DERMATOLOGIC PHYSICAL

EXAMINATION AND
DIAGNOSIS

Prepared by:
Jill Keddy-Grant, MD, FRCPC
Updated by Alexis Botkin, MD, FRCPC
 PHYSIC AL EXAMINATION

• Requires good visualization of skin – good lighting,

undressing the patient, proper positioning
• Consider whether a full skin examination is required – eg.
widespread rashes or examination for skin cancers
• If a localized examination is reasonable, check go together
areas
• Other techniques may be required – magnification,
dermoscopy, diascopy, Wood’s lamp
 GO TOGETHER AREAS

• Palms and soles

• Elbows and knees
• Intertriginous areas
• Mucous membranes
• Hair and nails
• Photo-distribution
 DERMATOLOGIC DIAGNOSIS

• Identify the primary lesion (morphology)

• Determine the disease group
• Assess differentiating factors:
• History
• Color
• Shape, and size
• Arrangement
• Location and extent
• Borders – sharp or ill defined
• Other distinguishing features
• Secondary lesions
 COLOR

• White - decrease or absence of melanocytes, decreased

production of melanin, decreased transfer of melanin, fibrous
tissue
• Brown - increased number of melanocytes or melanosomes,
increased production of melanin, thickening of the epidermis
• Red - dilated vessels (temporary or permanent), increased
number of vessels, blood outside the vessels, collections of
lymphocytes
• Yellow - sebum, fat, mast cells, histiocytes
 ARRANGEMENT

• Solitary – round, oval, annular, linear

• Grouped - herpetiform, geographic, guttate,
dermatomal, Blaschko’s lines, follicular
 LOC ATION AND EXTENT

• Localized
• Patchy
• Acral
• Intertriginous
• Truncal
• Generalized
• Symmetric/ Asymmetric
• Scalp, hair, nails or mucous membranes
 OTHER DISTINGUISHING
FEATURES

• Surface change – scaly, smooth, shiny,

verrucous, filiform, lichenoid
• Consistency – soft, fluctuant, firm, hard
• Elevated or depressed
 SECONDARY LESIONS

• Crusts
• Excoriations
• Lichenification
• Erosions
• Ulceration
• Atrophy
• Scars
 DISEASE GROUP
(MORPHOLOGY)

• Papulosquamous
• Dermatitic
• Maculopapular
• Vesiculobullous
• Pustular
• Nodules & Tumors
• Ulcers
• Others – Hair, Nails, Pigmentation
 PRACTICE CASES
PART 1
• For the following slides:
• Decide on the primary lesion
• Decide on the disease grouping
• Describe differentiating features
• Answers are in the notes at the bottom of the slide