pendekatan klinis peny kulit.ppt

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PHYSICAL

EXAMINATION IN

DERMATOLOGY

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CLIENT ASSESSMENT

EXAMINATION OF THE SKIN, HAIR,

NAIL, AND MUCOUS MEMBRANE

GENERAL PHYSICAL EXAMINATION

RELATED TO SKIN DISEASES

DESCRIPTION OF THE PHYSICAL

EXAMINATION IN DERMATOLOGY

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CLIENT ASSESMENT

1.  Notice the initial clinical impression.

2. Give the patient an adequate explanation

about the physical examination.

3. The patient is placed in an adequate

illumination, prefer under natural light or

 bright overhead fluorescent lighting.

4. Ask the patient to take off his/her clothes.

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EXAMINATION OF THE

SKIN, HAIR, NAIL ANDMUCOUS MEMBRANE

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EXAMINATION OF THE SKIN

Distribution of lesion

Location of lesion

Characteristic of lesion

Type of lesion :

 Primary lesion  Secondary lesion

 Specific lesion

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DISTRIBUTION OF LESION 

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LOCALIZED

Restricted to a limited region or to one spot

Basal cell carcinoma

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REGIONAL

Prurigo nodularis

Affecting a certain region or regions

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GENERALIZED

Varicella

Spread throughout the body

or affecting many parts

of the body

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UNIVERSAL

Involvement of the

entire skin Eritroderma lina

Erythroderma

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Characteristic pattern ofdistribution of lesion

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SIMMETRY

Atopic dermatitis

On each side of plane of the body

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ASIMMETRY

 Not symmetry

Cellulitis

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BILATERAL

Having two sides or pertaining to both sides

Psoriasis vulgaris

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UNILATERAL

Affecting one side of the body

Epidermal nevus

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DERMATOMAL

The area of skin

supplied with afferent

nerves fibres by

a single posterior

spindle root

Herpes zoster

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 LOCATION OF LESION 

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FLEXURAL

Pertaining toor affecting

a flexure

Atopic dermatitis

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EXTENSOR

Eczema

Pertaining to

or affecting

an extensor

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INTERTRIGINOUS

Occuring on apposed skin surface, such as the

axillae, creases of the neck, intergluteal fold,groin, between the toes, and beneath

 pendulous breast

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INTERTRIGINOUS

Erythrasma

Candidiasis interdigitalis

Axillae Between the toes

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GLABROUS

Smooth and bare area

Seborrheic dermatitis  Tinea corporis 

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PALMS

Palm :The flexor surface of

the hand

Pityriasis rubra pilaris

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SOLES

Sole :The bottom of the

foot

Irritant contact dermatitis

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EXPOSED AREA

The area that exposure to sunlight, such as the

dorsa of the hands and arms, the neck, and face.

Polymorphous light eruption

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CHARACTERISTIC OF

LESION

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The number of lesions

 Soliter  Multiple

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SOLITER

Only one lesion

Epidermal cyst

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MULTIPLE

More than one lesion

Neurofibromatosis

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Discrete or confluence ?

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DISCRETE

Made up of separated parts or characterized bylesions which do not become blended

Molluscum contagiosum

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CONFLUENCE

Becoming merged; not discrete

Tinea corporis Pustular psoriasis

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Shape and arrangement

of lesions

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- Irregular - herpetiform- Annular - zosteriform

- Linear - serpiginous

- Round - corymbiform

- Oval - polycyclic

- Iris

- Umbilicated

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Irregular

Haemangioma

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ANNULAR

A ring-shaped

arrangement of a numberof lesions form a

complete circle

Tinea corporis

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Tinea corporis

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LINEAR

A linear shape ofa single lesion

Koebner phenomenon in psoriasis

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ROUND

Ball-shaped

Tinea corporis

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OVAL

Egg-shaped

“Herald patch” in Pityriasis rosea 

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IRIS

An erythematous annular macule or papule with a purplish or dusky, papular or vesicular center

Erythema multiforme

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UMBILICATED

Marked with depressed

areas resembling

the umbilicus

Molluscum contagiosum

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HERPETIFORM

Cluster or groups of vesicles

Herpes simplex virus infection

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ZOSTERIFORM

Vesicles or bullae that occur ina bandlike pattern following a dermatome

Herpes zoster

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SERPIGINOUS

A snake-like arrangement of lesions

Cutaneous larva migrans

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Scrophuloderma

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CORYMBIFORMA group of arrangement that consist of a central

cluster of lesions beyond which are scattered

individual lesions

Intertriginous candidiasis

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Intertriginous candidosis

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POLYCYCLIC

Lesions composed of

several intersecting portion of circles

Tinea corporis

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The size of lesions

 Milier

 Guttate

 Nummular

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MILIER

Minute lesions resembling millet seeds

Miliaria crystallina

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GUTTATE

A small round lesions,

like drops

Guttate psoriasis

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 NUMMULAR

A large round lesions, like a coin

Nummular eczema

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The border of lesions

- Well-defined

- Ill-defined

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WELL-DEFINED

With marked border

Tinea fascialis

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ILL-DEFINED

With unmarked border

Pityriasis alba

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 TYPES OF SKIN LESIONS

1. primary skin lesion

2. secondary skin lesion

3. specific skin lesion 

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PRIMARY SKIN LESIONS

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MACULE 

A circumscribed, flat (without elevation or

depression) lesion differs from the

surrounding skin because of its color

1. Hyperpigmentation2. Hypopigmentation

3. Depigmentation

4. Erythematous5. Petechiae

6. Purpura

7. Ecchymoses 

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Hyperpigmentation macule 

Melasma Solar lentigo

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Hypopigmentation macule 

Pityriasis versicolor

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Depigmentation macule

Vitiligo

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Erythematous macule

Vascular abnormalities, capillary dilatation

Erythema multiforme

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Purpura

Extravasated

red blood cells.

Vasculitis

Petechiae

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Small, pinpoint purpuric spots often seen in thrombocytopenic states

Petechiae 

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Ecchimoses 

Larger, bruise-like

 purpuric lesions.

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PAPULE 

A solid, elevated and circumscribed lesion, varyingin size (pinhead to 1 cm) projects above the

 plane of the surrounding skin.

Lichen planus

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PLAQUE 

A broad papule or

confluence of papules,

1 cm or more

in diameter flat, but

may be centrally

depressed.

The center of a plaquemay be normal skin.

Plaque type psoriasis

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TUMOR  

A soft or firm and freelymovable or fixed massesof various sizes andshapes.

The term is used to implyenlargement of the tissues

 by normal or pathologicalmaterial or cells that form

a mass inflammatory ornon-inflammatory, benignor malignant process.

Keratoacanthoma

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WHEAL

A rounded or flat-topped

 papule or plaque 

evanescent, edematous,disappearing within

hours, usually pink to

red, and surrounded by pink areola

Urticaria and Angioedema of the eyes

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VESICLE

A circumscribed,

fluid-containing,epidermal

elevation, 1-10 mm 

in size

Varicella

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BULLAE 

A rounded or irregularly

shaped blisterscontaining serous or

seropurulent fluid 

differ from vesicles onlyin size, being larger than

1 cm.Bullous pemphigoid

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PUSTULE 

A circumscribed,

raised lesion 

contains a purulent

exudates.

Pus, composed of

leukocytes with or

without cellulardebris, may contain

 bacteria or sterile.Folliculitis

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CYST 

A sac that contains liquidor semisolid material

(fluid, cells, and cell

 products)

Steatocystoma multiplex

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ABSCESS 

A localized collection of pus in a cavity formed bydisintegration or necrosis of tissue

Furuncle

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SINUS 

A tract leading from a

suppurative cavity to the

skin surface, or between

cystic or abscess cavities

Scrofuloderma

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SECONDARY SKIN

LESIONS

SCALE

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SCALE 

A dry or greasy

laminated masses ofkeratin that caused by

abnormal shedding or

accumulation of stratumcorneum in perceptible

flakes. Psoriasis vulgaris

Psoriasiform scale

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CRUST

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CRUST 

Dried serum, pus, or blood,

usually mixed with epithelial

and sometimes bacterial

debris.

Crust

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Crust

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Crust

EROSION

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EROSION 

Loss of all or portions

of the epidermis alone.

It may or may not

 become crusted, but it

heals without a scar.

Pemphigus vulgaris

EXCORIATION

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EXCORIATION 

A punctate or linear

abrasion produced by

mechanical means,usually involving only

the epidermis but not

uncommonly reachingthe papillary layer of the

dermis.

FISSURE

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FISSURE 

A linear cleft or crack through the epidermis,or into the dermis

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ULCER

Rounded or irregularly

shaped excavations thatresult from complete loss

of the epidermis plus

some portion of thedermis.

Plantar ulcer

SCAR

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SCAR  

Composed of new

connective tissue that

replaced lost substancesin the dermis or deeper

 parts as a results of

injury or disease, as part

of the normal preparative

 process. Keloid

At h

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Atrophy

LICHENIFICATION

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LICHENIFICATION 

An area of skin to appear

as thickened plaqueswith accentuated skin

markings. The lesions

may resemble tree bark.

Lichen simplex chronicus

SCLEROSIS

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SCLEROSIS 

A circumscribed or

diffuse hardening or

induration in the skin

It is detected more

easily by palpation 

than by inspection.

Systemic sclerosis

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SPECIFIC SKIN LESIONS

COMEDO

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COMEDO 

A plug of keratin and sebum in a dilated pilosebaceous orifice

Acne Vulgaris

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White head

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Black head

TELEANGIECTASES

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TELEANGIECTASES 

Permanent dilatations of

capillaries that may or

may not dissapear with

application of pressure.

They form nonpulsatile,

fine, bright red lines or

netlike patterns on theskin.

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CANALICULI (BURROW) 

A small tunnel in theskin that houses a

metazoal parasite, such

as the scabies acarus.

Larva migrans

MILIA

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MILIA 

A tiny white cyst containing lamellated keratin. 

Milia

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EXAMINATION OF THE NAILS

ONICHODISTROPHY

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ONICHODISTROPHY

Irritant contact dermatitis

SPLINTER HAEMORRHAGE

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SPLINTER HAEMORRHAGE

Psoriasis vulgaris

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PITTING NAIL

Psoriasis vulgaris

SUBUNGUAL DEBRIS

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SUBUNGUAL DEBRIS

Tinea unguium

ONICHOLYSIS

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ONICHOLYSIS

Psoriasis vulgaris

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EXAMINATION OF THE HAIR

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ALOPECIA AREATA

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ALOPECIA TOTALIS

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TELOGEN EFFLUVIUM

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EXAMINATION OF THE

MUCOUS MEMBRANES

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ORAL CANDIDIASIS

STOMATITIS

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STOMATITIS

GEOGRAPHIC TONGUE

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Psoriasis

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GENERAL

PHYSICAL EXAMINATION

RELATED TO

PRESENT SKIN ILLNESS

LYMPHADENOPATHY

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A. Tuberculous chancre on the thigh

B. Regional lymphadenopathyC. A positive tuberculin test

Tuberculosis

cutisA

BC

JOINT

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JOINT

Psoriatic arthritis

on metacarpophalangeal joint

DESCRIPTION OF

PHYSICAL EXAMINATION IN

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PHYSICAL EXAMINATION IN

DERMATOLOGY Dermatological status :

 Distribution : …………………… 

 Location :……………………….

 Characteristic : …………………. 

 Type of lesion : ………………… 

General status :  Hair, nail, mucous membrane and

other organ : ……………………. 

Distribution : RegionalDermatological status :

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  Distribution : Regional

Location :

Both of elbows, extensorsurface of arms, lower

 back, buttock, and both

of thighs

Characteristic :

Multiple, confluents,

irregular, 2 x 1 cm to

30 x 20 cm, well-defined,

elevated from surrounding

skin, dry. Type of lesion :

Erythematous plaque with

thick white scales 

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General status : Nails : Oily spot

Splinter haemorrhage

Pitting nail

Diagnosis : Psoriasis vulgaris

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Dermatological status : Distribution : regionalLocation : cheeksCharacteristic : Multiple, mostly confluents, round and oval, 0,5 x

0,5 cm to 3 x 2 cm, well-defined, elevated fromsurrounding skin, dry.

Type of lesions :Erythematous macules and papules, pustules, crusts and comedones

Diagnosis : Acne vulgaris

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