The Examination

The dermatologic physical examination must be performed on the disrobed patient in a room with adequate lighting. All skin and mucosal surfaces must be inspected, including hair, nails, scalp, and mucous membranes. Then, the specific skin lesions must be inspected. A magnifying lens and a portable lamp are helpful for conducting the examination.

The skin should be examined in a systematic, methodical, orderly process. The distribution, pattern, arrangement, morphology, extent, and evolutionary changes of the lesions must be determined. Distribution is the location of the skin findings while the pattern is the anatomic, functional, and physiologic arrangement of the lesions. For example, the patient with a unilateral band-like arrangement of lesions on the thorax suggest varicella-zoster infection ( Fig 241-5). Skin diseases often present with a predilection for certain body areas; as such, location will assist in narrowing the diagnostic possibilities ( T§ble..,23Z:.l). From the anatomic perspective, the skin surfaces that are usually considered as separate areas of distribution include scalp, hair, face, eyelids, mouth, trunk, axilla, perineum, extremities, and nails;

the extremities may be further subdivided into upper versus lower and proximal versus distal, as well as wrists/ankles and hands/feet ( Fig 239:5). Rashes on exposed portions of the skin should prompt inquiries about sun exposure, jewelry, or topical agents. Refer to TabJe...23Z.-2 for a differential diagnosis of skin lesions as a function of location.

TABLE 237-1 Distribution and Pattern Descriptors riiur JidU äT iLm «SH-f-K AírTTMHftd. -cifrad-Mil. «¡ftFM, riiur JidU äT iLm «SH-f-K AírTTMHftd. -cifrad-Mil. «¡ftFM,

TABLE 237-2 Differential Diagnosis Relative to Lesion Distribution/Pattern

Lesion arrangement refers to both the symmetry and configuration. Bilateral symmetry suggests either a systemic internal event or symmetric external exposure, as seen in erythema multiforme, with plaque-like lesions on the flexor surfaces of the extremities ( Fig..241:1A) or in the patient with contact dermatitis related to a lotion application. An asymmetric arrangement supports a localized process. Configuration may apply to a single lesion with reference to its individual features or, alternatively, to multiple lesions and their relationship to one another. For instance, internal configuration is illustrated by the relationship between the central papule relative to the erythematous ring in the target lesion of erythema multiforme ( Figi:i..,.241-1B); on the total-body scale, configuration is demonstrated by clustering of lesions in a herpes virus infection (Fig. 241-5) or by a linear arrangement in poison ivy or oak. Other terms used to describe the lesion configuration are listed in Table 237-3.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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