PHYSICAL EXAMINATION

IN DERMATOLOGY

Dermato-Venereology
Department

 CLIENT ASSESSMENT
EXAMINATION OF THE SKIN, HAIR,

NAIL, AND MUCOUS MEMBRANE

GENERAL PHYSICAL EXAMINATION

RELATED TO SKIN DISEASES

DESCRIPTION OF THE PHYSICAL

EXAMINATION IN DERMATOLOGY

CLIENT ASSESMENT
1. Notice the initial clinical impression.
2. Give the patient an adequate

explanation about the physical

examination.
3. The patient is placed in an adequate
illumination, prefer under natural light
or bright overhead fluorescent lighting.
4. Ask the patient to take off his/her
clothes.

EXAMINATION OF THE SKIN

Distribution of lesion
Location of lesion
Characteristic of lesion
Type of lesion :
Primary lesion
Secondary lesion
Specific lesion

LOCALIZED
Restricted to a limited region or to one spot

Basal cell carcinoma

REGIONAL
Affecting a certain region or regions

Prurigo nodularis

GENERALIZED
Spread throughout the body
or affecting many parts
of the body
(normal skin visible > 20%)

Varicella

UNIVERSAL
Involvement of the
entire body
surface
Eritroderma lina

Erythroderma

Characteristic pattern of
distribution of lesion

SIMMETRY
On each side of plane of the body

Atopic dermatitis

ASIMMETRY

Not symmetry

Cellulitis

BILATERAL
Having two sides or pertaining to both sides

Psoriasis vulgaris

UNILATERAL
Affecting one side of the body

Epidermal nevus

DERMATOMAL
The area of skin
supplied with afferent
nerves fibres by
a single posterior
spindle root

Herpes zoster

DERMATOMAL

DERMATOMAL

FLEXURAL
Pertaining to
or affecting
a flexure

Atopic dermatitis

EXTENSOR

Pertaining to
or affecting
an extensor

Eczema

INTERTRIGINOUS
Occuring on apposed skin surface,
such as the
axillae, creases of the neck,
intergluteal fold,
groin, between the toes, and beneath
pendulous breast

INTERTRIGINOUS
Axillae

Between the toes

Candidiasis interdigitalis
Erythrasma

GLABROUS
Smooth and bare
area

Seborrheic dermatitis

Tinea corporis

PALMS

Palm :

The flexor
surface of
the hand

Pityriasis rubra pilaris

SOLES
Sole :

The bottom
of the foot

Irritant contact dermatitis

EXPOSED AREA
The area that exposure to sunlight, such as the
dorsa of the hands and arms, the neck, and
face.

Polymorphous light eruption

The number of lesions

Soliter
Multiple

SOLITER

Only one lesion

Epidermal cyst

MULTIPLE

More than one

lesions

Neurofibromatosis

Discrete or confluence ?

DISCRETE
Separated by normal skin in between lesions

Molluscum contagiosum

CONFLUENCE
Becoming merged; not discrete

Tinea corporis

Pustular psoriasis

- Annular
herpetiform
- Linear - zosteriform
- Round
- serpiginous
- Oval
corymbiform
- Iris
- polycyclic
- Irregular
- Umbilicated

ANNULAR
A ring-shaped
arrangement of a
number
of lesions form a
complete circle

Tinea corporis

Tinea corporis

LINEAR

A linear shape of
a single lesion

Koebner phenomenon in psoriasis

ROUND

coin-shaped

Tinea corporis

OVAL
Egg-shaped

Herald patch in Pityriasis rosea

IRIS
An erythematous annular macule or papule
with a
purplish or dusky, papular or vesicular center

Erythema multiforme

Irregular

Haemangioma

UMBILICATED

Marked with
depressed areas
resembling
the umbilicus
Molluscum contagiosum

HERPETIFORM
Cluster or groups of vesicles

Herpes simplex virus infection

ZOSTERIFORM
Vesicles or bullae that occur in
a bandlike pattern following a dermatome

Herpes zoster

SERPIGINOUS
A snake-like arrangement of lesions

Cutaneous larva migrans

Scrophuloderma

CORYMBIFORM
A group of arrangement that consist of a central
cluster of lesions beyond which are scattered
individual lesions

Intertriginous candidiasis

Intertriginous candidosis

POLYCYCLIC
Lesions composed of
several intersecting portion of circles

Tinea corporis

Measurement of size
with ruler

WELL-DEFINED
With marked border

Tinea fascialis

ILL-DEFINED
With unmarked border

Pityriasis alba

MACULE
A circumscribed, flat (without elevation
or
depression) lesion
differs from the
surrounding skin because of its color
1. Hyperpigmentation
2. Hypopigmentation
3. Depigmentation
4. Erythematous
5. Petechiae
6. Purpura
7. Ecchymoses

Hyperpigmented macule

Melasma

Solar lentigo

Hypopigmented macule

Pityriasis versicolor

Depigmentated macule

Vitiligo

Erythematous macule
Vascular abnormalities, capillary dilatation

Erythema multiforme

Purpura

Extravasated
red blood cells.

Vasculitis

Petechiae
Small, pinpoint purpuric spots
often seen in thrombocytopenic states

Ecchimoses

Larger, bruise-like
purpuric lesions.

PAPULE
A solid, elevated and circumscribed lesion, varying
in size (pinhead to 0.5 cm) projects above the
plane of the surrounding skin.

Lichen planus

PLAQUE
A broad papule or confluence of papules,

1 cm or more in diameter flat, but

may be centrally depressed.
The center of a plaque may be normal
skin.

Plaque type psoriasis

TUMOR
A soft or firm and

freely movable or fixed

masses of various
sizes and shapes.
The term is used to
imply enlargement of
the tissues by normal
or pathological
material or cells that
form a mass
inflammatory or noninflammatory, benign
or malignant process.

Keratoacanthoma

WHEAL
A rounded or flat-topped
papule or plaque evanescent, edematous,
disappearing within
hours, usually pink to
red, and surrounded by
pink areola

Urticaria and Angioedema of the eyes

VESICLE

A circumscribed,
fluid-containing,
epidermal
elevation, < 0.5
cm
in size

Varicella

BULLAE/BLISTER
A rounded or irregularly
shaped blisters
containing serous or
seropurulent fluid
differ from vesicles only
in size, being larger
than
0.5 cm.

Bullous pemphigoid

PUSTULE
A circumscribed,

raised lesion
contains a purulent
exudates.
Pus, composed of
leukocytes with or
without cellular
debris, may
contain bacteria or
sterile.
Folliculitis

CYST
A sac that contains
liquid
or semisolid
material
(fluid, cells, and cell
products)

Steatocystoma multiplex

ABSCESS
A localized collection of pus in a cavity formed by
disintegration or necrosis of tissue

Furuncle

SINUS
A tract leading from a
suppurative cavity
to the
skin surface, or
between
cystic or abscess
cavities

Scrofuloderma

SCALE
A dry or greasy
laminated masses of
keratin that caused by
abnormal shedding or
accumulation of
stratum
corneum in perceptible
flakes.

Psoriasiform scale

Psoriasis vulgaris

Pityriasiform scale

CRUST
Dried serum, pus, or blood,
usually mixed with
epithelial
and sometimes bacterial
debris.

Crust

Crust

EROSION
Loss

of all or
portions of the
epidermis alone.
It may or may not
become crusted
Heals without a
scar.
Pemphigus vulgaris

EXCORIATION
An abrasion
produced by
mechanical means,
usualy causing loss
of epidermis
portion but not
uncommonly
reaching the
papillary layer of
the dermis.

ULCER
Rounded or irregularly
shaped excavations
that
resulted from
complete
loss of the epidermis
plus some portion of
the dermis.
Plantar ulcer

FISSURE
A linear cleft or crack through the
epidermis,
or into the dermis

SCAR
Composed of new
connective tissue that
replaced lost substances
in the dermis or deeper
parts as a results of
injury or disease, as part
of the normal preparative
process.

Keloid

Atrophy

LICHENIFICATION
An area of skin to
appear as
thickened plaques
with accentuated
skin
markings. The lesions
may resemble tree
bark.
Lichen simplex chronicus

SCLEROSIS
A circumscribed or

diffuse hardening
or induration in
the skin
It is detected more
easily by palpation
than by
inspection.

Systemic sclerosis

COMEDO
A plug of keratin and sebum in a dilated
pilosebaceous orifice

Acne Vulgaris

White head

Black head

TELEANGIECTASES
Permanent

dilatations of
capillaries that may
or may not dissapear
with application of
pressure.
They form
nonpulsatile, fine,
bright red lines or
netlike patterns on
the skin.

CANALICULI (BURROW)
A small tunnel in the
skin that houses a
metazoal parasite,
such
as the scabies
acarus.
Larva migrans

MILIA
A tiny white cyst containing
lamellated keratin.

Milia

ONICHODISTROPHY

Irritant contact dermatitis

SPLINTER HAEMORRHAGE

Psoriasis vulgaris

PITTING
NAIL

Psoriasis vulgaris

SUBUNGUAL DEBRIS

Tinea unguium

ONICHOLYSIS

Psoriasis vulgaris

ALOPECIA AREATA

ALOPECIA TOTALIS

TELOGEN EFFLUVIUM

ORAL CANDIDIASIS

STOMATITIS

GEOGRAPHIC TONGUE

Psoriasis

LYMPHADENOPATHY
A. Tuberculous chancre on the thigh
B. Regional lymphadenopathy
C. A positive tuberculin test

Tuberculosis
cutis

JOINT

Psoriatic arthritis
on metacarpophalangeal joint

DESCRIPTION OF
PHYSICAL EXAMINATION IN
DERMATOLOGY
Dermatological status :
Distribution :
Location : .
Characteristic : .
Type of lesion :

General status :
Hair, nail, mucous membrane and

other organ : .

Dermatological status :

Distribution : Regional
Location :
Both of elbows, extensor
surface of arms, lower
back, buttocks, and
posterior of thighs
Characteristic :
Multiple, mostly confluents,
irregular, 2 x 1 cm to
30 x 20 cm, well-defined,
elevated from surrounding
skin, dry.
Type of lesion :
Erythematous plaque with
thick white scales

Dermatological status :
Distribution : regional
Location : cheeks
Characteristic : Multiple, mostly confluents, round and oval, 0,5 x
0,5 cm to 3 x 2 cm, well-defined, elevated from
surrounding skin, dry.
Type of lesions :
Erythematous macules and papules, comedones, pustules, crusts
Diagnosis : Acne vulgaris