PHYSICAL EXAMINATION OF THE SKIN

Anatomy and Physiology

Skin: heaviest single organ, 16% of body weight, 1.2-2.3

meters squared

Layers of the Skin

epidermis Crust scale
- outer horny layer
- inner cellular layer Miscellaneous:
dermis
subcutaneous tissue • lichenification – thickening and roughing of the
skin with increased
visibility of the normal skin furrows
• atrophy – thinning of the skin with loss of normal
skin furrow

Lichenification atrophy

• excoriation – scratch mark

• scar – replacement of destroyed tissue by fibrous
tissue
• keloid – hypertrophied scar

Pigments
• melanin (brown)
• carotene (golden yellow)
• oxyhemoglobin
• deoxyhemoglobin

Inspect and Palpate

• Color: brown, grayish/bronze, blue, reddish blue, red,
jaundice
• Moisture Excoriation scar keloid
• Temperature Primary circumscribed, flat, non- palpable lesions
• Mobility/ Turgor 1. Macule – small up to 1 cm
• Texture 2. Patch - > 1 cm
• Lesions

Lesions
• Anatomic location: generalized, localized
• Patterns and shapes: linear, clustered, annular,
dermatomal
• Appearance/type of skin lesion: macules, papules,
vesicles, pustules Macule
• Color patch
• Measurement or dimension Palpable, elevated masses
• Tenderness 1. Papule – up to 0.5 cm
2. Plaque - > 0.5 cm
Secondary lesions: 3. Nodule – 0.5 to 1-2 cm; deeper & firmer
• Loss of skin surface 4. Tumor - > 1 to 2 cm
• Erosion – loss of superficial epidermis 5. Wheal – irregular, relatively transient, superficial
area of a localized skin edema
• Ulcer - deeper loss of the skin surface
• Fissure - linear crack of the skin

• Material on skin surface

• Crust = dried residue of serum, pus or
blood
• Scale = thin flakes of exfoliated epidermis
 2. Harlequin dyschromia
• one side of the body is red & the other pale – a
border separates the 2 sides
• transient: Unknown etiology

Papule plaque
nodule 3. Acrocyanosis
• blueness of the hands and feet
• if it won’t disappear within 8 hours, rule out CHD
4. Mongolian spots
• blackish-blue areas located over the buttocks and
skin of the scrotum
• due to pigmented cells of the deeper layers of the
skin

Tumor wheal

Circumscribed, superficial, elevated, formed by free

fluid in a cavity:
1. Vesicles – up to 0.5 cm Acyanosis Mongolian
2. Bulla - > 0.5 cm spots
3. Pustule – filled with pus
5. Lanugo
• fine, downy hair mostly on the shoulders and
back
• shed within 2 weeks
6. Vernix caseosa
• cheesy white material composed of sebum and
desquamated epithelial cells
7. Milia
Vesicles bulla a. pinhead-sized, smooth, white, raised areas
pustule without surrounding erythema
b. common in the nose, chin and forehead
• Comedo – “blackhead”, plugged opening of a
sebaceous gland
• Telangiectasia – dilated small blood vessels
• Nevus – “mole”; flat to slightly elevated, round,
evenly pigmented lesion

Lanugo vernix caseosa

milia

8. Miliaria rubra
• scattered vesicles on an erythematous base
usually on the face and trunks
• secondary to the obstruction of ducts of sweat
Comedo telangiectasia nevus glands
Infancy: • disappear spontaneously in 1-2 weeks
1. Cutis marmorata 9. Erythema toxicum
• mottled appearance • usually appear on the 2nd-3rd day of life
• common on the trunk, arms and legs • erythematous macules with central urticarial
• secondary to vasomotor changes of the dermis wheals or vesicles
and SQ
• response to cooling or chronic exposure to radiant
• disappear spontaneously within a week
heat
• prominent among pre-terms, cretin and Trisomy
 Miliaria rubra erythema
toxicum

10. Capillary hemangioma, nevus flammeus, nevus

vasculasus, telangiectatic nevus
• found on the nape “stork’s beak” mark
• upper eyelid, forehead and upper lip “angel kisses”
• disappear about 1 year of age

11. Portwine stain

• larger, darker, more sharply demarcated
• may involve the mucosa of the mouth or vagina
• if there is involvement of the skin innervated by
the ophthalmic portion of the trigeminal nerve ---
vascular network of the meninges and ocular orbit
may also be affected -- meningeal calcifications,
seizures, hemiparesis,mental retardation &
glaucoma= Sturge- Weber Syndrome