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
Echymosis
Burrow

Bleeding under the skin

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