PHYSICAL EXAMINATION IN DERMATOLOGY : 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. .

EXAMINATION OF THE SKIN : Distribution of lesion, Location of lesion ,Characteristic of lesion,

Type of lesion : Primary lesion, Secondary lesion, Specific lesion..

DISTRIBUTION OF LESION : 1. LOCALIZED (Restricted to a limited region or to one spot) example

basal cell carcinoma. 2. Regional (Affecting a certain region or regions) example Prurigo nodularis.
3. GENERALIZED (Spread throughout the body or affecting many parts of the body) example
varicella. 4. Universal (Involvement of the entire skin) example Erythroderma. .

Characteristic pattern of distribution of lesion : 1. SIMMETRY (On each side of plane of the body)
example Atopic dermatitis. 2. ASIMMETRY (Not symmetry) example Cellulitis. 3. Bilateral (Having
two sides or pertaining to both sides) example Psoriasis vulgaris. 4. Unilateral (Affecting one side
of the body) example Epidermal nevus. 5. Dermatomal (The area of skin supplied with afferent
nerves fibres by a single posterior spindle root) example Herpes zoster..

LOCATION OF LESION : 1. Flexural (Pertaining to or affecting a flexure) example Atopic dermatitis.

2. Extensor (Pertaining to or affecting an extensor) example eczema. 3. INTERTRIGINOUS (Occuring
on apposed skin surface, such as the axillae, creases of the neck, intergluteal fold, groin, between
the toes, and beneath pendulous breast) ( axillae example erythrasma , between the toes example
Candidiasis interdigitalis). 4. GLABROUS (Smooth and bare area) example Seborrheic dermatitis,
Tinea corporis. 5. Palms (The flexor surface of the hand) example Pityriasis rubra pilaris. 6. Soles
(The bottom of the foot) example Irritant contact dermatitis. 7. EXPOSED AREA (The area that
exposure to sunlight, such as the dorsa of the hands and arms, the neck, and face) example
Polymorphous light eruption..

CHARACTERISTIC OF LESION : The number of lesions 1. Soliter (Only one lesion) example Epidermal
cyst 2. Multiple (More than one lesion) example Neurofibromatosis.. Discrete or confluence ?
discrete (Made up of separated parts or characterized by lesions which do not become blended)
example Molluscum contagiosum. Confluence (Becoming merged; not discrete) example Tinea
corporis, Pustular psoriasis..

Shape and arrangement of lesions : 1. Irregular (Haemangioma) 2. ANNULAR (A ring-shaped

arrangement of a number of lesions form a complete circle) Tinea corporis, Tinea corporis.. 3.
Linear (A linear shape of a single lesion) Koebner phenomenon in psoriasis. 4. Round (Ball-shaped)
Tinea corporis. 5. Oval (Egg-shaped) “Herald patch” in Pityriasis rosea.. 6. Iris (An erythematous
annular macule or papule with a purplish or dusky, papular or vesicular) Erythema multiforme.
7.umblicated (Marked with depressed areas resembling the umbilicus) Molluscum contagiosum. 8.
HERPETIFORM (Cluster or groups of vesicles) Herpes simplex virus infection. 9. ZOSTERIFORM
(Vesicles or bullae that occur in a bandlike pattern following a dermatome) herpes zoster. 10.
SERPIGINOUS (A snake-like arrangement of lesions) Cutaneous larva migrans. 11. CORYMBIFORM
(A group of arrangement that consist of a central cluster of lesions beyond which are scattered
individual lesions) Intertriginous candidiasis. 12. POLYCYCLIC (Lesions composed of several
intersecting portion of circles) Tinea corporis..

The size of lesions : Milier (Minute lesions resembling millet seeds) Miliaria crystallina, Guttate ( A
small round lesions, like drops) Guttate psoriasis, Nummular (A large round lesions, like a coin)
Nummular eczema.
The border of lesions : WELL-DEFINED (With marked border) Tinea fascialis, ILL-DEFINED (With
unmarked border) Pityriasis alba..

TYPES OF SKIN LESIONS : a. PRIMARY SKIN LESIONS .. 1. Macule (A circumscribed, flat (without
elevation or depression) lesion differs from the surrounding skin because of its color

1. Hyperpigmentation (Melasma , Solar lentigo)

2. Hypopigmentation (Pityriasis versicolor)

3. Depigmentation (vitiligo)

4. Erythematous (Erythema multiforme)

5. Petechiae (Small, pinpoint purpuric spots often seen in thrombocytopenic states)

6. Purpura (Extravasated blood cells) vasculitis.

7. Ecchymoses (Larger, bruise-like purpuric lesions)

2. papule (A solid, elevated and circumscribed lesion, varying in size (pinhead to 1 cm)  projects
above the plane of the surrounding skin) Lichen planus.

3. 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).

4. 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 non-inflammatory, benign or malignant process. (Keratoacanthoma)

5. 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.

6. vesicle (A circumscribed, fluid-containing, epidermal elevation, 1-10 mm in size) varicella.

7. bullae (A rounded or irregularly shaped blisters containing serous or seropurulent fluid  differ
from vesicles only in size, being larger than 1 cm.

8. pustule (A circumscribed, raised lesion  contains a purulent exudates.Pus, composed of

leukocytes with or without cellular debris, may contain bacteria or sterile (Folliculitis).

9. cyst (A sac that contains liquid or semisolid material (fluid, cells, and cell products)
Steatocystoma multiplex.

10. abscess (A localized collection of pus in a cavity formed by disintegration or necrosis of tissue)
Furuncle

11. sinus (A tract leading from a suppurative cavity to the skin surface, or between cystic or
abscess cavities) Scrofuloderma.

SECONDARY SKIN LESIONS : 1.scale (A dry or greasy laminated masses of keratin that caused by
abnormal shedding or accumulation of stratum corneum in perceptible flakes. Psoriasis vulgaris

2.crust (Dried serum, pus, or blood, usually mixed with epithelial and sometimes bacterial debris.
3. erosion (Loss of all or portions of the epidermis alone.It may or may not become crusted, but it
heals without a scar) Pemphigus vulgaris.

4. excoriation (A punctate or linear abrasion produced by mechanical means, usually involving

only the epidermis but not uncommonly reaching the papillary layer of the dermis)

5. fissure (A linear cleft or crack through the epidermis, or into the dermis)

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

7. 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.

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

9. sclerosis (A circumscribed or diffuse hardening or induration in the skin It is detected more

easily by palpation than by inspection (Systemic sclerosis).

SPECIFIC SKIN LESIONS : 1. Comedo (A plug of keratin and sebum in a dilated pilosebaceous orifice)
acne vulgaris. 2. 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.. 3, CANALICULI (BURROW) (A small tunnel in the skin that houses a metazoal
parasite, such as the scabies acarus. Larva migrans . 4. Milia (A tiny white cyst containing
lamellated keratin) milia.

EXAMINATION OF THE NAILS : 1. ONICHODISTROPHY, 2. SPLINTER HAEMORRHAGE, 3. PITTING

NAIL 3.SUBUNGUAL DEBRIS. 4. ONICHOLYSIS

EXAMINATION OF THE HAIR : 1. ALOPECIA AREATA, 2. ALOPECIA TOTALIS, 3. TELOGEN

EFFLUVIUM

DESCRIPTION OF PHYSICAL EXAMINATION IN DERMATOLOGY : Dermatological status :

Distribution , Location + Characteristic pattern of distribution of lesion: Characteristic; Type of
lesion :General status , Hair, nail, mucous membrane and other organ :

Characteristic ( Number lesion, Discrete or confluence, Shape, Size, Border, Elevated / not, Dry /
wet).

Dermatological status : Distribution : Regional, Location : Both of elbows, extensor surface of

arms, lower back, buttock, and both of thighs. Bilateral.. Characteristic : Multiple, confluents,
irregular, 2 x 1 cm to 30 x 20 x 0,1 cm, well-defined,mostly elevated from surrounding skin, dry.

Type of lesion : Erythematous plaque with thick white scales.

General status : Nails : Oily spot Splinter haemorrhage Pitting nail, Diagnosis : Psoriasis vulgaris.

Dermatological status : Distribution : regional . Location : cheeks, bilateral. Characteristic :

Multiple, mostly confluents, round and oval, 0,5 x 0,5 cm to 3 x 2 x 0,1 cm, well-defined, mostly
elevated from surrounding skin, dry. Type of lesions : Erythematous macules and papules,
pustules, crusts and comedones Diagnosis : Acne vulgaris