Dermatology – The Basics

Debbie King MSN, CFNP, CPNP

Advanced Health Assessment
Fall 2008
Characteristics
 Size
 Shape
 Color
 Texture
 Elevation or depression
 Pedunculation
Characteristics
 Exudates
 Color
 Odor
 Amount
 Consistency
Characteristics
 Configuration
 Annular (rings)
 Grouped
 Linear
 Arciform (bow-Shaped)
 Diffuse
Characteristics
 Location and distribution
 Generalized or localized
 Region of the body
 Patterns
 Discrete or confluent
Macule and Patch
 Description
 Circumscribed
 Flat
 Discoloration
 Smaller than 0.5 cm-macule
 Larger that 0.5 cm- patch
 May be brown, blue, red or
hypogigmented
 Macule and Patch
 Examples of Brown
 Café au lait spot

 Freckle

 Phototoxid or photoallergic drug eruption

 Examples of Blue
 Ink (tattoo)

 Mongolian spot
Macule and Patch
 Red
 Rheumatic fever

 Drug eruptions

 Viral exanthems

Examples of
Hypopigmented
 Vitiligo
 Tuberous sclerosis
 Tinea versicolor
Papule
 Description
 Lesion up to 0.5 cm in diameter
 Color varies
 May become confluent
 May form plaques
 Colors are-flesh or yellow or white,
brown, red, blue or violaseous
Papules
 Examples of flesh, yellow, white
papules
 Flat warts
 Skin tages
 Closed comedo (acne)
 Molluscum contagiosum
Papules
 Brown
 Nevi
 Warts
 Melanoma
 Red
 Acne
 Urticaria
 Folliculitis
 Insect bites
Papules
 Blue or Violaceous examples
 Blue nevus
 Kaposi’s sarcoma
 Melanoma
 Venous lake
Plaque
 Description
 Circumscribed
 Palpable
 Solid lesion
 More that 0.5 cm in diameter
 Often formed by the confluence of
papules
Plaque
 Examples of Plaques
 Eczema
 Pityriasis roseas
 Tinea corporis
 Psoriasis
 Cutaneous T-cell lymphoma
Nodule
 Description
 Circumscribed
 Often round
 Solid lesion
 More that 0.5 cm in diameter
 Larger nodule is a tumor
Nodule
 Examples of a nodule
 Warts
 Lipoma
 Neurofibromatosis
 Erythema nodosum
 Furnuncle
 Hemangioma
 Squamous cell and metastitic CA, Melanoma
Pustule
 Description
 Circumscribed collection of leukocytes
 Free fluid
 Varies in size
 Examples of a pustule
 Impetigo
 Herpes simplex, zoster, varicella
 Acne
 Keratosis pilaris
Vesicle
 Description
 Circumscribed collection of free fluid
 Up to 0.5 cm in diameter
 Examples of vesicle
 All the herpes
 Eczema
 Impetigo
 Scabies
Bulla
 Description of bulla
 Circumscribed collection of free fluid
 More that 0.5 cm in diameter
 Examples of bulla
 Fixed drug eruption
 Lupus erythematous
Wheal (hive)
 Description
 Firm
 Edematous
 Papule or plaque
 Are transient
 Result from infiltration of fluid into the
dermis
Wheal
 Examples of wheals
 Hives
 Urticaria
 dermographism
Secondary skin lesions
 Scales
 Crust
 Erosion
 Ulcer
 Fissure
 Atrophy
 Scar
Scales
 Fine to stratified appearing
 Examples
 Psoriasis- silvery
 Scarlet fever tinea
 Scaling in sheets- examples
 Kawasaki
 Scarlet fever – hands and feet
 Staphylococcal scaled skin syndrome
 Toxic shock syndrome
Crust
 Is a collection of dried serum and
cellular debris- a scab
 Examples
 Acute eczematious inflammation
 Atopic on the face
 Impetigo- golden or honey colored
 Tinea capitis
Erosion
 Is a focal loss of epidermis, and
heal with scarring
 Examples
 Eczematous diseases
 Candidiasis
 Vesiculobullous disease
Ulcer
 A focal loss of epidermis and
dermis, and heal with scarring
 Examples
 Decubitus
 Ischemic
 Stasis ulcers
 Neoplasms
Fissure
 A linear loss of epidermis and
dermis with sharply defined nearly
vertical walls
 Examples
 Chapping – hands and feet
 Eczema on the finger tip
Atrophy
 A depression in the skin resulting
from thinning of the epidermis or
dermis
 Examples
 Aging
 Lupus
 Striae
Scar
 An abnormal formation of connective
tissue, implying dermal damage, after
injury
 Are initially thick and pink, but become
white and atropic
 Examples
 Post surg.
 Burns
 Keloid
 Post any herpes
Special skin lesions
 Excoriation
 Comedo
 Millia
 Cyst
 Burrow
 Lichenification
 Telangiectasia
 Petechiae
 Purpura
Excoriation
 An erosion caused by scratching
 Are often linear
 Examples
 Scabies
 Atopic dermatitis
 Dry skin
Comedo
 A plug of sebaceous and keratinous
matter lodged in the opening of a hair
follicle
 Dilated follicular orifice-blackhead
 Narrowed follicular orifice- whitehead or
closed comedo
 Examples
 Acne, epidermal cyst, lupus, solar
comedones
Millia
 A small superficial keratin cyst with
no opening seen
 Examples
 Chronic solar damage, inherited
blistering disorders
Cyst
 A circumscribed lesion with a wall
and a lumen, it may contain fluid
or solid matter.
 Examples
 Epidermal, pilar
Burrow
 A marrow, elevated, tortuous
channel produced by a parasite
 Examples
 Scabies, creeping eruption
Lichenification
 An area of thickened epidermais
induced by scratching
 Skin lines are accentuated so it
looks like a washboard
 Examples
 Atopic dermatitis, chronic eczematous
dermatitis
Telangiectasia
 Dilated superficial blood vessels
 Examples
 CREST syndrome (mild scleroderma),
lupus basal cell ca, rosacea,
scleroderma
 Vascular spiders

Pregnancy
 Cirrhosis
Petechiae
 A circumscribed deposit of blood
 Less than 0.5 cm in diameter
 Does not blanch!!
 Examples
 ITP, meningococcemia, vasculitis,
leukemia, other BAD stuff or could
just be a minor injury site
Purpura
 A circumscribed deposit of blood
 Greater that 0.5 cm in diameter
 Does not blanch!!
 Is usually raised
 Examples
 Rocky mt spotted fever, HSP, platelet
abnormalities, advanced BAD stuff
Skin examinations
 Often holds the diagnoses for skin
abnormalities as well as internal
abnormalities
 Remember the skin develops at the
same time as the neurological system
and may be your first clue to a big
problem.
 Do not be afraid to ask if you are not
sure what you are seeing is significant
or not.