Lecture Note
Outline of Dermatologic Diagnosis Part I
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University:
American Career College -
Course:
NURS-113 | Beginning Medical/Surgical Nursing Academic year:
2018
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Views:
226
Pages:
48
Author:
KillSteel
OUTLINE OF DERMATOLOGIC
DIAGNOSIS 1.History:
2.Examination:
-Distribution
-Morphology
Terminology of lesions:
-Primary lesions
-Secondary lesions
3.Special tools and techniques: Skin: “Learning to Read”
The entire skin should be inspected and this
should include
-mucous membranes,
-genital and anal regions,
-as well as hair and nails
-and peripheral lymph nodes. The prerequisite of dermatologic diagnosis is thus the
recognition of
(1) the type of skin lesion,
(2) the color,
(3) margination well defined or ill defined.
(4) consistency, palpation :
(1) consistency (soft, firm, hard, fluctuant, boardlike);
(2) temperature (hot, cold)
(3) mobility .
Note presence of tenderness ,
and estimate the depth of the lesion (i.e., dermal or
subcutaneous).
(5) shape round, oval, polygonal, polycyclic, annular (ringshaped), iris, serpiginous (snake like), umbilicated. (6) arrangement, Multiple lesions may be
(1) grouped : herpetiform, arciform, annular, reticulated
(net-shaped), linear, serpiginous (snakelike);
or (2) disseminated : scattered discrete lesions.
(7)distribution of lesions;
Consider
(1) extent : isolated(single lesions), localized,
regional, generalized, universal,
and (2) pattern : symmetric, exposed areas, sites of
pressure, intertriginous area, follicular localization, random. Primary lesions
Most skin diseases begin with a basic lesion that is
referred to as a primary lesion.
Identification of the primary lesion is the key to accurate
diagnosis.
Secondary lesions
Secondary lesions develop during the evolutionary
process of skin disease or are created by scratching or
infection.
They may be the only type of lesion present, in which
case the primary disease process must be inferred. 1.Macule (Latin: macula, “spot”):
A macule is a circumscribed area of change in skin color without
elevation or depression.
It is thus not palpable. Macules can be well and ill-defined.
Macules may be of any size or color. White, as in vitiligo;
brown, as in cafe-au-lait spots ; blue, as in Mongolian spots ; or red,
as in permanent vascular abnormalities such as port-wine stains. vitiligo port-wine
stains 2.Papule (Latin: papula, “pimple”)
-A papule is a superficial, elevated, solid lesion,
generally considered <0.5 cm in diameter.
-Most of it is elevated above, rather than deep
within, the plane of the surrounding skin.
-A papule is palpable. It may be well- or illdefined.
-Superficial papules are sharply defined.
-Deeper dermal papules have indistinct borders.. Papules
-may be dome-shaped ,cone-shaped or flat-topped (as
in lichen planus)
-or consist of multiple, projected elevations that are
known as a vegetation.
-A rash consisting of papules is called
a papular exanthem
.
-Confluence of papules leads to the development of
larger, usually flat-topped, circumscribed , plateau-like
elevations known as plaques (French: plaque, “plate”) Papules Lichen planus
Wart (cylindrical projections) Molluscum contagiosum 3.Plaque
-It is usually well defined.
-Frequently it is formed by a confluence of
papules, as in psoriasis. Eczema Psoriasis
Lichen planus 4.Nodule
- A circumscribed, elevated, solid lesion more than 0.5
cm in diameter; a large nodule is referred to as a tumor.
- May involve the epidermis , dermis , or subcutaneous
tissue.
- Nodules may be well defined (superficial) or ill defined
(deep); if localized in the subcutaneous tissue, they can
often be better felt than seen.
- Nodules can be hard or soft upon palpation.
-They may be dome-shaped and smooth or may have a
warty surface or crater-like central depression. Nodule
Neurofibromatosis
Basal cell carcinoma
Hemangioma 5.Vesicle ( Blister )
-(Latin: vesicula , bulla , “bubble”)
-A circumscribed collection of free fluid up to 0.5 cm in
diameter.
6.Bulla
- A circumscribed collection of free fluid more than 0.5 cm
in diameter.
-Often the roof of a vesicle/bulla is so thin that it is
transparent, and the serum or blood in the cavity can be
seen.
-Vesicles containing serum are yellowish; those containing
blood from red to black. Since vesicles/bullae are always superficial they are always well
defined.
-A rash consisting of vesicles is called a vesicular
exanthem ;
-a rash consisting of bullae a bullous exanthem. Chickenpox
Eczema (acute)
Bullous pemphigoid 7.Pustule
A circumscribed collection of leukocytes and free fluid
may be white, yellow, greenish-yellow, or hemorrhagic.
Pustules thus differ from vesicles in that they are not clear but
have a turbid content.
This process may arise in a hair follicle or independently that varies
in size .
A rash consisting of pustules is called a pustular exanthem.. Folliculitis Impetigo 8.Wheal (hive)
A wheal is a rounded or flat-topped ,pale, red papule or plaque that
is characteristically evanescent, disappearing within 24–48 h.
It is due to edema in the papillary layer of the dermis.
Wheals may be round, gyrate, or irregular ,changing rapidly in size
and shape due to shifting papillary edema.
A rash consisting of wheals is called an urticarial exanthem or
urticaria. Hives Angioedema Secondary skin lesions:
1.Crusts (Latin: crusta , shell”)
Crusts develop when serum, blood, or purulent
exudate dries on the skin surface .
-Crusts are yellow when formed from dried
serum; green or-yellow-green when formed from
purulent exudate; or
-brown, dark red, or black when formed from
blood.
. 2.Scales (squames) :(Latin: squama , “scale”)
-Scales are flakes of stratum corneum.
-They may be large like membranes , tiny (like dust),
pityriasiform (Greek: pityron ,“bran”), adherent, or loose.
A rash consisting of papules with scales is called a
papulosquamous exanthem .
A. Fine to stratified Tinea versicolor
(fine) B.Scaling in sheets
(desquamation)
Kawasaki disease. A
Scarlet fever (hands and feet)
Staphylococcal scalded skin syndrome .B
Toxic shock syndrome 3.Erosion
A focal loss of epidermis; erosions do not penetrate below the
dermoepidermal junction and therefore heal without scarring.
Tinea pedis 4.Ulcer
A focal loss of epidermis and dermis; ulcers heal with scarring. 5.Fissure
A linear loss of epidermis and dermis with sharply defined,
nearly vertical walls.
-Chapping (hands, feet)
-Eczema (fingertip)
-Intertrigo
-Perlèche
Eczema 6.Scar
An abnormal formation of connective tissue implying
dermal damage ;after injury or surgery. Scars are initially
thick and pink but with time become white and atrophic
-Acne
-Burns
-Herpes zoster
-Keloid 7.Atrophy
A depression in the skin resulting from thinning
of the epidermis or dermis.
Epidermal atrophy is manifested by a thinning of the
epidermis, which becomes transparent, revealing the
papillary and subpapillary vessels ; there are loss of skin
texture and
cigarette paper–like wrinkling.
In dermal atrophy there
are loss of connective
tissue of the dermis and
depression of
the lesion Special skin lesions:
-Cyst
A cyst is a cavity containing liquid or solid or semisolid
materials and may be superficial or deep.
It is lined by an epithelium and often has a fibrous
capsule; depending on its contents it may be skin colored,
yellow, red, or blue.
An epidermal cyst producing keratinaceous material and a
pilar cyst that is lined by a multilayered epithelium are shown in
Image below. 2.Excoriation
An erosion caused by scratching; excoriations are often linear 3.Comedone
A plug of sebaceous and keratinous material lodged in the
opening of a hair follicle; the follicular orifice may be dilated
(blackhead) or narrowed (whitehead or closed comedone) 4.Milia
A small, superficial keratin cyst with no visible opening 5.Petechiae
A circumscribed deposit of blood less than 0.5 cm in diameter.
Henoch-Schönlein purpura 6.Purpura
A circumscribed deposit of blood greater than 0.5 cm in
diameter.
Sun-damaged skin 7.Burrow
A narrow, elevated, tortuous channel produced by a parasite
Scabies burrow 8.Lichenification
An area of thickened epidermis induced by scratching;
skin lines are accentuated so the surface looks like a
washboard. 9.Telangiectasia
Dilated superficial blood vessels
Telangiectasia rosacea
T. spider angioma
Outline of Dermatologic Diagnosis Part I
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