Diagnosis of skin

diseases
By
Zeinab abdel azim
MD dermatology

www.mansfans.com
 Www.MansFans.Com
Skin
Flexible membranous tissue that forms
the external covering of the body
Skin makes up about 18% of an adult's
weight and approximate total area of 1.5
– 2 m²
It operates as a complex organ of
numerous structures (sometimes called
the integumentary system) performing
vital protective and metabolic functions .
Www.MansFans.Com
www.mansfans.com
www.mansfans.com
 Functions of the skin
Protection:
– Mechanical protection of deeper structures.
– Protection against light
– Protection against invasion by microorganisms
Heat regulation through:
– Evaporation of sweat.
– The skin is rich in blood vessels, through their constriction or
dilatation heat loss is decreased or increased.
– Fat in subcutaneous tissue is poor conductor and prevents heat
loss.
Excretion of certain substances through sweat. e.g. Na
Cl, lactic acid, ammonia and some drugs.
Formation of vitamin D: from ergosterol by UVR.
perception of sensations as heat, cold, pain and touch.
Reflection of internal feeling e.g., fear, shame and
anger.
Immunological functions.
 Www.MansFans.Com
Diagnosis

Initial history

Examination

Follow up history

investigations
 Initial history
Personal
Complaint
Present history
– Duration
– Onset
Mode of onset: acute (within hours), rapid (within days)
or gradual (within weeks or months).
Site of onset.
– Course:stationary, progressive, regressive or
recurrent.
– Symptoms:itching, burning, pain, anaesthesia or
disfigurement.
 Www.MansFans.Com
Examination
Skin examination must be done in good
light.
It should involve oral mucous membrane,
hair, nails and lymph nodes.
The following points should be noticed
during examination:
– Distribution
– Configuration
– Morphology of individual lesion
 Distribution
Localized: Affecting one
anatomical area
Generalized: affecting
more than one anatomical
area.
Special sites: e.g. pressure
areas such as elbows &
knees, sun exposed areas
or intertriginous areas.
Distribution may be
symmetrical or
asymmetrical.
Distribution
Configuration
Linear
Configuration
Circinate
 Configuration
Polycyclic( Geographic)
Configuration
Grouped
Configuration
Discrete
 Morphology of individual lesion
Macule& patch
 Circumscribed
change in skin color
up to 0.5cm .
 Larger lesion is a
patch They may be:
Hyperpigmented
Hypopigmented
Red
– Erythema
– Purpura
Morphology of individual lesion
Macule
Macule
Morphology of individual lesion
Macule
 Morphology of individual lesion
Papule

Small, solid,
elevated lesion up
to 0.5cm.
Morphology of individual lesion
Papule
 Morphology of individual lesion
Nodule

Nodule: palpable, solid

lesion > 0.5cm . Nodules
may be located in the
epidermis (B) or extend
into the dermis or
subcutaneous tissue (A).

Www.MansFans.Com
 Morphology of individual lesion
cyst
A cyst is a sac that
contains liquid or
semisolid material

Www.MansFans.Com
Morphology of individual lesion
Nodule&Cyst
 Morphology of individual lesion
Plaque
Circumscribed area
of abnormal skin
formed by extension
or coalescence of
either papules or
nodules .

Www.MansFans.Com
Morphology of individual lesion
Plaque
 Morphology of individual lesion
Vesicle& Bulla
A vesicle is localized
visible collection of
fluid up to 0.5 cm in
diameter
A bulla is a vesicle
larger than 0.5 cm.
Morphology of individual lesion
Vesicle& Bulla
www.mansfans.com
 Morphology of individual lesion
Pustule
localized visible
collection of pus.
Morphology of individual lesion
Pustule
Morphology of individual lesion
Crust
Crusts result when
serum, blood, or
purulent exudate
dries on the skin
surface and are
characteristic of
injury and pyogenic
infections.
Morphology of individual lesion

Crust
 Morphology of individual lesion
Scale
Flat plate of horny layer formed
by accumulation of excess
keratin.
scale
 Morphology of individual lesion
Wheal
Evanescent elevated oedematous erythematous lesion.
Evanescent means that lesion does not persist > 48 hrs
Morphology of individual lesion
Comedo

 Plug of keratin and

sebum in a dilated
pilosebaceous orifice.
 When plug is superficial
open (black) comedo.
 When plug is deep 
closed (white) comedo.
 Comedo is the 1ry
lesion of acne vulgaris
 Morphology of individual lesion
Burrow
Superficial tunnel in skin caused by mite
that appears as black dot at end of burrow.
It is tortuous, straight or S shaped, skin
coloured or grayish and 0.5-1.5cm in
length. It is the 1ry lesion of scabies.
 Morphology of individual lesion
Non scarring alopecia
loss of hair from a normally hairy area.
Non scarring: with visible follicular
opening.
Morphology of individual lesion
Scarring alopecia
Scarring alopecia : devoid of follicular
opening.
 Morphology of individual lesion
Erosion:Localized loss of epidermis above basal
layer. It heals without scar.
 Morphology of individual lesion
Erosion
Localized loss of epidermis
above basal layer. It heals
without scar.
 Morphology of individual lesion
Ulcer
Localized loss of epidermis and dermis. Ulcer may
extend into SC fat. It heals with scar.
 Morphology of individual lesion
Ulcer
Localized loss of epidermis and dermis. Ulcer may
extend into SC fat. It heals with scar.

Www.MansFans.Com
 Morphology of individual lesion
Excoriation
Scratch that removes skin. It may be linear or
circumscribed; superficial or deep.
Morphology of individual lesion
Excoriation

www.mansfans.com
 Morphology of individual lesion
Fissure
linear gap or slit in skin (crack in epidermis and dermis).
Fissure
 Morphology of individual lesion
Lichenfication
Thickened skin e’exagerated skin
marking in response to
prolonged rubbing or itching
Morphology of individual lesion
Lichenfication
Morphology of individual lesion
Lichenification
 Morphology of individual lesion
Atrophy
It results from loss of
tissue.
Epidermal atrophy
manifests with loss of
skin marking.
Dermal atrophy
manifests with
depression in skin.
Morphology of individual lesion
Atrophy
 Morphology of individual lesion
Hypertrophic Scar
healing of injured skin by fibrous tissue
formation. Atrophic scar with thin skin.
Hypertrophic scar with elevated skin.
Morphology of individual lesion
Hypertrophic Scar
Morphology of individual lesion
Atrophic Scar
 Morphology of individual lesion
Sclerosis
• Circumscribed or diffuse hardening or
induration in the skin
•Detected more easily by palpation than
by inspection.
 Follow up history
Family H
Medical H
General symptoms
Social H
Relation of skin condition to
– Food
– Drug
– Season
– Physical factor
H of drug intake
 Follow up history
Social H:
– Emotional stress
– Skin exposure H. in
hand eczema
– Birthplace
– Hobbies
– Economic state

www.mansfans.com
 Investigations
Skin biopsy
Fungus investigation
– ME
– Wood’s light
– Culture
Patch test
Oral provocation test

www.mansfans.com
 Pathological Terms
Hyperkeratosis: Increased thickness of horny layer.
Parakeratosis: Immature keratinization resulting in
retention of nuclei in cells of horny layer.
Acanthosis: Increased thickness of prickle cell layer.
Acantholysis: Loss of coherence between epidermal or
epithelial cells. Primary acantholysis occurs among
unaltered cells as a result of dissolution of the
intercellular substance, e.g., pemphigus. Secondary
acantholysis occurs among altered or damaged cells,
e.g. impetigo, viral vesicles.
Spongiosis: Intercellular oedema in prickle cell layer.

www.mansfans.com
Hyperkeratosis+Parakeratosis+Acanthosis
Acantholysis
 Spongiosis

Www.MansFans.Com
Wood’light
Wood’light
 Investigations
Culture of fungus

www.mansfans.com
Patch test
 Topical Therapy
Active agent e.g., antibiotics
Vehicle (base) e.g. liquid, powders,
creams or ointments.
 Liquids: in acute weeping diseases
(Solutions ,Lotions,Tincture,Paint).
 Creams: semisolid emulsion of oil in water
used in subacute condition.
 Ointments: greasy base for dry hyperkeratotic
or lichenified skin.
 Gels: Non greasy transparent, semisolid
emulsions that liquify on contact with skin
suitable for treating hairy parts of the body
Www.MansFans.Com
‫الحمد ل‬