/ tinea corporis
Arciform arc-like
Polycyclic different shapes (seen in granuloma annulare - HIV)
Grouped lesions xanthomas (cholesterol deposits that can be
yellowish or reddish)
Round
Oval
Vesicles in a band on dermatome/ zosteriform
Herpes zoster
Only one side of body
50-70%- found in trunk
Multiple coalescing vesicles; erythematous lesion
Umbilicated looks like an umbilicus (presence of indentation in
the middle part
Distribution
Extent of involvement circumscribed, regional, generalized,
universal (*generalized entire body)
What percent of the body surface is involved? (entire palm is
roughly 1%)
Pattern symmetry, exposed areas, sites of pressure,
intertriginous areas
o * pressure urticaria
o * intertriginous fungal/candidal infections axillary,
intramammary, inguinal areas
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Characteristic location
o Flexural e.g., childhood atopic dermatitis
o Extensors
o Intertriginous areas
o Glabrous areas without hair
o Palms and soles (e.g., scabies)
o Dermatomal
o Trunks
o Lower extremities
o Exposed areas
Basic/Primary Skin Lesions
- Most of the time, patient does not have basic lesion anymore
due to late consultation
Macule
Circumscribed, flat lesion
o Differs in color
Size < 1 cm
Any shape
Sometimes with fine scaling:
o Maculosquamous
Hyperpigmented Ephelides/freckles
Tinea vesicolor
freckles, flat moles, tattoos, port-wine stains, and the rashes
of rickettsial infections, rubella, measles, and some allergic
drug eruptions
Patch
Circumscribed, flat lesion
Size > 1cm
Any shape
Fine scaling
Is a large macule (coalescence of many macules)
E.g., vitiligo
Papule
Small (<1 cm), solid elevated lesion
Projects above plane of skin
Variety of shapes (dome [milia], flat-topped)
nevi, warts, lichen planus, insect bites, seborrheic and actinic
Plaque
Mesa-like elevation that occupies larger surface area than
height
>1cm
May be formed by confluence of papules
Lichenification: due to rubbing (kalyo?)
Psoriasis vulgaris and granuloma annulare
Nodule
Palpable, solid, round/oval lesion
Deeper than papule
o Depth (not diameter) distinguishes it from papule
o Hard, soft, movable, fixed, etc
Neurofibromatosis
nevi, warts, lichen planus, insect bites, seborrheic and actinic
Wheal
Hives/uticaria
o Evanescent flat/ rounded papule or plaque, pink
(evanescent meaning can travel from one location to
another within 24 hours)
o Epidermis- unaffected
o Borders unstable
o Allergic response
o dermographism when there is scratching an elevated
lesion will occur at the site due to histamines effect on the
skin
o Warm
o Skin asthma, ectopic dermatitis
Vesicle
0.5 - <1cm
Circumscribed lesion that contains fluid
Herpes simplex lesions, dermatitis, dyshydrophic eczema
Arise from cleavage at various skin levels
Bulla
> 0.5 1cm, contains fluid
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References:
Lecture and Notes from Dr. Medel
Ultimate Mafia Trans
Trans by: Relloras, Revelo, Reyes
General P.E.
Indicated by clinical presentation and differential diagnosis
Pay particular attention to vital signs, lymphadenopathy,
hepatomegaly, splenomegaly
Summary
Dermatological diagnosis is based primarily on visual
inspection
o Use magnifying glass, oblique lighting and woods lamp
Palpation, diascopy, scratching of lesions
o Provides further clues
Combine PE with clues from the history to come up with
diagnosis
Approach to Dermatologic Patient
There are hundreds of cutaneous disease
A disease entity may have different clinical appearances
Skin diseases are dynamic and may evolve in morphology
Obtain a brief history from the patient
NOTE:
o Duration when did it start?
o Rate of onset how did it start?
o how have lesions changed?
o Location where did it start?
o how did it spread?
Brief History
Previous episodes has something similar occurred before?
Family history
Allergies, medical history
Occupation,, hobbies, travel, exposure
Previous treatments
Review of systems
Determine the extent of the eruption by having the patient
disrobe completely under good lighting
Determine the primary lesion
Determine the nature of the secondary lesion
Determine the distribution of the lesion
Formulate a differential diagnosis
Special Procedure
Skin Biopsy
o Punch biopsy disposable
o 2-10mm diameter
o Punch thru layers, making sure to include all up to fat area
o Apply local anesthetic
Gram stain
o Crusts, scales, exudates
Potassium hydroxide examination
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