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Dermatologic Physical Examination 2022-2023 - Clinical Skills Session

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The document provides guidance on conducting a dermatologic physical examination and making a diagnosis. It outlines key steps which include properly visualizing the skin, examining localized and widespread areas, identifying the primary lesion and disease group, and assessing differentiating factors such as color, shape, arrangement, location and secondary lesions. Determining these characteristics helps narrow the diagnosis. The examination requires evaluating various areas of the body and using different techniques as needed to properly diagnose skin conditions.

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Dermatologic Physical Examination 2022-2023 - Clinical Skills Session

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dafasdfasf
19 views63 pages
The document provides guidance on conducting a dermatologic physical examination and making a diagnosis. It outlines key steps which include properly visualizing the skin, examining localized and widespread areas, identifying the primary lesion and disease group, and assessing differentiating factors such as color, shape, arrangement, location and secondary lesions. Determining these characteristics helps narrow the diagnosis. The examination requires evaluating various areas of the body and using different techniques as needed to properly diagnose skin conditions.

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The document provides guidance on conducting a dermatologic physical examination and making a diagnosis. It outlines key steps which include properly visualizing the skin, examining localized and widespread areas, identifying the primary lesion and disease group, and assessing differentiating factors such as color, shape, arrangement, location and secondary lesions. Determining these characteristics helps narrow the diagnosis. The examination requires evaluating various areas of the body and using different techniques as needed to properly diagnose skin conditions.

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© All Rights Reserved
Download as PDF, TXT or read online from Scribd
Download as pdf or txt
19 views63 pages

Dermatologic Physical Examination 2022-2023 - Clinical Skills Session

Uploaded by

dafasdfasf
The document provides guidance on conducting a dermatologic physical examination and making a diagnosis. It outlines key steps which include properly visualizing the skin, examining localized and widespread areas, identifying the primary lesion and disease group, and assessing differentiating factors such as color, shape, arrangement, location and secondary lesions. Determining these characteristics helps narrow the diagnosis. The examination requires evaluating various areas of the body and using different techniques as needed to properly diagnose skin conditions.

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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

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