Dermatology Examination

Dr. Adhimukti T. Sampurna, SpKK

Dermato-Venereology Department
University of Indonesia
Objective?
 Skin lesion examination

1.Location
2.Type of skin lesion
3.Number
4.Color
5.Size
6.Border
7.Shape and arrangement skin lesion
8.Distribution
 Skin Examination Tools
• Magnifying tool
• Bright focused light
• Glass slide or hand magnifier (Diascopy)
• Alcohol pads to remove scale or surface oil
• Gauze pads or tissue with water to remove
makeup
• Gloves for examination (Scabies)
• Ruler
• Scalpel
• Camera
Location

Fitzpatrick T B, Johnson R A, Wolf K, Suurmond D. Color Atlas & Synopsis of Clinical Dermatology.
Common and Serious Diseases. Fourth Edition. New York, Mc Graw Hill Medical, 2001.
Type of Skin Lesions

Garg A, Levin N A, Bernhard J D. Structure of Skin Lesions and Fundamentals of Clinical

Diagnosis. In: Fitzpatrick’s Dermatology in General Medicine. Editors: Wolf K, Goldsmith L,
Katz S I, Gilchrest B, Paller A, Leffell D J. Seventh Edition. New York, Mc Graw Hill
Medical. 2008: 23-40.
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).
 Different
colors

Garg A, Levin N A, Bernhard J D. Structure of Skin Lesions and Fundamentals of Clinical

Diagnosis. In: Fitzpatrick’s Dermatology in General Medicine. Editors: Wolf K, Goldsmith
L, Katz S I, Gilchrest B, Paller A, Leffell D J. Seventh Edition. New York, Mc Graw Hill
Medical. 2008: 23-40.
 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)
 Shapes and surface of Papules
• Sessile • Rough
• Pedunculated • Smooth
• Dome-shaped • Filiform
• Flat topped • With scales 
• Umbilicated papulosquamous
 NODULES

A nodule is palpable, solid, round or ellipsoidal

lesion. Depth of involvement and/or
substantive palpability, rather than diameter
(> 0,5 cm), differentiate a nodule from a
papule.
Nodule basal cell carcinoma
Nodule calcinosis cutis
 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.
Garg A, Levin N A, Bernhard J D. Structure of Skin Lesions and Fundamentals of Clinical
Diagnosis. In: Fitzpatrick’s Dermatology in General Medicine. Editors: Wolf K, Goldsmith
L, Katz S I, Gilchrest B, Paller A, Leffell D J. Seventh Edition. New York, Mc Graw Hill
Medical. 2008: 23-40.
 WHEALS

A wheal is a rounded or flat topped

edema (swelling of the skin) that is
characteristically evanescent,
disappearing within hours.
Garg A, Levin N A, Bernhard J D. Structure of Skin Lesions and Fundamentals of Clinical
Diagnosis. In: Fitzpatrick’s Dermatology in General Medicine. Editors: Wolf K, Goldsmith
L, Katz S I, Gilchrest B, Paller A, Leffell D J. Seventh Edition. New York, Mc Graw Hill
Medical. 2008: 23-40.
 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.
Confluenced vesicles/ bulla
 PUSTULES

A pustule is a
circumscribed, raised
lesion that contains a
purulent exudate.
Purulent bulae
 Telangiectasia

Telangiectases are permanent

dilatation of capillaries that may
or may not disappear with
application of pressure
Telangiectasia
 Basal cell carcinoma
Telangiectasia
Diascopy test
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 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
(sign of inflammation).
 Cysts

A cyst is an encapsulated cavity

/ sac that contain liquid or
semisolid material (fluid, cell
and cell product).
Epidermoid cyst
 Crusts

A crusts are hardened deposits that

result when serum, blood or purulent
exudate dries on the skin surface.The
color of the crusts determine the fluid
origin.
Crusts may be thin, delicate and friable
or thick and adherent.
 Scales

Scales is an abnormal
shedding or accumulation of
stratum corneum and
perceptible as flakes.
Psoriasiform scales
Exfoliative scales
Ichthyosiform scales
Lamelar scales