Dermatologic Examination

dr.Eddy Karta, SpKK Departemen Ilmu Kesehatan Kulit dan Kelamin FKUI/RSCM

Objective?

Skin lesion examination

Location Type of skin lesion Number Color Size Border Shape and arrangement skin lesion Distribution

Type of skin lesion

Flat lesion (Usually in the plane of the skin ) Elevated lesion (Above the plane of the skin) Depressed Lesion (below the plane of skin)

Flat lesion
Macule Infarct Sclerosis Telangiectasia

Elevated lesion
Papule Plaque Nodule wheal Vesicle and Bullae Pustule Abscess cyst Exudate (crust) Scale Scar Lichenification

Depressed lesion
Atrophy Sclerosis Erosion Excoriation Scar Ulcer Sinus Gangrene

Primary lesion

Macule
A macule is a circumbscribed, flat lesion that differs from surrounding skin because of its color.Macules may have any size and shape. They may be result of hyperpigmentation, hypopigmentation, vascular abnormalities, erythema (capillary dilatation) or purpura (extravasated red blood cells).

Papules
A papule is small, solid, elevated lesion generally smaller than half centimeter (Oblique lighting with a flashlight in a darkened room is often necessary to detect slight elevation).

Nodules
A nodule is palpable, solid, round or ellipsoidal lesion. Depth of involvement and/or substantive palpability, rather than diameter, differentiate a nodule from a papule.

Plaques
A plaque is mass like elevation that occupies a relatively large surface area in comparison with its height above skin level. Plaque are often formed by a confluence of papules.

Wheals
A wheal is a rounded or flat topped oedema that is characteristically evanescent, disappearing within hours.

Vesicle and Bulla

A vesicle is a circumscribed, elevated lesion that contains fluid. Often the vesicle walls are so thin that they are translucent and the serum, lymph, blood or extra cellular fluid is visible. A vesicle with a diameter greater than 0,5 cm is a bulla.

Pustules
A pustule is a circumscribed, raised lesion that contains a purulent exudate.

Telangiectasia
Telangiectases are permanent dilatation of capillaries that may or may not disappear with application of pressure

Secondary lesion

Lichenification
Lichenification is proliferation of keratinocytes and stratum corneum, in combination with changes in the collagen of the underlying dermis, causes lichenified areas of skin to appear as thickened plaques with accentuated skin markings.

Abscess
An abscess is a localized accumulation of purulent material so deep in the dermis or subcutaneous tissue that the pus is usually not visible on the surface of the skin. It is red, warm and tender.

Cysts
A cyst is a sac that contain liquid or semisolid material (fluid, cell and cell product).

Crusts
A crusts are hardened deposits that result when serum, blood or purulent exudate dries on the skin surface. Crusts may be thin, delicate and friable or thick and adherent.

Scales
A scales is an abnormal shedding or accumulation of stratum corneum in perceptible flakes.

Scar
A scar occurs wherever a wound or ulceration has taken place and reflect the paterns of healing in the affected area. Scar may be atrophic or hypertrophic.

Keloid
Hypertrophic scar that become pathologic, because it grow passed the margin of wound and tend to get bigger

Atrophy
An Atrophy is diminution or thinning of the skin . It may be limited to the epidermis or the dermis or may occur simultaneously in both.

Erosions
An erosion is a moist, circumscribed, usually depressed lesion that result from loss of all or portion of the viable epidermis. After the rupture of vesicles or bullas, the moist areas remaining at the base are called erosion.

Excoriations
Excoriations are superficial excavations of epidermis that may be linear or punctate and result from scratching.

Anetoderma
The loss of skin elasticity or atrophic without any significant changes at other part of skin

Sclerosis
Sclerosis refers to a circumsribed or diffuse hardening or induration in the skin, it is detected more easily by palpation than by inspection.

Verrucous
Warty surface

COLOR
Erythema Hypopigmentation Hyperpigmentation Others : brown, yellow, etc.

SIZE
Milliar Lenticular Nummular Plaque Centimeter Comparison with such as eggs, peanuts, coins, etc.

Shape and Arrangement of Lesions

Linear Annular Nummular Discoid Arciform Polycyclic Group Irisform Herpetiform Zosteriform Corymbiform Reticular Serpiginous Round Oval Irregular Pedunculated

Border of Lesion or Rash

Distribution of Skin Lesions

Localized Regional Bilateral
Generalized Universal Symmetrical