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8/18/2019 2. Diagnosis of Skin Diseases
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Diagnosis ofSkin Diseases
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History and PhysicalExamination
• 90% of skin diseases can be properly diagnosed withmeticulous history and proper physical examination.
• In the history the chief complaint, onset, progression,
associated symptoms, drug history, past medicalhistory, personal history, family history, race, systemreview are all important.
• The prinicipal steps in physical examination arepalpation and inspection.
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Skin Lesions
• lassi!ed as "#I$#&' ()*+#& (-I+)(I*+(.
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Primary Skin Lesions
$acule
"atch
"apule
+odule
Tumor"la/ue
esicle
"ustule
1ullae
2heal Telangiectasia
bscess
"etechiae, purpura ' ecchymosis
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Macule
• 3at, coloredlesion, 45cm indiameter, not
raised above thesurface ofsurrounding skin
• 6reckle 7 prototype
of pigmentedmacule
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Macule
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patch
• large8:cmdiametr;3at lesionwith a color
di
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Papule
• small, solidlesion, 40.> cmin diameter, raised
above the surfaceof surrounding skin' hence palpable
• )g? white head in
acne
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Papule
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Nodule
• large 8 5 cm ;,!rm lesion raisedabove the surface
of surrounding skin.• i
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Tumor
• solid,raisedgrowth :cm indiameter
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Plaque
• large 5cm, 3attoppedAplateau likeraised lesion, edges
may either bedistinct 8 inpsoriasis ; orgradually blend
with surroundingskin 8 inec=ematousdermatitis;
• iameter greater
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esicle
• are small papule,3uid !lled lesion,45cm in diameter,
raised above theplane ofsurrounding skin.6luid is often visible
and the lesion aretranslucent
• esicles in llergicontact ermatitis
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Pustule
• vesicle !lled withleukocytes ' pus45cm
• The presence ofpustule does notnecessarily signifythe the existance of
infection
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!"scess
• localisedcollection of pus ina cavity, more than
5 cm in diameter
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"ulla
• 3uid !lled ,raised, often atranslucent lesion
5cm in diameterand it is the largerform of vesicles.
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#heal
• raised,erythematous,edematous,
papule A pla/ue,usuallyrepresenting shortBlived vasodilatation
andvasopermeability
• )g? utricaria
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telangiectasia
• dilated super!cialblood vessel like
C".
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Petechiae$ purpura %ecchymosis
• "etechiae 7 pinheadBsi=ed macules of extravascular blood in the dermis.
• "etechiae are 3at.
• The larger ones are referred to as purpura
• If bleeding involves deeper structures then it iscalled ecchymosis
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&urro'
• linear or cuvillinear papule, caused byburrowing scabies mite
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(omedones
• plug of keratin and sebum wedged in dilatedpilosebaceous ori!ce.
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Secondary Skin Lesions
(cale
rust
)xcoriation
)rosion6issure
(inus
(car
trophy(triae
icheni!cation
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Scale
• 3ake arising fromstratum corneumdAt excessive
accumulation.• )g? psoriasis
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(rust
• ried exudate ofbody 3uids 8blood Aserous 3uid;
•2hich might beeither yellow8 serous crust ;
red 8hemorrhagiccrust ;
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)lcer
• n area of skinfrom which thewhole of epidermis
' atleast the upperpart of dermis hasbeen lost
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Excoriation
• inear, angularerosions that maybe covered by crust
and are caused byscratching.
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Erosion
• rea of skindenuded8removed;by complete or
partial loss ofepidermis.
• +o associated lossof dermis
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*issure
• slitB shaped deepulcer
• )g? irritant
dermatitis of hands
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Sinus
• cavity or channelthat permits theescape of pus or
3uid
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Scar
• change in theskin secondary totrauma or
in3ammation• (ites may be
erythematous,hypopigmented or
hyperpigmenteddepending upontheir ageAcharacter.
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Scar
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!trophy
n ac/uired loss ofsubstance .
In skin, this mayappear as a depression
with intact epidermis8 loss of dermal Asubdermal tissues ;
*r appear as sites of
shiny, delicate,wrinkled lesions8 epidermal atrophy ;
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Striae
• streak like,linear , atrophic,pink, purple or
white lesion dAtchanges inconnective tissue
• )g? cushings
syndrome,pregnancy induced
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Licheni+cation
• distinctivethickening of skinthat is
characteri=ed byaccenuated skinBfold markings.
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Primary Skin Lesions
Macule: 3at area of altered colour or texture 8less than 0.> cm;
Patch: large macule 8more than : cm in diameter; Papule: elevated solid lesion 8less than 0.> cm;
Nodule: elevated solid lesion 8more than 0.> cm, diameter@thickness;
Plaque: elevated area of skin of more than : cm indiameter8diameter the thickness;.
Vesicle: 3uid !lled papule 8less than 0.> cm;
Bulla: larger blister 8more than 0.> cm; TD$*#B larger bullae or nodule8more than :cm;
Pustule: collection of free pus
Abscess: locali=ed collection of pus in a cavity 8more than 5 cm;
Petechia, Ecchymosis, Purpura
Telangiectasia
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Secondary Skin Lesions
Scale: 3ake from the horny layer rust: dried serum, exudates or tissue 3uid
!lcer: whole of the epidermis and part of dermis lost
E"coriation: linear erosion or ulcer produced by
scratching Erosion: partial loss of the epidermis
#issure: slit in the skin
Sinus: channel that permits escape of pus or 3uid
Scar: result of healing, normal structure replaced by!brous tissue
Atrophy: thinning of skin.
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!rrangement of Skin Lesions
• iscreteAseparate
• EroupedAcoalese
• inear
•
rcuate• ircinate
• Eyrate
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Distri"ution of Skin Lesions
• (ymmetry, asymmetry
• 6lexural, extensor
• )xposed, overed
•
"hoto• (ebaceous
• ermatomalA(egmental
• cral, entral
•
"alms and soles
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Special Techniques
5. ). "ercutaneous Testing
. $ite )xamination
J. -*K )xamination
L. T=ank (mear
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Principles of Treatment
• rugs for skin diseases could be given topicaly,oraly, parentraly or intralesionaly.
• Topical therapy is the milestone
• onsidering the active ingradient coupled with thevehicle is important.
• Topical preparations are classi!ed based on thevehicle.
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•reams
•*intments•otions
•(hampoos•"astes
•Eels
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Topical Steroids
• The most commonly used topical preparations
• Improper use has led to signi!cant side e
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Principles of using topicalsteroids
• onHt use for uncertain diagnosis and cosmeticreason
• 6irst treat concomittent infection
• Dse the mildest steroid possible
• onHt apply potent steroids to the baby skin, faceand intertreginous areas
• onHt apply potent steroids more than two weeks.
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Side E,ects of Steroids
• ocal• 1alnching
• trophy
• cne form eruptions
• Infections• Elaucoma
• ataract
• (ystemic side e