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Dermatological assessment Flashcards

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1
Q

Setting the scene (2)

A

EXPOSURE: when examining the skin, you need to look at the whole skin.

LIGHTING + MAGNIFICATION: A through skin examination cannot be carried out without good lighting.

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2
Q

RASH: Definition

A

A rash is a change of the human skin which affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin.

Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell, and may be painful.

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3
Q

LESION: Definition

A

An area of abnormal tissue. A lesion may be benign (not cancer) or malignant (cancer).

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4
Q

Patient assessment: Dermatology (6)

A
  • Look
  • Palpate
  • Describe
  • Examine hidden sites
  • Relevant general examination
  • Record findings
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5
Q

Blanching vs. non-blanching rash

A

Non-blanching rash (NBR) is a term for any rash in which the colour is unchanged with direct pressure. The redness is likely caused by blood outside the blood vessels.

Blanching rash is caused by blood in vessels.

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6
Q

Location + distribution of skin lesions

A
  • Acral
  • Extensor
  • Flexural
  • Follicular
  • Dermatomal
  • Seborrhoeic
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7
Q

Location + distribution of skin lesions: ACRAL

A

Affecting distal areas, hands + feet

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8
Q

Location + distribution of skin lesions: EXTENSOR

A

Extensor sufaces, elbows, knees

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9
Q

Location + distribution of skin lesions: FLEXURAL

A

Flexural surfaces, axillae, genital area, cubital fossa

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10
Q

Location + distribution of skin lesions: FOLLICULAR

A

Arising from hair follicles

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11
Q

Location + distribution of skin lesions: DERMATOMAL

A

Corresponding with nerve root distribution

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12
Q

Location + distribution of skin lesions: SEBHORRHOEIC

A

Associated with areas where there are sebaceous glands, face and scalp

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13
Q

Configuration of the lesion(s)

A

Configuration refers to the shape or outline of skin lesions. The pattern of multiple lesions or shape of an individual lesion can assist in diagnosis.

  • Assess if the lesion is discrete or confluent
  • Assess the shape of the lesion(s)
  • Assess the border of the lesion(s) – well defined vs poorly defined
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14
Q

Types of configurations

A
  • Discrete
  • Confluent
  • Linear
  • Discoid (coin-shaped)
  • Target
  • Annular
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15
Q

Types of configurations: DISCRETE

A

Discrete lesions – individual lesions, clearly separated from one another

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16
Q

Types of configurations: CONFLUENT

A

Confluent lesions – lesions that appear to be merging together

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17
Q

Types of configurations: LINEAR

A

Linear lesions – e.g. scratching related lesions

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18
Q

Types of configurations: DISCOID

A

Discoid (coin shaped) – discoid eczema/discoid lupus

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19
Q

Types of configurations: TARGET

A

Target lesions – concentric rings of varying colour – resembles a bullseye – erythema multiforme

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20
Q

Types of configurations: ANNULAR

A

Annular – ring like lesions

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21
Q

Assess the colour of the lesion: (5)

A
  • Erythema
  • Purpura
  • Hyperpigmentation
  • Hypopigmentation
  • Depigmentation
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22
Q

Assess the colour of the lesion: Erythema

A

Erythema:

  • Redness of the skin
  • Caused by increased blood supply
  • Blanches when pressure is applied to it
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23
Q

Assess the colour of the lesion: Purpura

A

Reddish/purple discolouration of the skin

  • Caused by bleeding into the skin
  • Do not blanch when pressure is applied

Types of purpura include:

  • Petechiae – small red/purple spots on the skin (<2mm in width)
  • Ecchymosis – larger red/purple lesions (>2mm) – commonly referred to as a bruise
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24
Q

Assess the colour of the lesion: Hyperpigmentation

A
  • An increased amount of melanin production results in hyperpigmentation of the skin
  • It can be diffuse or focal and has many causes
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25
Assess the colour of the lesion: Hypopigmentation
- Areas of paler skin caused by melanocyte and melanin depletion or dysfunction. - Pityriasis versicolour is a superficial fungal infection of the skin that impairs melanocyte function resulting in hypopigmentation.
26
Assess the colour of the lesion: Depigmentation
- Depigmentation describes the absence of melanin within the skin resulting in the skin appearing completely white. - Vitiligo is an autoimmune condition that results in the destruction of melanocytes and therefore the loss of pigment in the areas of skin affected.
27
Morphology
Assess the form and structure of the lesion – Is the lesion flat, raised above the plane of skin, or depressed below the plane of skin? These can be: - Primary lesions - Secondary lesions
28
Morphology: Primary lesions (12)
- Macule - Patch - Papule - Nodule - Plaque - Vesicle - Bulla - Pustule - Abscess - Wheal - Boil/furuncle - Carbuncle
29
Morphology: Secondary lesions
Secondary lesions are modifications of primary lesions that occur due to trauma to, or evolution of, the primary lesion. Examples include: - Excoriation - Lichenification - Scales - Crust - Scar - Ulcer - Fissure - Striae
30
Morphology: Primary lesions - MACULE
A flat area of altered colour <1.5cm in diameter
31
Morphology: Primary lesions - PATCH
A flat area of altered colour >1.5cm in diameter
32
Morphology: Primary lesions - PAPULE
Solid raised palpable lesion <0.5cm in diameter
33
Morphology: Primary lesions - NODULE
Solid raised palpable lesion >0.5cm in diameter
34
Morphology: Primary lesions - PLAQUE
- Palpable flat lesion usually >1cm in diameter - Most are raised, but some may just be thickened without being visible raised - Its borders may be well defined or poorly defined
35
Morphology: Primary lesions - VESICLE
Raised, clear fluid filled lesion <0.5cm in diameter
36
Morphology: Primary lesions - BULLA
Raised, clear fluid filled lesion >0.5cm in diameter
37
Morphology: Primary lesions - PUSTULE
Pus containing lesion <0.5cm in diameter
38
Morphology: Primary lesions - ABSCESS
Localised accumulation of pus
39
Morphology: Primary lesions - WHEAL
Oedematous papule or plaque caused by dermal oedema.
40
Morphology: Primary lesions - BOIL/FURUNCLE
Staphylococcal infection around or within a hair follicle
41
Morphology: Primary lesions - CARBUNCLE
Staphylococcal infection of adjacent hair follicles (multiple boils/furuncles)
42
Morphology: Secondary lesions - EXCORIATION
Loss of epidermis associated with trauma
43
Morphology: Secondary lesions - LICHENIFICATION
- Thickening of the epidermis seen with exaggeration of normal skin lines - It is usually due to chronic rubbing or scratching of an area
44
Morphology: Secondary lesions - SCALES
- Visible fragments of the stratum corneum as it is shed from the skin - Most commonly associated with psoriasis
45
Morphology: Secondary lesions - CRUST
- Rough surface consisting of dried serum, blood, bacteria and cellular debris - The serum, blood, bacteria and debris has usually exuded through an eroded epidermis
46
Morphology: Secondary lesions - SCAR
- New fibrous tissue which occurs after skin injury - Atrophic scarring – thinning of the normal tissue - Hypertrophic scarring – hyperproliferation of scar tissue within the wound boundary - Keloidal scarring – hyperproliferation of scar tissue beyond the wound boundary
47
Morphology: Secondary lesions - UCLER
- Localised defect in the skin of irregular size and shape where epidermis and some dermis have been lost - Results in scarring
48
Morphology: Secondary lesions - FISSURE
- Sharply-defined, linear or wedge-shaped tears in the epidermis with abrupt walls - Usually due to excess dryness
49
Morphology: Secondary lesions - STRIAE
- Often referred to as stretch marks - Evolution in colour = Purple -> Pink ->White - Associated with growth spurts, excess steroid use or production and pregnancy
50
Assessment of a pigmented lesion
If lesion is pigmented use the ABCDE assessment method: - Asymmetry - Border - Colour - Diameter - Evolution
51
PALPATION of skin lesions
Assess SURFACE characteristics of the lesion - Texture – smooth/rough – e.g. roughness in hyperkeratosis (scales) - Flat, raised or depressed? - Crust – if present, are you able to remove crust and see what is underneath? - Temperature – is the lesion warm? Assess DEEPER characteristics of the lesion - Consistency – hard/soft/firm/fluctuant - Mobility – is the lesion attached to the underlying/overlying tissue? - Tenderness – is the lesion tender on palpation?
52
NAIL pathology
- Nail pitting - Onycholysis - Koilonychia - Nail clubbing
53
Nail pathology: Nail PITTING
- Punctate depressions of the nail plate | - Associated with eczema, psoriasis and alopecia areata
54
Nail pathology: ONYCHOLYYSIS
- Separation of the distal end of the nail plate from the nail bed - Associated with psoriasis and fungal nail infection
55
Nail pathology: KOILONYCHIA
- Spoon shaped indentation of the nail plate | - Associated with iron deficiency anemia, can also be congenital
56
Nail pathology: NAIL CLUBBING
- Loss of the angle between the posterior nail fold and nail plate - Associated with many conditions including inflammatory bowel disease, cyanotic heart disease, lung cancer, bronchiectasis
57
OTHER pathology
Elbows: - Xanthomas – secondary to underlying hyperlipidaemia - Psoriasis plaques on elbows
58
Inspect the HAIR + SCALP
- Loss of hair - Excess hair - Scalp
59
Inspect the HAIR + SCALP: Loss of hair
- Alopecia areata – well defined patches of hair loss with surrounding normal hair - Alopecia totalis – loss of all hair from the scalp (affects 5% of those with autoimmune hair loss)
60
Inspect the HAIR + SCALP: Gain of hair
- Hirsutism – androgen dependent excess hair growth in females - Hypertrichosis – non-androgen dependent excess hair growth
61
Inspect the HAIR + SCALP: Scalp
- Psoriasis plaques | - Dandruff – e.g. seborrheic dermatitis

Dermatology (8 decks)

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