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Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine

2019

DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Melissa P. Sandejas, MD Medicine 3B

Drkhkh

   
   

HISTORY AND PHYSICAL EXAMINATION

  • - The advantage in dermatology is that you can see and feel what you need to examine and a thorough physical examination is paramount in diagnosing a disease

  • - Physical examination before history taking

PRIMARY LESIONS
PRIMARY LESIONS
  • - Most skin diseases produce or present with lesions with more or less distinct characteristic.

  • - The original lesions are known as primary lesion.

  • - They are lesions not altered by trauma, manipulation or natural regression over time

  • - Macule/ Patch

  • - Papule

  • - Plaque

  • - Nodule

  • - Tumor

-

Wheal

  • - Vesicle

  • - Bullae

  • - Pustule

MACULE / PATCH

  • - Discoloration of skin, flat < 1cm size

  • - Brown(epidermis), blue (dermis), red (RBCs, blood vessels, inflammatory infiltrates

  • - Mainly a discoloration on the skin, of any shape, flat.

  • - Brown discoloration is usually pigmentation in the epidermis.

  • - Blue discoloration is usually pigmentation in the dermis,

  • - Red discoloration could be collection of erythrocytes within blood vessels, or inflammatory infiltrates (leukocytes) within the immediate surrounding of blood vessels.

  • - Clinical picture of patch stage of mycosis fungoides.

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
  • - Tan colored macules and patches called café-au-lait (coffee and milk) macules seen in neurofibromatosis.

  • - Vitiligo.

  • - Special macules:

o

(1) pinpoint to pinhead-sized bright

o

red macules called petechiae (2) slightly bigger called purpura

o

(3) very big and sometimes purplish in color called echymosis.

  • - Green or blue seen commonly in newborn, was used to be identified in Asians but actually doesn’t have racial predilection, called Mongolian spot

  • - Use the term morbilliform instead of maculopapular

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Café au lait

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Vitiligo

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Purpura/Petechiae

Ecchymoses

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Morbiliform

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Mongolian Spot

PAPULE

  • - Raised lesion, with no visible fluid less than 1cm.

  • - Acuminate, rounded, conical, flat-topped, umbilicated

  • - Clinical picture shows Lichen planus.

   

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Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine

2019

DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Melissa P. Sandejas, MD Medicine 3B

Drkhkh

   
   
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Lichen Planus

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Molluscum contagiosum Melanocytic nevus

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Basal Cell Carcinoma

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Neurofibromas

Xanthomas

Xanthomas

 

TUMOR

-

Soft or firm, freely movable or fixedmasses, various shapes

 

-

Generally > 2cm in diameter;their consistency depends on the constituents of the lesion

-

Tumor is usually used to denote neoplasia

 
Xanthomas TUMOR - Soft or firm, freely movable or fixedmasses, various shapes - Generally > 2cm
 

PLAQUE

  • - Raised lesion, more than 1cm, usually flat- topped but maybe centrally depressed

 
  • - Broad papule or confluence of papules

WHEAL

NODULE

NODULE

NODULE - Basic descriptions o erythematous and edematous papules and plaques, evanescent

-

Basic descriptions o erythematous and edematous papules and plaques, evanescent

-

Clinical picture o a wheal is a prototypic lesion of Urticaria

Xanthomas TUMOR - Soft or firm, freely movable or fixedmasses, various shapes - Generally > 2cm
Xanthomas TUMOR - Soft or firm, freely movable or fixedmasses, various shapes - Generally > 2cm
  • - Important feature is that these lesions are deep.

  • - The pathology is centered in dermis or subcutaneous fat and are larger than 1 cm

  • - Clinical pictures (L-R): basal cell carcinoma, neurofibromatosis

 
   

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Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine
 

2019

DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Melissa P. Sandejas, MD Medicine 3B

Drkhkh

   
   

VESICLE (Intraepidermal: Subcorneal)

  • - Fluid-filled, less than 1cm they maybe pale

o Bullouspemphigoid (starts with wheal-like lesions, then develop

or yellow from serous exudate or red if

blisters;

seen more commonly in the

mixed with blood

elderly)

  • - May be subclassified depending on where the split occurs.

  • - Left picture shows the split occuring right beneath the stratum corneum, naming this subcornealintraepidermal vesicle.

  • - Clinical picture

o Impetigo
o
Impetigo
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

VESICLE (Intraepidermal)

  • - The split can occur mid-epidermis or right over the basal layer.

  • - Clinical picture o shingles; grouped vesicles

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

VESICLE (Subepidermal)

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
  • - The split can also occur right beneath the epidermis.

  • - Clinical picture o Pemphigusvulgaris

BULLAE

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
  • - Fluid-filled, more than 1cm. They only differ from the vesicle on in size

  • - The fluid content of a vesicle or a bullae may be useful in cytologically confirming the diagnosis of a skin disease

  • - Clinical picture:

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

PUSTULE

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
  • - Pus-filled lesions usually of necrotic inflam cells

  • - Doesn’t necessarily mean there is an infectious process since there is such a thing as a sterile pustule.

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
  • - Left clinical picture:

o

lakes of pus, seen in psoriasis

(pustular type)

  • - Right clinical picture:

o Candidiasis

CYST

  • - Described as an encapsulated lesion, with liquid or semi-solid contents.

   

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Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine

2019

DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Melissa P. Sandejas, MD Medicine 3B

Drkhkh

   
   
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Milia

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Hidracystoma

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Epidermal cyst Milium
Epidermal cyst
Milium

Steatocystoma multiplex

SECONDARY LESIONS

  • - Result of regression, trauma or other extraneous factors towards your primary lesions. For example the primary lesion in sunburn is macular erythema but with resolution secondary lesion will occur such as scales and increased pigmentation

  • - Scale

  • - Crust

  • - Fissure

  • - Erosion

  • - Ulcer

  • - Scar

SCALE

  • - Dry or greasy laminated masses of keratin

  • - Our body normally sheds imperceptible fragments of stratum corneum everyday. When formation of epidermal cells is rapid, or when there is disturbance in normal keratinization, then we see pathologic exfoliation, characterized by your scales.

  • - Clinical picture

o

close up of seborrheic dermatitis

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
  • - They vary in size, some are fine, delicate and branny like in pityriasis or tineaversicolor

  • - Others are coarser as in ichthyosis

  • - Some are stratified (“air-trapping”, giving it a silvery color) as in psoriasis

  • - Large sheets of desquamated epidermis are seen in TEN, SSSS

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Tinea versicolor

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Ichthyosis

Psoriasis SSSS
Psoriasis
SSSS

CRUST

  • - Composed of keratin, dried serum, leukocytes, bacteria, debris.

  • - Dry golden yellow, soft, friable and superficial as in impetigo

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
   

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Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine

2019

DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Melissa P. Sandejas, MD Medicine 3B

Drkhkh

   
   

FISSURE

  • - Linear cleft through the epidermis or into the dermis

  • - They occur most when the skin is and inelastic from inflammatin and dryness.

  • - This usually produces pain when the lesion deepens or opens or form new ones

  • - Seen in chronic skin conditions such as: Chronic allergic contact dermatitis

  • - Psoriasis

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

EROSION

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
  • - Loss of part of the epidermis.

  • - Important for the basal layer to be intact since this is where new skin will arise. No scarring

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

ULCER

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
  • - Loss of all of the epidermis with or without part of the dermis.

  • - Loss of the basal layer of the epidermis means the connective tissue in the dermis will try to fill up the defect, giving you the scar.

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

SCAR

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
  • - Scars are composed of new connective tissues that replaced lost substance in the dermis or deeper parts as a result of injury or disease.

  • - Scars could be o Hypertrophic o Keloidal Atrophic

o

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Keloidal

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Atrophic

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Hypertrophic Scar

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Keloid

  • - Hypertrophic scar (the scar doesn’t go beyond the margins of the original wound; there may be slight stretching of the skin, expanding the wound)

  • - Keloid is overabundance of connective tissue, seen in the ear-piercing of the earlobe, which doesn’t produce a hole and instead you have the protruding mass.

EXCORIATIONS AND ABRASIONS

  • - Punctate or linear lesions involving epidermis sometimes reaching papillary dermis.

  • - Usually caused by scratching with fingernails in an effort to relieve itching like in atopic dermatitis.

  • - If the skin damage is the result of mechanical trauma or constant friction the term

abrasion may be used

   

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Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine

2019

DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Melissa P. Sandejas, MD Medicine 3B

Drkhkh

   
   
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

PHYSICAL EXAMINATION

  • - Well-lit room (sunlight)

  • - Wood’s light (365nm)

  • - Magnifying lens

  • - PALPATION, rubbing (Darier’s sign), scraping/ scratching (Auspitz sign), lateral pressure (Nikolsky sign),pressure on top of blister (Asboe-Hansen sign), pinching (Fitzpatrick’s sign)

  • - Distribution

  • - Grouping, Configuration

  • - Evolution, Involution

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
  • - Darier’s sign in Urticariapigmentosa

o

Rubbing

o causing urtication and erythematous halo when one rubs the lesion

  • - Fitzpatrick’s sign or dimple sign in Dermatofibroma o Pinching o produces depression

  • - Auspitz sign in Psoriasis o scraping/scratching

o presence of punctate bleeding when scales are removed

  • - Nikolsky sign in Pemphigus o lateral sliding pressure o dislodgement of the superficial epidermis by shearing force.

  • - Asboe-Hansen sign in Pemphigus

o

pressure over the blister

DIAGNOSTIC DETAILS

  • - Distribution

  • - Configuration

  • - Grouping (DH, HS, HZ, SY)

  • - EVOLUTION and involution

  • - Color

  • - Consistency

  • - Hyperesthesia/Anesthesia

CONFIGURATION AND GROUPING

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
   

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Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine

2019

DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Melissa P. Sandejas, MD Medicine 3B

Drkhkh

   
   
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Herpes zoster

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Pityriasisrosea (Christmas Tree Pattern)

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION

Epidermal Nevi

on Blaschko’s Lines

Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Far Eastern University NICANOR REYES MEDICAL FOUNDATION Doctor of Medicine 2019 DERMATOLOGY: HISTORY & PHYSICAL EXAMINATION
Polycyclic Varicella
Polycyclic
Varicella

When lesions disapper can have Ulcers, eschars and scars of pityriasislichenoidesacuta

   

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