Dermatological Examination

EXAMINATION THE SKIN, HAIR, NAIL, AND MUCOUS MEMBRANE

- Examination of the skin
6.
Distribution of lesion
Examine the entire skin surface and assess the extent of involvement:
- Localized, regional, generalized or universal?
- Characteristic pattern?
(symmetry/asymmetry, bilateral/unilateral, dermatomal)
Configuration is the shape of single lesions and the arrangement of clusters of lesions.
Linear lesions take on the shape of a straight line and are suggestive of some forms of contact
dermatitis, linear epidermal nevi, and lichen striatus. Traumatically induced lesions, including
excoriations caused by the patient's fingernails, are typically linear.
Annular lesions are rings with central clearing. Examples include granuloma annulare, some
drug eruptions, some dermatophyte infections (eg, ringworm), and secondary syphilis.
Nummular lesions are circular or coin-shaped; an example is nummular eczema.
Target (bulls-eye or iris) lesions appear as rings with central duskiness and are classic for
erythema multiforme.
Serpiginous lesions have linear, branched, and curving elements. Examples include some
fungal and parasitic infections (eg, cutaneous larva migrans).
Reticulated lesions have a lacy or networked pattern. Examples include cutis marmorata and
livedo reticularis.
Herpetiform describes grouped papules or vesicles arranged like those of a herpes simplex
infection.
Zosteriform describes lesions clustered in a dermatomal distribution similar to those of herpes
zoster.

7.

Location of lesion
- Determine the location of the lesion from the scalp to the soles in succession (according to
anatomical region)
- Characteristic location: flexural, extensor, intertriginous, glabrous, palms and soles,
exposed area, etc.
Although few patterns are pathognomonic, some are consistent with certain diseases.
Psoriasis frequently affects the scalp, extensor surfaces of the elbows and knees, umbilicus,
and the gluteal cleft.
Lichen planus frequently arises on the wrists, forearms, genitals, and lower legs.
Vitiligo may be patchy and isolated or may group around the distal extremities and face,

particularly around the eyes and mouth.

Discoid lupus erythematosus has characteristic lesions on sun-exposed skin of the face,
especially the forehead, nose, and the conchal bowl of the ear.

8.

Characteristic of lesion
Determine the characteristic of lesion by inspection:
- The number of lesion: soliter or multiple
If multiple: Discrete or confluence
- Shape of individual lesion(s)
(annular, iris, arciform, linear, round, oval, umbilicated,
etc) and arrangement of multiple lesions (herpetiform, zosteriform, annular, arciform,
linear, etc.)
- The size of lesion
(by measuring the lesion :cm X.cm X.cm or
specific size: milier, gutata, nummular)
- The border of lesion (well-defined or ill-defined)
By palpation:
- Elevated, plane or depressed from surrounding skin.
- Dry or wet
- Consistency and feel of lesion (soft, doughy, firm, hard,
mobile or tender).
Type of skin lesions
Determine:
a. Primary skin lesions:
1
1. macule
2. papule
3. pustule
4. plaque
1.
nodule
2.
cyst
3.
wheal
4.
vesicle and bullae
b. Secondary skin lesions:
1. erosion
2. excoriation
3. fissure
4. scar atrophy / hypertrophic
5. ulcer
6. scar
7. scale
8. crust

c. Specific skin lesions:

1. comedone
2. teleangiectasis
3. canaliculi
4. milia
DESCRIPTION OF DERMATOLOGICAL STATUS

> Dermatological status:

- Distribution

- Location

- Characteristic of lesion

- Type of lesion

Results of hair, nail, mucous membrane examination:

Consider whether the distribution is symmetrical or asymmetrical. (Symmetrical

distribution suggests an endogenous condition such as psoriasis, whilst asymmetry is
more typical of an exogenous condition such as tinea.) Some rashes have a characteristic
distribution such as with shingles and herpes zoster in area of dermatomes.

Note whether flexor or extensor surfaces are involved.

Establish whether there are areas of friction or pressure.

Note whether sweaty regions are involved.

Note whether exposed regions are involved.

Consider whether sexual contact is a factor (consider genital lesions but also the
lower abdomen and upper thighs).

Note the size of the lesion. Measure for accuracy.

Establish whether it is single or multiple.

If a rash exists, consider its morphology. Are individual lesions:

Macular? Papular? Vesicular? Crusty? Urticarial?

Note colour, shape, regularity or irregularity. Note whether areas of inflammation around it

exist. Consider whether the edge is clearly demarcated or poorly defined

1. Macula is circumscribed in the skin colour without change in texture or

palpable thickening without elevation or depression of the surface.
Pathogenesis nya adalah hasil dari hypopigmentation,
hyperpigmentation, or permanent vascular abnormalities of the skin,
as capillary hemangioma and transient capillary dilation(erythemaic)
Hyperpigmentation may be caused by excess of melanin or
haemosiderin deposits which result in skin colour that is darker than
normal. Hypopigmentation is loss of normal melanin and results in skin
colour which is paler than normal but not completely white.
In carotenaemia, excessive circulating beta-carotene results in yellowto-orange skin colouration. It is most pronounced on palms and soles
and, unlike jaundice, it does not affect the cornea.
Erythema is red skin due to increased blood supply and it will blanch
on pressure.
rashes of rickettsial infections, rubella, measles (can also have papules
and plaques), and some allergic drug eruptions.
2. Papules are circumscribing palpable elevation under 0.5cm in diameter.
Pathoegenesisnya produced by epithelia hyperplasia, by combination
of a dermal cellular infiltrate with thickening by deposition of lipid,
ecm, etc
insect bites,seborrheic keratoses, actinic keratoses, some lesions of
acne, and skin cancers.
3. Vesicles are epidermal elevation of 1 to 4mm in size, and usually
contain a clear fluid. The colour may be pale, yellowish from
seropurulent or reddish from serum mixed with blood, and
ocassionally hae deep reddish areola, vesicle can be discrete,

4.
5.

6.

7.

iregurarly scattered, grouped in herpes zoster, or linear as in poison ivy

dermatitis
Pathogenesisnya bias muncul tiba2 atau berasal dari macule atau
papula, bisa breaking dalam sekejap atau menjadi blebs through
coalescence or enlargement, or developing into pustules.
Vesicles are characteristic of herpes infections, acute allergic contact
dermatitis, and some autoimmune blistering disorders (eg,dermatitis
herpetiformis).
Boil atau furuncle, deep necrotizing folliculitis, infection of hair follicle
with suppuration
Abcess: a localization of purulent material so deep in the dermis or
subcutan tissue that pus usually not visible in surface area. It
frecuently begin from folliculitis et causa strepto/staphylococcal
infection.
Ulcers result from loss of the epidermis and at least part of the
dermis. Causes include venous stasis dermatitis, physical trauma with
or without vascular compromise (eg, caused by decubitus ulcers or
peripheral arterial disease), infections, and vasculitis.
Erosions are open areas of skin that result from loss of part or all of
the epidermis. Erosions can be traumatic or can occur with various
inflammatory or infectious skin diseases. An excoriation is a linear
erosion caused by scratching, rubbing, or picking.