EXAMINATION OF THE SKIN

Objectives
• To identify primary and secondary lesions
of the skin
• To define and describe skin lesions
accurately
• To corelate skin lesions with clinical
diagnosis
 EXAMINATION

ADEQUATE EXPOSURE
ADEQUATE LIGHT
(SKIN, HAIR, NAILS ,MUCOSAE)
INSTRUMENTS

HAND LENS
TORCH
GLASS SLIDE
WOODS LAMP
DERMATOSCOPE
EXAMINATION

INSPECTION
PALPATION
 EXAMINATION
• PRIMARY LESIONS
• SECONDARY LESIONS
• SPECIAL LESIONS
 PRIMARY LESIONS
• MACULE
• PAPULE
• PLAQUE
• NODULE
• WHEAL
• VESICLE
• BULLA
• PUSTULE
• CYST
 MACULE– circumscribed
alteration in skin colour
PAPULE – small solid elevation
of the skin
Papule- small solid elevation of
the skin less than 1 cm
 NODULE – palpable solid
rounded elevation more than 1cm
Plaque – solid plateau like
elevation
 WHEAL –map like elevations
with erythema & edema( dermal)
hallmark of urticaria
 VESICLE- circumscribed
elevated superficial lesion
containing clear fluid less than
0.5 cms
BULLA – vesicle larger than 0.5
cms .
 PUSTULE– a circumscribed
elevated lesion containing pus
CYST – A sac that contains
liquid or semisolid material
SECONDARY LESIONS

Atrophy
Erosion
Ulcer
Scale
Crust
Lichenification
ATROPHY- reduction in
components of tissue
Dermal
Epidermal
Phenomenon of peeling of epidermis -
Desquamation or exfoliation
EROSION – Loss of Epidermis
with intact dermis
ULCER- Defect with loss of
epidermis and dermis
 Scale – Visible flaking of the
Stratum corneum
Crust –Dried exudate on the skin
surface
 Special lesions
• Petechiae
• Purpura Bleeding under the skin
• Echymosis

• Burrow
Purpura
Echymosis
Burrow ( Scabies)
Target lesions
 ARRANGEMENT
DISTRIBUTION

ARRANGEMENT- Grouped , Reticulate

DISTRIBUTION - Generalised, Localised, Zosteriform

 Investigations

Smears for Grams, KOH

Skin scrapings (scabies)
Cytology (Tzanck)
Cultures
Woods light
Patch tests
Skin Biopsy
 Clinical tests
Diascopy- to differentiate between erythema and purpura

Skin scrape – Diagnosis in fungal infections

Testing for skin sensation -
temperature , touch and pain