Dermatological Semiology

‭Semiology‬ ‭Examination‬ ‭It should be noted :‬ ‭The history of dermatosis‬ ‭Mode of onset: abrupt or gradual; localized or immediately‬‭extended‬ ‭Initial appearance‬ ‭Local extension mode: centrifugal, curvilinear,‬‭plate, etc.‬ ‭Evolutionary mode: temporal and spatial,‬ ‭Treatments used‬ ‭THE‬‭functional signs dermato‬‭: pruritus, pain?‬ ‭THE‬‭medication taken‬‭:specify the chronology in relation‬‭to the‬ ‭appearance of the dermatosis‬ ‭THE‬‭environmental factors‬‭:habitat, profession, leisure‬ ‭activities, clothing habits, sun exposure, etc.‬ ‭Personal and family ATCD: dermatological, concept‬‭of atopy, cancer, etc.‬ ‭1‬ ‭Dermatological clinical‬‭examination‬ ‭2 systematic‬ ‭steps‬‭:‬ ‭Inspection:‬ ‭complete (including hair, nails, mucous membranes),‬‭with‬ ‭good lighting, possibly with Wood's light‬ ‭Describe the type of lesions‬ ‭Specify the type of possible grouping by coalescence‬‭of lesions of‬ ‭the same nature (plaque, linear, annular, arciform, polycyclic,‬ ‭roundel)‬ ‭Palpation:‬‭specifies the relief or infiltration/non-infiltration‬‭of the lesions‬ ‭Other exams‬‭:‬ ‭Vitro Pressure In‬‭case of erythematous macule‬ ‭Curettage‬‭(curette, wooden spatula) for analyzing‬‭scaly‬ ‭lesions and removing scabs‬ ‭Friction Using‬‭a blunt tip (highlighting a dermographism, a Darier‬ ‭sign, a Nikolski sign)‬ ‭The objective is to determine the elementary lesion(s)‬‭and its‬ ‭topography.‬ ‭CLINICAL‬ ‭Visible but not‬ ‭palpable‬ ‭Palpable‬ ‭Surface weathering‬ ‭ hanging the‬ C ‭consistency‬ ‭TYPE OF INJURY‬ ‭Macule‬ ‭ olid content:‬‭papule, nodule, vegetation‬ S ‭Liquid content:‬‭vesicle, bubble, pustule‬ ‭Erosion, fissure, ulceration Scale, necrosis, scab‬ ‭Keratosis, atrophy Gangrene, necrosis‬ ‭Sclerosis, atrophy, edema‬ ‭Remarks :‬ ‭Skin tumors can be represented by all kinds of‬‭elementary lesions.‬ ‭Many dermatoses consist of an association of primary‬‭or‬ ‭secondary elementary lesions.‬ ‭2‬ ‭The clinical dermatological examination must be accompanied by a general‬ ‭examination.‬ ‭Paraclinical examinations in dermatology‬ ‭Often not necessary‬ ‭Skin imaging‬‭:photography or dermatoscopy‬ ‭Superficial microbio sample looking‬‭for:‬ ‭infectious agent: bacteria, fungus, virus or parasite‬ ‭Tzanck cytodiagnosis‬ ‭Skin biopsy for‬‭histological analysis‬ ‭Primary elemental lesions‬ ‭Non-palpable lesions = Macules:‬ ‭ he lesions are only visible‬‭⇒‬‭dyschromic spot, without relief,‬ T ‭without‬‭infiltration‬ ‭3‬ ‭1.‬ ‭Red spots on‬‭3 types, which can be distinguished by vitro‬ ‭ ressure:‬‭erythema‬‭(fades), the vascular‬ ‭macule‬‭(is partially‬ p ‭erased) and‬‭purpura‬‭(does not fade).‬ ‭ rythema‬‭:‬‭localized or generalized redness secondary‬ ‭to‬ E ‭congestion of the vessels of the superficial dermis.‬‭Clears‬ ‭with vitro pressure.Erythema‬‭can be:‬ ‭active‬‭arteriole-capillary vasodilation;‬ ‭passive by‬‭blood stasis without dilation (erythrocyanosis)‬ ‭There are 3 main types of erythema:‬ ‭ carlatiniform‬‭(resembles scarlet fever): bright‬‭red erythema, large‬ s ‭continuous closets without intervals of healthy skin‬ ‭ orbilliform‬‭(resembles measles): extensive red‬‭erythema made up‬ M ‭of small elements (‬‭≤‬‭1 cm in diameter)‬‭with intervals‬‭of healthy‬ ‭skin.‬ ‭ oseoliform‬‭(resembles syphilitic roseola): erythema‬‭made of‬‭pink‬ R ‭spots‬‭, poorly demarcated with wide‬‭ranges of healthy skin‬‭.‬ ‭ ascular macula‬‭:‭S‬ econdary to abnormal‬‭vascular dilation or excess‬ V ‭dermal capillary‬‭. Partially erased by vitro pressure;‬‭There are 2 main‬ ‭types‬ ‭telangiectasia:‬‭acquired red lesion, forming a fine‬‭and tortuous line,‬ ‭often localized‬ f‭ lat angioma:‬‭congenital lesion causing purplish‬‭red plaques‬ ‭with clear borders‬ ‭Purpura‬‭:‬‭Secondary to an extravasation‬‭of red blood cells into the‬ ‭dermis by‬‭inflammation of the vascular wall (‬‭vasculitis‬‭) or blood‬ ‭abnormality (especially thrombocytopenia).‬‭Does not fade with vitro‬ ‭ ressure‬‭.‬‭It is an initially dark red spot which evolves according to the hues‬ p ‭of biligenesis, preferentially located in sloping regions. There are different‬ ‭semiological forms of purpura:‬ ‭ etechial‬‭:multiple small spots 1-2 mm in diameter (=‬ p ‭petechiae)‬ ‭in vigor‬‭:linear drag following skin friction‬ ‭4‬ ‭ecchymotic‬‭:variable size closet‬ ‭necrotic‬ ‭Acute purpura is an emergency.‬ ‭2.‬‭Pigmented macule:‬‭Secondary pigment‬‭buildup in‬‭the skin‬ ‭ elanin buildup‬‭. Light brown to black pigmentation,‬‭sometimes‬ M ‭bluish (mongoloid spot in infants),‬‭accentuated by‬‭Wood's light‬ ‭localized: pregnancy mask, café-au-lait stain, etc.‬ ‭generalized: melanoderma‬ ‭ ccumulation of other pigments‬‭(iron, silver…). Variable‬ A ‭pigmentation, not accentuated by Wood's light.‬ ‭3.‬ ‭Hypo- and achromic macule:‬‭Secondary to a reduction‬‭or‬ ‭ bsence of melanocytes in the epidermis or‬‭secretion of‬ a ‭melanin by them.‬ ‭We distinguish the causes:‬ ‭primitive‬‭:acquired or hereditary, generalized (albinism)‬‭or localized‬ ‭secondary+‬‭:post-healing, tinea versicolor‬ ‭Noticed‬‭:at the scalp level, we use the terms poliosis‬‭(1 white streak) and‬ ‭canities (generalized whitening)‬ ‭Palpable lesions:‬ ‭Solid content‬ ‭Papule‬‭:‬‭protruding non-indurated elevation‬‭,‬‭well‬‭circumscribed‬‭,‬‭<1cm‬‭.‬ ‭There are different types:‬ ‭epidermal (acanthosis): dry and keratotic (e.g.‬‭flat wart)‬ ‭edematous dermal: pale pink, elastic, migratory (e.g.‬ ‭urticaria)‬ ‭dermal by cellular infiltrate: inflammatory, firm,‬‭clearly raised, not‬ ‭reducible to pressure (e.g. lichen planus)‬ ‭5‬ ‭dermal dysmetabolic: overload of amorphous, firm‬‭material (e.g.‬ ‭xanthoma)‬ ‭follicular by damage to the hair follicle: epidermal‬‭(acuminate, hard)‬ ‭or dermal (rounded)‬ ‭military by damage to the sweat glands and ducts. Red and‬ ‭acuminate (rare)‬ ‭Plaque: same as papule but > 1cm‬ ‭ odule‬‭:more or less protruding elevations,‬‭round‬‭Or‬‭oval‬‭and‬‭of‬ N ‭large size (>1cm)‬‭,‭s ‬ olid‬‭,‬‭firm and infiltrated‬‭. We also‬‭use the‬ ‭terms:‬ ‭nodality‬‭:small nodule‬‭(0.5-1 cm)‬ ‭ not‬‭:nodule of big‬‭size‬‭, spread out and not‬‭very prominent‬ k ‭(=hypodermic nodule)‬‭,‬‭painful‬‭(e.g. erythema nodosum)‬ ‭ um: protruding, solid, hypodermic and inflammatory‬ G ‭bulky formation:‬‭It is therefore a nodule which has‬‭undergone‬ ‭modifications over time:‬ ‭1° Crudity phase:‬‭of firm or even hard consistency.‬ ‭ ° Softening:‬‭over time, the nodule will soften and‬ 2 ‭become soft.‬ ‭3° Fistulization:‬‭then it will perforate (one or more‬ ‭pores) and release a liquid: purulent, chalky, whitish or‬ ‭hematic red in color.‬‭4° Healing:‬‭while leaving an‬ ‭indelible mark (does not disappear), retractable‬ ‭(abnormal skin) with flanges (strings of skin)‬ ‭ egetation‬‭:‭v V ‬ ery superficial lesion‬‭,‬‭irregular surface‬‭,‬‭nippled‬‭e,‬ ‭generally fleshy‬‭and fragile,‬‭preferably on‬‭the mucous membranes‬ ‭and around natural orifices‬ ‭W ith liquid content‬ ‭6‬ ‭ esicle‬‭:translucent lesion small‬‭size containing‬‭initially‬‭clear‬ V ‭serosity‬‭.‬‭Fragile and transient lesion‬ ‭ ubble‬‭:Fluid collection > 5mm superficial with‬‭clear or serohematic‬ B ‭contents su.‬‭Fragile and transient lesion.‬ ‭ ustular‬‭:lesion of variable‬‭size containing suspicious serosity‬ P ‭or frank pus‬‭.‬ ‭Surface weathering‬ ‭ cales: Film or horny lamella‬‭Who‬‭comes off the skin‬‭.‬‭There are‬ S ‭different types:‬ ‭ ityriasiform‬‭:fine, whitish, mealy, loose and small,‬‭dry or‬ p ‭greasy‬ ‭scarlatiniform‬‭:large, homogeneous and fine shreds‬ ‭ichthyosiform‬‭:regular polygonal shape, like fish scales, dry‬ ‭ soriasiform‬‭:bright white, thick, often large and‬‭adherent,‬ p ‭crumbling into strips (candle sign)‬ ‭follicular‬‭:small, in seedling, with the emergence‬‭of a hair‬ ‭ eratosis: Thickening of the cornea‬‭, lesion hard‬‭and rough‬‭. We‬ K ‭distinguish :‬ ‭hyperkeratosis‬‭:thickening wider than tall‬ ‭the Horn‬‭:thickening higher than wide–‬‭leukokeratosis on‬‭the mucous‬ ‭membranes‬ ‭Secondary lesions‬ ‭ rust‬‭:secondary to the coagulation‬‭of a hemorrhagic serous exudate‬‭Or‬ C ‭purulent‬‭.‬ ‭ car‬‭:culmination of a repair process after a loss‬‭of substance. Normal scars often‬ S ‭combine‬‭atrophy‬‭And‬‭sclerosis‬‭. Raised pathological scars‬‭are of 2 types:‬ ‭ ypertrophic scar‬‭:rounded, well limited, regular,‬‭favorable‬ h ‭evolution over 12-18 months‬ ‭7‬ ‭ eloid scar‬‭:similar in appearance but with crab‬‭claw extensions and‬ k ‭extensive development. More common on black skin‬ ‭Atrophy‬‭:Thinning of the skin, forming a depressed,‬‭smooth, pearly cup lesion‬ ‭Sclerosis‬‭:Thickening and loss of skin elasticity‬ ‭Loss of substance‬‭:there are different types‬ ‭erosion:‬‭superficial loss (epidermis)‬ ‭ulceration:‬‭deeper loss (dermis/hypodermis)‬ ‭ulcer‬‭:ulceration without healing tendency‬ ‭ rack :‬‭Linear erosion or ulceration. We speak of‬‭rhagade at the level of‬ c ‭the folds and perlèche at the level of the lip corner.‬ ‭canker:‬‭erosion or ulceration at the site of inoculation‬‭of an infectious‬ ‭pathology‬ ‭ angrene and bedsores:‬‭necrosis of vascular or infectious‬‭origin, loss of‬ g ‭substance leading to an ulcer‬ ‭Mucosal damage‬ ‭The‬ ‭canker‬ ‭sore:‬‭oral‬ ‭ulcer‬ ‭characterized‬ ‭by‬ ‭its‬ ‭yellowish‬ ‭background‬‭(color‬‭of‬ ‭fresh‬ ‭butter)‬ ‭surrounded‬ ‭by‬ ‭a‬ ‭red‬ ‭inflammatory‬ ‭halo,‬ ‭this‬ ‭erythematous‬ ‭ring‬ ‭is‬ ‭essential for the diagnosis of canker sore.‬ ‭Leukoplakia:‬‭whitish‬ ‭deposit‬ ‭(+/-‬ ‭warty)‬ ‭on‬ ‭the‬ ‭mucous‬ ‭membrane,‬ ‭adherent,‬ ‭ ainful‬ ‭or‬ ‭not,‬ ‭fixed,‬ ‭which‬ ‭does‬ ‭not‬ ‭disappear‬ ‭when‬ ‭wiped.‬ ‭FDR:‬ ‭tobacco.‬ ‭It‬ ‭is‬ p ‭either:‬ ‭Removable: when it is infectious, when there is‬‭Candida or fungi‬ ‭Fixed: We are talking about precancerous lesions,‬‭cancer of the mucosa.‬ ‭Biopsy becomes inevitable‬ ‭Erythroplasia:‬‭defined by a red area, bright, with‬‭a clear border, fixed over time,‬ ‭chronic occurring on a mucous membrane‬ ‭ heilitis:‬‭These are fine scales that break off,‬‭causing inflammation of the lip.‬ C ‭It appears with a whitish appearance and‬ ‭8‬ ‭desquamative of the half-mucosa of the lips.‬ ‭The occurrence of erosion or infiltration should raise fears of‬ ‭malignant transformation.‬ ‭9‬