Upload
igm-ardika-aryasa
View
231
Download
0
Embed Size (px)
Citation preview
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
1/55
dr. NM Dwi Puspawati, SpKKBag/SMF I. Kes. Kulit & KelaminFK Unud/RS Sanglah Denpasar
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
2/55
The art of Diagnosis in General :
• Anamnesis
• Physical Examination
• Laboratory finding
Detailed systematic history with good physicalexamination, supplemented by appropriate laboratory
test will be the golden rule for the correct approach inthe diagnosis
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
3/55
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
4/55
GENERAL HISTORY
! "ace, geographical
#! $ocial bac%ground, ethnic tradition, dietary habits
&! Past medical history : allergy to medication, hay fe'er,asthma, past ma(or illness or operation
)! $ocial * occupational history: tra'el abroad, hobbiesand details of the type of wor%, substances in contact
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
5/55
History of present illness : duration, date * site of onset,details of spread, e'olution of rash * original morphology,symptoms such as itchiness, pain, burning sensation, numbness,precipitating and relie'ing factors such as climate, sunlightetc!, treatment +topical * systemic medication sought or
applied
Past history of skin disorders : history of sunburn
Faily history of skin disorders : e!g! s%in cancers and atopicdisorders-stigmata atopic
!r"#s : include herbs, topical, systemic, patient initiated orphysician prescribed! Patient.s own perception on the cause ofthe problem
SPE$IAL HISTORY
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
6/55
E%A&INATION OF S'IN
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
7/55
! Ade/uate pri'acy
#! Good lighting
&! $patula, magnifying glass and transparent glass slide fordiascopy
0t is a good practice if affordable to ha'e thoroughexamination of the whole body especially for newconsultation and for the elderly
$ometimes, examination of the bac% and buttoc% of the
elderly may pic% up unexpected lesions, e'en the patienthimself or herself may not notice them e!g! persistentchronic annular erythematous rash in the buttoc% found ina case of tuberculoid leprosy
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
8/55
Do not s%ip examination of the nail, scalp and oral mucous
membrane because there may be 'aluable clues, find theatopic stigmata
0n dermatology : uni/ue of physical examination by the'isual of the s%in and the s%in lesions E11L2"E$3E43E
Good and clear description of s%in lesion can be diagnosedof some s%in disease with a high degree of confidence
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
9/55
EFFLORES$EN$E :A s%in lesion is an abnormal growth or an area of s%in that
does not resemble the s%in surrounding it +normal s%in2b(ecti'e appearance
!ETAIL !ES$RI(E! OF S'IN LESION :!Type of s%in lesion#!3haracteristic of lesion : colour, multiple or soliter,shape, margin, si5e, surface characteristics, temperatureand smell
&!Arrangement and configuration)!Distribution
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
10/55
)* Type of skin lesion :!! Primary lesion :•
6acula• Papule• Pla/ue• 7esicle• Pustule
!#! $econdary lesion :• $cale•
3rust• 8lcer• Erosion• Excoration
•
4odul• 8rtica• 9ula• 3yst
• Lichenification• Atrophy• $car• 1issure
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
11/55
#! $hara+teristi+ of skin lesion :
• 3olour salmonpin%, erythematous,
hyperpigmented, s%in colour, yellow• 6ultiple or soliter
• $hape geometric shape, o'al
• 6argin sharpness of edge, welldefined, illdefined
• $i5e diameter, punctata, numuler
• $urface characteristics domeshaped, umbilicated,
spi%e li%e• Temperature and smell warm on palpation, mousyodor
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
12/55
&! Arran#eent and +onfi#"ration :• Grouped as in dermatitis herpetiformis, herpessimplex, common warts• Annular or arciform as in granuloma annulare, mycosis
fungoides, tinea circinata, erythema annularecentrifugum• Linear pattern as in lichen planus, lichen striatus,morphoea, lichen sclerosis, phytophotodermatitis
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
13/55
,* !istri-"tion :•
symmetrical, asymmetrical• exposed area, sun exposed area• scalp region, hand• extensor aspect, flexor aspect
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
14/55
P"06A"; LE$024
Primary lesions are the first toappear and are due to thedisease or abnormal state
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
15/55
A* &A$.LE
flat, nonpalpable circumscribed area of color changein the s%in! 6acules are < # cm in si5e!
6acules may be the result of
+Ainflammatory 'ascular dilation-hyperemia+9bleeding-hemorhagia-purpura
+3change of s%in pigmentation
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
16/55
A*)* Hypereia /0as+"lar dilatation1
+Latin hyper: = o'er> :emia = related to blood is atemporary s%in redness due to increased blood flow in aparticular s%in, or mucosal area! The lesion blanch uponpressure +diascopy!
! "oseola +@ cm-nail plate#! Erytematous + cm
&! Telengictasis : dilated
superficial blood 'essels,especially of the upperreticular dermal plexus!
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
17/55
A purpura (Latin purpura = purple) is a small (3mm– 1 cm) purplish bruise/ violaceous color due toextravasations of blood into the tissue. t does notblanch on appl!in" the pressure.1.#etechia $ (Latin petecchia (plural = petechiae) =spot on s%in) is a small (& 3 mm) red or purple bruise'.ibises3.cchimoses (lar"e* + 3 mm)
cchimoses* purpurae* and petechiae are caused b!trauma* or disorders of the blood or vessels
A*2* Heorha#ia3p"rp"ra
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
18/55
A*4* $han#e of skin pi#entation
! Byperpigmentation increase of pigmentation
o! 6elasma gra'idarum o! Efelides-fri%el o! Drugs : $ulfonamide, Cina o! Addisons disease
o! 6ongolian spot
Biperpigmentation
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
19/55
#! Bypopigmentation decrease of pigmentationo! Pithyriasis 'ersicolor
o! Leucoderma
&! Depigmentasi no pigmento! 7itiligo
Bipopigmentation
http://www.pediatrics.wisc.edu/derm/tuta/03.html
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
20/55
•
$mall solid ele'ation of s%in generally < mm in diameter!• Papules may be flattopped, as in lichen planus> or dome shaped, asin xanthomas> or spicular, if related to hair follicles
• Papules may result from :
+A dermal metabolic deposits
+9 locali5ed dermal cellular infiltrates
+3 locali5ed hyperplasia of dermal or epidermal cellularelements
(* PAP.LE
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
21/55
Two firm domeshaped papules dermalmelanocytic ne'i
6ultiple welldefined and coalescing papules lichen planus!
$ PLA5.E
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
22/55
palpable, plateauli%e ele'ation of s%in, usually more than #cm in diameter and rarely more than mm in height! 2ftenformed by a con'ergence of papules, as in psoriasis!
$* PLA5.E
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
23/55
Pla/ues occupy a relati'ely largesurface area in comparison with itsheight abo'e the s%in!
elldefined, reddish,scaling pla/ues
http://dermnetnz.org/common/image.php?path=/scaly/img/ps3.jpg
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
24/55
7esicles are raised lesions less than cm! in diameter
that are filled with clear fluid! 7esicle walls can be sothin that the contained serum, lymph, blood, orextracellular fluid is easily seen! 1luid can beaccumulated within or below the epidermis!
!* 6ESI$LE
http://www.dermnet.com/image.cfm?passedArrayIndex=15&moduleID=21&moduleGroupID=307
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
25/55
E (.LA /(LISTER1
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
26/55
9ula +Lat! bulla = bubble is a 'esicle that exceeds cm in si5e
circumscribed, ele'ated lesion that is cm in diameter, containingserous +clear fluid! A 'esicle-bulla is the technical term forblisters!
E* (.LA /(LISTER1
F P.ST.LE
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
27/55
superficial, ele'ated lesion that contains pus +pus ina blister! Pustules may 'ary in si5e and shape! The
color may appear white, yellow, or greenishyellowdepending on the color of the pus! Pus is composedof leu%ocytes with or without cellular debris! 0tmay also contain bacteria or may be sterile!
F* P.ST.LE
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
28/55
A pustule is basically a papule
containing pus
$uperficial, subcornealpustules pustular psoriasis
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
29/55
palpa-le7 solid7 ro"nd7 or ellipsoidal lesion* 0ts depth of in'ol'ement
and-or palpability differentiate it from a papule rather than itsdiameter +although nodules are usually larger than papules: mmdiameter! 4odules can in'ol'e any layer of the s%in and can beedematous or solid! 9ased on the anatomical component+s in'ol'ed,there are fi'e types of nodules: epidermal, epidermaldermal, dermal,
dermalsubdermal, and subcutaneous!Telangiectasia can be seen
G* NO!.LE
H $YST
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
30/55
An epithelial lined ca'ity containing
li/uid or semisolid material +fluid, cells,and cell products! A spherical or o'alpapule or nodule may be a cyst if, whenpalpated, is resilient +feels li%e aneyeball!
! 6ost common are +A epidermalcysts, lined by s/uamous epithelium andproduce %eratinous material! +9 Pilarcysts, lined by multilayered epitheliumwhich does not mature through the
granular layer!
#! 9luish, resilient cyst filled withmucous material adnexal tumor+cystic hidradenoma!
H* $YST
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
31/55
Transitory, compressible papule
or pla/ue of dermal edema!
The papule or pla/ue is usuallyrounded or flattoped, ande'anescent, disappearing within
hours! The borders of a whealare sharp, but not stable andcan mo'e from in'ol'ed toad(acent unin'ol'ed areas o'er
hours!
A wheal may be large coalescingpla/ues as in this allergicreaction!
I* 8HEAL OR .RTI$A
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
32/55
An er"ption of 9heals is tered "rti+aria and"s"ally it+hes
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
33/55
, -omedo
acne, elen"iectasion, urro0 scabies
* SPE$IAL LESION
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
34/55
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
35/55
$E324DA"; LE$024
"esult from the naturale'olution of primary lesions
E
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
36/55
$cale accumulation or abnormal shedding of horny
layer %eratin +stratum corneum in perceptiblefla%es! $cales usually indicate inflammatory changeand thic%ening of the epidermis! The may be fine,as in pityriasis> white and sil'ery, as in psoriasis> orlarge and fishli%e, as in ichtyosis
A* S$ALE
+A Para%eratotic scale +withretained nuclei can be seen inpsoriasiform epidermal
hyperplasia
+9 Actinic %eratosis is adensely adherent scale withgritty feel due to a locali5edincrease in stratum corneum
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
37/55
Typical psoriasis scaling
$cales may build up to form an asbestosli%e layerco'ering the underlying lesion!
( L$ER
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
38/55
circumscribed area of s%in lossextending through the epidermisand at least part of the dermis+papillary!
! 9asically, it.s a Fhole in thes%inF! 8lcers usually result fromthe impairment of 'ascular andnutrient supply to the s%in!
#! Gigantic ulcer, red granulatingbase with punched out borders!
(* .L$ER
$ $R. T
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
39/55
• Dried serum, blood, or pus
on the surface of s%in!6ay be thin, delicate, andfriable or thic% andadherent!
• 3rusts are yellow, if fromserum> green or yellowgreenif from pus> or brown ordar% red if formed fromblood! 3haracteristic of
pyogenic infections!• 3rusts that occur ashoneycoloured, delicate,glistening particulates aretypical of 0mpetigo!
$* $R.ST
! EROSION < E%$ORATION
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
40/55
Erosion: oist7 +ir+"s+ri-ed7
sli#htly depressed areas of skind"e to loss of all or part of theepideris
)* Often res"lts fro er"ptionsof 0esi+les and -"llae* Seen ininfe+tion fro herpes 0ir"ses andin pephi#"s*
2* To;i+ epideral ne+rosis+a"ses erosion*
!* EROSION < E%$ORATION
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
41/55
E;+oriation: linear orpunctate superficial
exca'ations of epidermiscaused by scratching,rubbing, or pic%ing!
E LI$HENIFI$ATION
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
42/55
3hronic thic%ening of the s%in along with increased s%inmar%ings! "esults from scratching or rubbing!
E* LI$HENIFI$ATION
F ATROPHY
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
43/55
There is loss of normal s%in texture
Paperthin, wrin%led s%in with easily 'isible'essels! "esults from loss of epidermis,dermis or both! $een in aged, some burns,and longterm use of highly potent topicalcorticosteroids!
+A Dermal atrophy manifests as adepression in the s%in
+9 Epidermal atrophy manifests as thinalmost transparent s%in> may not retain
normal s%in lines!
F* ATROPHY
G S$AR
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
44/55
"eplacement of normal
tissue by fibrous connecti'etissue at eh site of in(ury tothe dermis! $cars may behypertrophic, atrophic,sclerotic or hard due tocollagen proliferation!"eflects pattern of healingin the affected area!
! +A Bypotrophic or +9atrophic scar!
#! Bypertrophic scar!
G* S$AR
H FISS.RE /RHAGA!E1
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
45/55
A fissure is linear clea'age of s%in which extendsinto the dermis!
H* FISS.RE /RHAGA!E1
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
46/55
A""A4GE6E4T A4D
32410G8"AT024
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
47/55
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
48/55
Linear lesions occur in a lineor bandli%e configuration!This descripti'e term may
apply to a wide 'ariety ofdisorders! 2ne should becertain that the lesions arenot following a dermatome
)* LINEAR LESION
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
49/55
2* 'OE(NER PHENO&ENON
The Coebner phenomenon,also called the isomorphicresponse, refers to theappearance of lesions alonga site of in(ury! This
phenomenon is seen in a'ariety of conditions> forexample, lichen planus,warts, molluscum
contagiosum, psoriasis,lichen nitidus, and thesystemic form of (u'enilerheumatoid arthritis!
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
50/55
4* G.TTATE
Guttate lesions loo% asthough someone too% adropper and dropped thislesion on the s%in! Guttatelesions are characteristicof one form of psoriasis,
though that is not the onlyexample!
= ANN.LAR
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
51/55
Annular lesions are seen in a ring shape! Tinea corporis,
erythema migrans +the lesion associated with lymedisease, and granuloma annulare are three commonexamples!
=* ANN.LAR
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
52/55
>* $ONFL.ENT
3onfluent lesions tend to run together
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
53/55
D0$T"098T024 21 $C04
LE$024
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
54/55
8/20/2019 1. BCS LCD Efloresensi dr. PS.ppt
55/55