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History and examination of skin problems

Majority of Photographs kindly supplied by: http://www.dermnet.com


5/7/2009 Clinical Skills Resource Centre, University of Liverpool, UK

Features of history to be considered


Use the generic symptoms framework Additional features to consider pruritus (itchiness) pain pattern of spread of the skin disorder progress response to any treatment

family history occupational history hobbies any precipitants, including medication Duration of condition Improving or worsening Site of onset Any contacts with similar problems
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Clinical Skills Resource Centre, University of Liverpool, UK

Skin examination I

Magnifying glass is useful to examine skin lesions A good light is essential A Woods light is helpful in fungal infections (ultraviolet) Skin should be gently palpated to assess texture and blanching of lesions Assess depth and elevation of lesions Assess tenderness and temperature Need to examine as much of the skin as is necessary to establish extent of skin disorder Skin disorders may be

primary skin diseases secondary to a generalised or systemic disease

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Clinical Skills Resource Centre, University of Liverpool, UK

Skin examination II

General examination of skin (including mucous membranes)


Rashes

Site(s) and distribution


colour texture rashes

symmetry truncal or peripheral light exposed contact pattern

Hair and nails should normally be examined General physical examination as indicated Genitalia, if indicated

Extent Number of lesions Size of lesions Colour Discrete or confluent Type of lesion(s)

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Clinical Skills Resource Centre, University of Liverpool, UK

Glossary I

Abscess Alopecia Cellulitis Desquamation Eczema Erosion Excoriation Enanthem Exanthem Erythema

- Localised collection of pus - Loss of hair - An infection of skin - Peeling of skin - pimples and blisters on a red background - Superficial break in skin - Scratched lesion - Eruption on mucous membrane - Skin eruption - Area of redness fades on pressure
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5/7/2009

Glossary II

Fissure

- Linear, superficial skin break(cracked skin) Herpetiform - Groups of vesicles Keratosis - a horn-like skin thickening Lesion - a pathological entity Lichenification - Skin thickening with increased skin markings (seen typically in atopic eczema) Urticaria -Vascular reaction characterised by wheals which are transient itchy flesh coloured elevated patches
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Macule

Small and circumscribed Flat (e.g.. Freckles or the rash of measles)

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Papule

Small and circumscribed lump e.g. pimple Usually <5 mm in diameter Solid Palpable Raised

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Nodule = lump

Palpable lesion Solid rounded lesion Usually > 0.5cm Elevated

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Vesicle

Small, elevate, palpable, fluid filled (blister) e.g.. Herpes simplex (cold sores), Chickenpox.
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Bulla

Localised Within or beneath the epidermis Fluid filled >5 mm in diameter Elevated Large blister

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Pustule

Small Elevated Palpable Fluid filled with pus (white cells)

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Purpura (bleeding under the skin) Does not blanch under pressure

May be in the form of a rash within the skin or mucous membranes (seen in meningitis) Large areas (bruises) known as ecchymosis The individual spots (less than 1-2mm) are known as petechiae

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Telangiectasia

Localised dilatations of capillaries Superficial Maybe familial http://www.immunologyclinic.com

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Plaque

Raised area of skin e.g. common in psoriasis Patch or patches >5 mm in diameter

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Ulcer

Results from loss of epidermis and at least part of http://www.immunologyclinic.com the,exposes deeper tissue

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