EXAMINATION OF SKIN

1. General Survey:

   - Assess the overall skin color, noting any pallor, erythema, cyanosis, or jaundice.

   - Observe for any lesions, scars, or tattoos on the exposed areas.

2. Moisture:

   - Evaluate the skin's moisture level, looking for dryness or excessive sweating.

3. Temperature:

   - Gently palpate different areas to assess skin temperature variations.

4. Texture:

   - Run your fingers across the skin to identify any areas of roughness, smoothness, or unusual textures.

5. Hair and Nails:

   - Inspect the hair for texture, distribution, and any abnormalities.

   - Examine the nails for shape, color, and texture, noting any clubbing or abnormalities.

6. Lesions:

   - Systematically examine the skin for lesions. Use the ABCDE criteria for moles (Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolution/change).

7. Palpation:

   - Palpate lesions or rashes to assess their characteristics, such as tenderness, warmth, or texture.

8. Distribution:

   - Note the distribution of any skin findings, whether localized or widespread.

9. Special Areas:

   - In specific regions like the face, scalp, hands, and feet, pay extra attention to unique characteristics and potential pathologies.

10. Documentation:

    - Record your findings systematically, including the location, size, color, shape, and any associated symptoms.

In dermatology, categorizing and describing skin lesions follow specific arrangements and terminologies

1. Primary Lesions:

   These are the initial, unaltered skin abnormalities that arise as a direct result of a disease process. Primary lesions can be categorized into various types:

1. Macule:

- Description: Flat, colored spot on the skin, less than 1 cm.

- Examples: Freckle, Petechiae, Café-au-lait spot.

2. Papule:

- Description: Small, elevated, solid bump.

- Examples: Elevated nevus (mole), Wart, Lichen planus.

3. Nodule:

- Description: Solid, raised lesion, larger and deeper than a papule.

- Examples: Lipoma, Dermatofibroma, Rheumatoid nodules.

4. Vesicle:

-  Description:Small, fluid-filled blister, less than 1 cm.

- Examples:Herpes simplex blister, Chickenpox vesicle, Poison ivy blister.

5. Bulla:

- Description: Large, fluid-filled blister, more than 1 cm.

- Examples: Pemphigus vulgaris blister, Bullous impetigo, Bullous pemphigoid blister.

6. Pustule:

- Description:Pus-filled lesion.

- Examples: Acne pustule, Folliculitis pustule, Pustular psoriasis.

7. Plaque:

- Description: Large, flat-topped elevation on the skin.

- Examples:Psoriasis plaque, Lichen simplex chronicus, Seborrheic keratosis.

8. Wheal:

-Description: Transient, raised, erythematous, and pruritic area.

-Examples: Insect bite reaction, Urticaria (hives), Angioedema.

2. Secondary Lesions:

    Secondary lesions result from changes in primary lesions over time, often due to natural progression, manipulation, or external factors such as scratching.

1. Erosion:

- Description: Loss of the epidermis, often moist.

- Examples:Ruptured vesicle, Erosive lichen planus, Excoriation.

2. Ulcer:

- Description: Loss of both epidermis and dermis, may bleed.

- Examples: Decubitus ulcer, Venous stasis ulcer, Syphilitic chancre.

3. Scale:

- Description: Flaking or shedding of the stratum corneum.

- Examples: Dry skin scales, Psoriasis scale, Seborrheic dermatitis scale.

4. Crust:

- Description: Dried serum, blood, or pus on the skin surface.

- Examples: Impetigo crust, Eczema crust, Scab from a healing wound.

5. Fissure:

- Description:Linear crack or break in the skin.

- Examples:Athlete's foot fissure, Anal fissure, Hand eczema fissure.

6. Lichenification:

- Description:Thickened, rough skin from chronic irritation or scratching.

- Examples: Chronic eczema lichenification, Lichen simplex chronicus, Atopic dermatitis lichenification.

7. Keloid:

- Description: Hypertrophic scar extending beyond the original injury.

- Examples: Keloid formation post-surgery, Keloid on earlobe, Keloid after acne.

3. Distribution Patterns:

   - Symmetrical: Lesions appear on both sides of the body.

   - Asymmetrical:Lesions are unevenly distributed.

   - Localized: Lesions confined to a specific area.

   - Generalized: Lesions widespread across the body.

4. Configuration Patterns:

   - Annular: Circular shape.

   - Linear:Lesions arranged in a line.

   - Grouped: Lesions clustered together.

   - Serpiginous:Wavy or snake-like configuration.

5. Color of Lesions:

   - Erythematous: Redness of the skin.

   - Hyperpigmented:Darker than surrounding skin.

   - Hypopigmented: Lighter than surrounding skin.

   - Depigmented: Loss of pigment, resulting in a white appearance.

6. Lesion Evolution:

   - Acute: Lesions that develop rapidly.

   - Chronic: Lesions persist over an extended period.

7. Special Lesions:

   - Comedones: Plugged hair follicles, blackheads, or whiteheads.

   - Lipomas: Benign tumors composed of adipose tissue.

   - Petechiae: Small, red or purple spots caused by bleeding into the skin.

 Important Skin pathologies with definitions, types, and diagnosis methods:

1. Acne:

   - Definition: Chronic inflammatory skin condition involving the hair follicles and sebaceous glands.

   - Types:Comedonal acne, Inflammatory acne, Nodulocystic acne.

   - Diagnosis: Clinical examination, grading system (e.g., Leeds Acne Grading System).

2. Atopic Dermatitis:

   - Definition: Chronic inflammatory skin condition characterized by dry, itchy skin and eczematous lesions.

   - Types: Allergic contact dermatitis, Nummular dermatitis, Seborrheic dermatitis.

   - Diagnosis: Clinical evaluation, patch testing, skin biopsy.

3. Basal Cell Carcinoma:

   - Definition: The most common type of skin cancer originating from basal cells in the epidermis.

   - Types: Nodular, Superficial, Pigmented.

   - Diagnosis:Skin biopsy, dermatoscopy, Mohs micrographic surgery.

4. Psoriasis:

   - Definition: Chronic autoimmune skin condition marked by red, scaly plaques.

   - Types: Plaque psoriasis, Guttate psoriasis, Inverse psoriasis.

   - Diagnosis: Clinical examination, skin biopsy, psoriasis area and severity index (PASI).

5. Eczema (Dermatitis):

   - Definition: Inflammatory skin condition causing redness, itching, and swelling.

   - Types: Atopic dermatitis, Contact dermatitis, Nummular dermatitis.

   - Diagnosis: Clinical evaluation, patch testing, skin biopsy.

6. Melasma:

   - Definition: Hyperpigmentation characterized by dark patches, often occurring due to hormonal changes.

   - Types: Epidermal, Dermal, Mixed.

   - Diagnosis: Clinical examination, Wood's lamp examination, skin biopsy.

7. Rosacea:

   - Definition: Chronic skin condition leading to redness, flushing, and visible blood vessels.

   - Types: Erythematotelangiectatic, Papulopustular, Phymatous.

   - Diagnosis: Clinical evaluation, exclusion of other conditions, skin biopsy.

8. Seborrheic Dermatitis:

   - Definition: Chronic inflammatory skin condition causing scaly, itchy patches, often on the scalp.

   - Types: Scalp seborrheic dermatitis, Facial seborrheic dermatitis, Trunk and extremities seborrheic dermatitis.

   - Diagnosis: Clinical examination, skin scraping for microscopy, fungal culture.

9. Vitiligo:

   - Definition: Loss of skin pigmentation resulting in white patches.

   - Types: Generalized, Focal, Segmental.

   - Diagnosis: Clinical examination, Wood's lamp examination, skin biopsy.

10. Hives (Urticaria):

    - Definition: Raised, itchy welts on the skin caused by an allergic reaction.

    - Types: Acute urticaria, Chronic urticaria, Physical urticaria.

    - Diagnosis: Clinical evaluation, allergy testing, blood tests.

11. Molluscum Contagiosum:

    - Definition: Viral skin infection characterized by small, flesh-colored bumps.

    - Types: Localized, Generalized, Giant Molluscum.

    - Diagnosis: Clinical examination, biopsy if necessary.

12. Actinic Keratosis:

    - Definition: Precancerous skin growth caused by sun damage, appearing as scaly patches.

    - Types: Hypertrophic, Atrophic, Bowenoid.

    - Diagnosis: Clinical examination, dermatoscopy, skin biopsy.

13. Lichen Planus:

    - Definition: Inflammatory skin condition characterized by itchy, flat-topped bumps.

    - Types: Classic, Hypertrophic, Bullous.

    - Diagnosis: Clinical examination, skin biopsy, sometimes blood tests.

14. Dermatomyositis:

    - Definition: Inflammatory disease affecting the skin and muscles.

    - Types: Classic dermatomyositis, Amyopathic dermatomyositis, Clinically amyopathic dermatomyositis.

    -  Diagnosis:Clinical evaluation, muscle biopsy, blood tests (e.g., creatine kinase).

15. Tinea (Ringworm):

    - Definition: Fungal infection of the skin, often presenting as a circular rash.

    - Types: Tinea corporis, Tinea pedis, Tinea capitis.

    - Diagnosis: Clinical examination, skin scraping for microscopy, fungal culture.

16. Impetigo:

    - Definition: Contagious bacterial skin infection characterized by blisters or sores.

    - Types: Bullous impetigo, Non-bullous impetigo.

    - Diagnosis:Clinical examination, bacterial culture if needed.

17. Hidradenitis Suppurativa:

    - Definition:Chronic skin condition characterized by painful, inflamed nodules in areas with sweat glands.

    - Types: Hurley Stage I, Hurley Stage II, Hurley Stage III.

    - Diagnosis: Clinical

Some additional points in examination of skin

Inspection: 

Color:  

     Variations in color can indicate changes in blood flow, melanin production, or underlying inflammation. Redness could point to inflammation or infection, while paleness might suggest reduced blood flow or anemia. Melanin changes can signal sun damage, hormonal imbalances, or skin disorders.

Distribution & Pattern: 

    Observing where and how a skin issue appears helps understand its potential cause. Localized issues might be linked to injury or contact with an irritant, while widespread patterns could suggest internal factors like allergies or autoimmune diseases.

Morphology: 

Bumps, scales, blisters, open sores all have specific meanings. 

Bumps might indicate raised moles, warts, or inflammatory lesions. 

Scales can suggest dryness, eczema, or psoriasis. 

Blisters point to fluid build-up due to burns, allergies, or infections. 

Open sores could indicate infections, ulcers, or trauma.

Hair & Nails: 

Hair and nail changes can reflect internal health and nutritional deficiencies. 

Dry, brittle hair or nails could indicate vitamin deficiencies, while changes in hair growth patterns might be linked to hormonal imbalances or skin conditions.

Palpation:

 Texture: 

Altered texture suggests changes in skin hydration, collagen production, or cell growth.

 Roughness could indicate dryness or eczema, while smoothness might be linked to excessive oil production. 

Abnormal thickness can suggest inflammation, infiltration, or scarring.

Temperature:

 Increased temperature indicates inflammation or infection, while lower temperature could point to vascular issues or nerve damage.

Moisture: 

  Dryness suggests impaired barrier function or dehydration, while excessive sweating might be linked to heat intolerance or underlying medical conditions.

Tenderness:

 Painful areas can indicate inflammation, nerve involvement, or infection.

Mobility: 

Tethered skin suggests underlying inflammation or scarring, while freely movable skin indicates normal tissue structure.

Additional Techniques:

Dermatoscope:    By visualizing deeper skin structures, the dermatoscope allows for better differentiation between benign and malignant melanocytic lesions. This is crucial for early detection of melanoma, where subtle color and structural changes are key.

Wood's Lamp: Ultraviolet light excites specific molecules in fungi and some bacteria, causing them to fluoresce and become visible for diagnosis. This is particularly helpful for diagnosing fungal infections of the scalp, nails, and hair.

Diascopy: Pressing a glass slide compresses blood vessels beneath the lesion, temporarily revealing underlying color changes. This helps differentiate inflammatory conditions from vascular tumors.

Specialized Examinations:

Skin Scrapings: Microscopic examination of skin flakes or crusts allows for direct identification of fungal elements, parasites, or scabies mites, aiding in their diagnosis and treatment.

Biopsy: This definitive diagnostic tool provides a tissue sample for detailed analysis under a microscope, revealing the cellular and structural features of the skin condition. This is crucial for diagnosing various skin cancers, autoimmune diseases, and other complex skin disorders.