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 - outer horny layer - inner cellular layer dermis subcutaneous tissue Crust scale

Miscellaneous: 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 Pigments melanin (brown) carotene (golden yellow) oxyhemoglobin deoxyhemoglobin Inspect and Palpate Color: brown, grayish/bronze, blue, reddish blue, red, jaundice Moisture Temperature Mobility/ Turgor Texture Lesions Lesions Anatomic location: generalized, localized

atrophy

excoriation scratch mark scar replacement of destroyed tissue by fibrous tissue keloid hypertrophied scar

Excoriation

scar

keloid

Primary circumscribed, flat, non- palpable lesions 1. Macule small up to 1 cm 2. Patch - > 1 cm

Patterns and shapes: linear, clustered, annular, dermatomal Appearance/type of skin lesion: macules, papules, vesicles, pustules Color Measurement or dimension Tenderness Macule

patch

Secondary lesions: Loss of skin surface Erosion loss of superficial epidermis Ulcer - deeper loss of the skin surface Fissure - linear crack of the skin

Palpable, elevated masses 1. Papule up to 0.5 cm 2. Plaque - > 0.5 cm 3. Nodule 0.5 to 1-2 cm; deeper & firmer 4. Tumor - > 1 to 2 cm 5. Wheal irregular, relatively transient, superficial area of a localized skin edema

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 border separates the 2 sides transient: Unknown etiology

nodule

Papule

plaque

Acrocyanosis blueness of the hands and feet if it wont 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 3.

Tumor

wheal

Circumscribed, superficial, elevated, formed by free fluid in a cavity: 1. Vesicles up to 0.5 cm 2. Bulla - > 0.5 cm 3. Pustule filled with pus

spots 5.

Acyanosis

Mongolian

Vesicles pustule

bulla

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 a. pinhead-sized, smooth, white, raised areas 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

milia 8.

Lanugo Miliaria rubra

vernix caseosa

scattered vesicles on an erythematous base usually on the face and trunks

Comedo

telangiectasia

nevus

Infancy: 1. Cutis marmorata mottled appearance common on the trunk, arms and legs secondary to vasomotor changes of the dermis and SQ response to cooling or chronic exposure to radiant heat prominent among pre-terms, cretin and Trisomy

secondary to the obstruction of ducts of sweat glands disappear spontaneously in 1-2 weeks 9. Erythema toxicum usually appear on the 2nd-3rd day of life erythematous macules with central urticarial wheals or vesicles disappear spontaneously within a week

Miliaria rubra toxicum

erythema

10. Capillary hemangioma, nevus flammeus, nevus vasculasus, telangiectatic nevus found on the nape storks 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