Skin examinations - (clinical skills related)

Question 1

What should your approach be when carrying out a skin examination ?

Answer 1

Should be methodical assess and record in turn:

• Distribution - which areas are affected
• Configuration- how lesions are arranged – helps with pattern recognition
• Morphology - what the lesion(s) look like – consider magnifying lens – Palpate (feel) as well as look

Question 2

Examining what other areas might give you an idea of what is the underlying skin conditions ?

Answer 2

• Nails : e.g. In psoriasis: pitting (depressions of nail plate) and onycholyisis (separation of nail plate from bed) are common findings
• Mouth : e.g. blistering disease – may see erosions of buccal mucosa
• Joints :e.g. psoriasis: look for signs of arthritis
• Hair : changes may be associated with underlying systemic disease – Hypertrichosis – general excess growth – Hirsutes – excess growth in male pattern (e.g. beard area) in women – Alopecia – loss of hair

Question 3

What should you think about when examining a skin lesion ?

Answer 3

Pick a typical area and assess in turn:

• Colour
• Size
• Raised or flat
• Border features
• Surface features: scale, crust

Question 4

Describe the type of skin lesion shown here

Answer 4

It is a purpura - also called blood spots or skin hemorrhages, refers to purple-colored spots. This will not blanche

Question 5

Describe the skin lesion shown here

Answer 5

Petechia - a small red or purple spot caused by bleeding into the skin

(Petechia – smaller 1- 2 mm area of flat purpura)

Question 6

What skin reaction is shown here ?

Answer 6

Erythema - superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilatation of the blood capillaries.

Question 7

What type of pigmentation change is shown?

Answer 7

Hypopigmentation - It is caused by melanocyte or melanin depletion, or a decrease in the amino acid tyrosine, which is used by melanocytes to make melanin.

Question 8

What type of pigmentation change is shown here?

Answer 8

Hyperpigmentation - condition in which patches of skin become darker in color than the normal surrounding skin. This darkening occurs when an excess of melanin

Question 9

Describe what type of skin lesion is shown here

Answer 9

Macule - an area of skin discoloration < 1cm

Described as a patch if >1cm

Question 10

Describe the skin lesion shown

Answer 10

Papule - a small pimple or swelling on the skin, often forming part of a rash.

localised elevated area < 0.5cm

If >0.5 cm then described as a nodule

Question 11

Describe the appearance of the skin lesion shown

Answer 11

Plaque - A plaque is a palpable flat lesion usually greater than 1 cm diameter. Most plaquesare elevated, but a plaque can also be a thickened area without being visibly raised above the skin surface.

Question 12

Describe the skin lesion shown

Answer 12

Wheal - A raised, itchy (pruritic) area of skin that is sometimes an overt sign of allergy. Not all wheals are alike. They may be redder or paler than the skin around them. It is a compressible dermal swelling

Question 13

What type of skin lesion is shown ?

Answer 13

Bulla - A bulla is a fluid-filled sac or lesion that appears when fluid is trapped between the dermis and epidermis

Reffered to as a vescile if < 0.5cm

Bulla if > 0.5cm

Question 14

Describe the type of skin lesion shown

Answer 14

Cyst - nodule containing semisolid material

Question 15

Describe the type of skin lesion shown

Answer 15

Pustule - A pustule is a circumscribed elevation of the skin that contains a purulent exudate that may be white, yellow, or greenish-yellow in color. (pus filled)

Question 16

When describing the border features of a skin lesion/problem what is the main 2 ways it can be defined ?

Answer 16

Can be defined as:

• Well defined/ sharp border (irregular or regular) or
• Poorly defined

Question 17

How would you describe the border of the skin lesion shown ?

Answer 17

Well defined

Question 18

How would you define the borders of the skin lesion shown ?

Answer 18

Poorly defined

Question 19

Describe the type of skin feature shown

Answer 19

Scale - accumulated fragments of keratin layer

Question 20

Describe the type of skin feature shown

Answer 20

Crust - dried exudate e.g. serum

Question 21

Describe the type of skin feature shown

Answer 21

Scar - an area of fibrous tissue (fibrosis) that replace normal skin after injury.

Question 22

Describe the type of skin feature shown

Answer 22

Lichenification - it is a skin condition that occurs in response to excessive itching or rubbing of the skin and results in thick, leathery patches of skin. This occurs because the outer layer of skin naturally thickens with the extra irritation, and it often happens in tandem with eczema or other skin disorders.

Question 23

Describe the type of skin feature shown

Answer 23

Skin fissure - linear split in epidermis

Question 24

Describe the type of skin feature shown

Answer 24

Skin atropy - loss of epidermis +/- dermis (surface remains intact)

Question 25

Describe the type of skin feature shown ?

Answer 25

Skin erosion - superficial break in epidermis

Question 26

Describe the type of skin feature shown

Answer 26

Skin ulcer - deeper brake into the dermis