Skin Examination

Question 1

What framework should be used to describe a rash and a lesion? (pigmented & non pigmented)

Answer 1

Rash: (DCM)

• Distribution (where is it)
• Configuration (groups, lines, random)
• Morphology (what sort of lesion)

Pigmented lesion: (ABCDE)

• Asymmetry
• Border
• Colour
• Diameter
• Elevation

Non pigmented lesion: (4 S’s)

• Site
• Size
• Shape
• Surrounding tissue

Question 2

What do the following distributions refer to:

1. acral
2. dermatomal
3. flexor
4. extensor
5. generalised
6. follicular
7. photosensitive
8. truncal
9. unilateral
10. seborrhoeic

Answer 2

1. Acral: Distal portion of areas, hands, feet, nose, ears.
2. Dermatomal: Follows the areas of a dermatome.
3. Flexor: Only on flexor surfaces.
4. Extensor: Only on extensor surfaces.
5. Generalised: Universally distributed.
6. Follicular: Arising from hair follicles.
7. Photosensitive: Arises from sunexposed areas.
8. Truncal: Favours the trunk not on the limbs.
9. Unilateral: Eruption only on one side of the body.
10. Seborrhoeic: Affecting oily skin, Scalp, behind ears, eyebrows, nasolabial folds, sternum and interscapular.

Question 3

What are the different configurations you can have?

Answer 3

Discoid (coin shaped)

Annular (grouped in a circle or oval)

Linear

Gyrate (appears to be whirling in a circle)

Target lesions

Question 4

Describe the following terms (provide examples)

1. macule
2. papule
3. nodule
4. plaque
5. vesicle
6. bulla
7. pustule

Answer 4

1. Macule: flat, non palpable area of colour change
   
   • Petechiae, lentigo
2. Papule: elevated, palpable mass less than 0.5cm in diameter
   
   • Seborrhoeic keratosis, viral warts
3. Nodule: elevated, palpable mass which is greater than 0.5cm, involves dermis +/- subcutis
   
   • Lipoma, metastases, neurofibroma
4. Plaque: elevated, flat topped palpable lesion
   
   • Psoriasis, keloid scar, cutaneous sarcoidosis
5. Vesicle: a papule filled with clear fluid, <5mm
   
   • Herpes simplex, varicella/zoster, pompholyx
6. Bulla: Elevated, filled with clear fluid, >5mm
   
   • Friction blister, bullous pemphigoid
7. Pustule: Elevated, usually <5mm, filled with purulent fluid (pus)
   
   • Acne vulgaris, folliculitis, pustular psoriasis

Question 5

Describe the following terms

1. telangiectasia
2. purpura
3. petechia
4. ecchymosis
5. fissure
6. lichenification

Answer 5

1. Telangiectasia: Visible dilatation of small cutaneous blood vessels
2. Purpura: non blanching macules or papules of blood in the skin
3. Petechia: non blanching pinsized maccules of blood in the skin
4. Eccychymosis: large extravasation of blood into the skin (a bruise)
5. Fissure: a thin crack or slit in the skin
6. Lichenification: thickening of the skin due to chronic scratching/rubbing