SCHEME OF EXAMINATION OF SKIN

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DETAILED SCHEME OF SKIN EXAMINATION 

Parameter	How to Record	If Abnormal / Positive – What to Note
1. Skin Color	Normal / Pale / Cyanosed / Jaundiced / Hyperpigmented / Hypopigmented / Depigmented	Distribution (generalized/localized), intensity, shade (yellow/blue/slate grey)
2. Lesions – Presence	Present / Absent	Type: macule/papule/vesicle/etc. Number: Single/Multiple Distribution: Localized/Generalized Surface: Scaly/etc.
3. Lesion Configuration	Specify: Linear / Annular / Grouped / Reticular / Serpiginous / Targetoid / Zosteriform	Helps infer etiology (e.g., grouped: herpes; linear: Koebner's phenomenon)
4. Lesion Shape	Round / Oval / Irregular / Polycyclic / Umbilicated	Specific patterns e.g., polycyclic in fungal infections, umbilicated in molluscum
5. Symmetry	Symmetrical /  Asymmetrical	Symmetry suggests systemic disorder (e.g., SLE, psoriasis)
6. Site of Lesions	Specify clearly: Face / Trunk / Scalp / Flexures / Extensors / Palms / Soles / Genitals	Important for diagnosis (e.g., flexural eczema vs extensor psoriasis)
7. Surface of Lesions	Smooth / Scaly / Crusted / Verrucous / Moist / Dry	Note the nature of scaling or crust
8.Temperature of Skin	Warm / Cool / Normal (Use dorsum of hand)	Warm: inflammation; Cool: ischemia, shock
9. Texture of Skin	Normal / Rough / Dry / Thickened / Atrophic	Rough/dry in ichthyosis; Atrophic in lichen sclerosus
10. Tenderness	Present / Absent	Localized/systemic; Painful lesions suggest inflammation/infection
11. Induration	Present / Absent	Nature: Soft / Firm / Hard
12.Consistency	Soft / Firm / Hard / Fluctuant	Suggests nature of lesion – cystic, solid tumor, abscess
13. Mobility (Skin over Lesion)	Freely mobile / Restricted / Fixed	Fixity suggests deeper or malignant involvement
14. Turgor	Normal / Reduced (Test: pinch over forearm or abdomen)	Decreased in dehydration, age-related skin laxity
15. Diascopy	Blanchable / Non-blanchable	Non-blanching: purpura, petechiae; Blanching: erythema
16. Nikolsky’s Sign	Positive / Negative	Positive in pemphigus vulgaris, SSSS
17. Auspitz Sign	Positive / Negative	Positive: pinpoint bleeding after scale removal – Psoriasis
18. Koebner’s Phenomenon	Present / Absent	Linear lesion at trauma site – Psoriasis, Lichen planus
19. Wood’s Lamp Test	Normal / Fluorescence Present	Color: Green – Tinea / Coral red – Erythrasma / Bright white – Vitiligo
20. Patch Test	Performed / Not performed	Positive allergens (if tested); delayed hypersensitivity indication
21. Hair Examination	Normal / Abnormal	Hair loss: Diffuse / Patchy / Scarring / Non-scarring Texture: Dry / Brittle / Coarse / Silky
22. Nail Examination	Normal / Abnormal	Clubbing / Pitting / Ridging / Discoloration / Onycholysis / Koilonychia
23. Mucosal Examination	Normal / Abnormal	Oral ulcers / Depigmented patches / Vesicles / Lichen planus-like lesions
24. Lymph Nodes	Enlarged / Not palpable	Site: Cervical / Axillary / Inguinal Character: Tender / Non-tender, Mobile / Fixed, Discrete / Matted
25. Systemic Associations	Present / Absent	Fever / Arthralgia / Oral Ulcers / Weight loss / Photosensitivity / Neuropathy (if present – describe)

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📝 Example of Recording in a Case Sheet:

Skin examination:
Color: Pale with patchy hypopigmented macules over the extensor surface of both arms.
Lesions: Multiple macules and papules arranged in linear and grouped patterns. Surface dry and scaly.
Temperature: Warm over lesions.
Tenderness: Absent.
Induration: Present, firm in consistency.
Diascopy: Non-blanchable. Nikolsky’s sign: Negative.
Hair and nails: Normal.
Oral mucosa: Normal.
Lymphadenopathy: Absent.
Wood’s lamp: Fluorescent white under UV – suggestive of vitiligo.
Systemic signs: Absent.

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