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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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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
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Skin examination II
Rashes
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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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
Clinical Skills Resource Centre, University of Liverpool, UK
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
Clinical Skills Resource Centre, University of Liverpool, UK
5/7/2009
Macule
Papule
Small and circumscribed lump e.g. pimple Usually <5 mm in diameter Solid Palpable Raised
Nodule = lump
Vesicle
Small, elevate, palpable, fluid filled (blister) e.g.. Herpes simplex (cold sores), Chickenpox.
http://www.dermnet.com
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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
http://www.dermnet.com
5/7/2009
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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
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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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