Dermatological History and Examination Flashcards
What are you looking to find out from the presenting complaint?
Nature, site and duration of issue Initial appearance and changes Symptoms - itch, pain Aggravating/Relieving Treatments? Recent contact, stress, travel history, illness, sun exposure Skin type
What things would you look at in the past medical history?
Atopy - asthma, hayfever, eczema
History of skin cancer & suspicious lesions
What other things do you ask about in a dermatological history?
Social history
Family history
Medication/Allergies
Impact on QoL
What is crucial when examining the skin?
Good exposure and lighting
What areas should you assess in a dermatological examination?
Hair
Scalp
Nails
Mucous membrane
What are the 4 principles when examining the skin?
Inspect
Describe
Palpate
Systematic check
How would you describe a skin lesion?
SCAM
S - size and shape
C - colour
A - associated secondary shape
M - Morphology and Margin
What features raise suspicion of melanoma in a pigmented lesion?
ABCD
Asymmetry
Border - irregular
Colours -2 or more within lesion
Diametre >6mm
What do you examine when palpating a lesion?
Surface Consistency Mobility Tenderness Temperature
Where would you assess during a systematic check?
Nails
Scalp
Hair
Mucous membranes
What is pruritis?
Itching
What is a lesion?
An area of altered skin
What is a rash?
An eruption
What is a naevus?
A localised malformation of tissue structures
What is a comedone?
A plug in a sebaceous follicle containing altered sebum, bacteria and cellular debris
How can comedone present?
Open - blackheads
Closed - whiteheads
What terms can be used to describe the distribution of lesions?
Generalised Widespread Localised Flexural Extensor Pressure areas Dermatomal Photosensitive
What areas are considered pressure areas?
Sacrum
Buttocks
Ankles
Heels
What terms can be used to describe the configuration of a dermatological lesion?
Discrete Confluent - lesions merge Linear Target - concentric rings Annular - a circle/ring Discoid/Nummular - coin shaped/round
What terms are used to describe the colour of a lesion?
Erythema Purpura - don't blanch Hypopigmented Depigmented Hyperpigmented
What terms are used to describe the morphology of a lesion?
Macule Patch Plaque Papule Nodule Vesicle Bulla Pustule Abscess
What is a macule?
Flat area of altered colour
What is a patch?
Larger flat area of discolouration (>2cm)
What is a papule?
Palpable, raised lesion <0.5cm diameter
What is a nodule?
Palpable, raised lesion >0.5cm diameter
What is a plaque?
Palpable, scaling raised lesion >0.5cm diameter
What is a vesicle?
Raised, clear fluid filled lesion <0.5cm diameter
What is a bulla?
Raised, clear fluid filled lesion >0/5cm diameter
What is a pustule?
Pus-containing lesion <0.5cm diameter
What is an abscess?
Localised accumulation of pus in the dermis or subcutaneous tissue
What are excoriations?
Loss of epidermis due to trauma - scratching
What is lichenification?
Well defined, roughening of skin with exaggerated skin markings
What are scales?
Flakes of stratum corneum
What is crusting?
A rough surface consisting of died serum, blood, bacteria and cellular debris that has exuded through an eroded epidermis
seen in Impetigo
What is a scar?
New fibrous tissue which occurs post wound healing
What is the difference between a hypertrophic scar and a keloid scar?
Keloid - hyperproliferation beyond wound boundary
Hypertrophic - within wound boundary
What is an ulcer?
Loss of epidermis and dermis
What is a fissure?
Epidermal crack often due to excess dryness
What are striae?
Linear area which progress from purple to pink/white with histological appearance of a scar
What is alopecia?
Loss of Hair
What is Hirsutism?
Androgen dependent hair growth in a female
What is hypertrichosis?
Non-androgen dependent excessive hair growth
What is clubbing? and what is it associated with?
Loss of angle between posterior nail fold and nail plate
Associated with - suppurative lung disease, cyanotic heart disease, IBD and can be idiopathic
What is Koilonychia? What is it associated with?
Spoon shaped depression of nail plate
Associated with iron deficiency anaemia
What is Onycholysis and what is it associated with?
Separation of distal end of nail plate from nail bed
Trauma, psoriasis, fungal nail infection, hyperthyroidism
What is pitting and what is it associated with?
Punctate depression of nail plate
Psoriasis, eczema, alopecia areata
