1.

Approach to dermatology patient

a. Careful history
i. Before a full history is done, patient is often examine
briefly
ii. Prompt right questions
b. Thorough physical examination
c. Usage of laboratory tests
i. Skin biopsy
ii. Skin scrapping
iii. Woods lamp
iv. Patch test
2. Important history
a. HOPI
i. Duration of lesion
ii. Pattern of spread / evolution
iii. Associated symptoms
1. Itching
2. Pain
3. Fever
iv. Aggravating factors
v. Relieving factors
3. Physical examination
a. Have 3 major skin signs
i. Morphology
ii. Distribution (Site)
iii. Configuration / arrangement
b. Morphology
i. Primary lesions
1. Macule / patch
a. Flat area of altered colour / texture
b. Macule <0.5cm
c. Patch >0.5cm
2. Papule / nodule
a. Elevated solid lesion
b. Papule <0.5cm
c. Nodule >0.5cm
3. Plaque
a. Elevated lesion with >2cm width
4. Vesicle / bullae
a. Fluid filled blister
b. Vesicle <0.5cm
c. Bullae >0.5cm
5. Pustule / abscess
a. Pus filled blister
b. Pustule <0.5cm
c. Abscess >0.5cm
6. Petechiae / ecchymoses
a. Extravasation of blood into skin
b. Petechiae <0.5cm

c. Ecchymoses >0.5cm
7. Wheal / angioedema
a. Accumulation of dermal oedema
b. Wheal = dermal oedema of any size
c. Angioedema = dermal + subcutaneous
oedema
8. Tumour
9. Papilloma
10. Burrow
11. Comedone
a. Plural for comedo
b. Also known as blackheads
12. Purpura, bruise
13. Telangiectasia
a. small, widened blood vessels on the skin
14. Poikiloderma
a. Extra pigmentation of the skin that
demonstrates a variety of shades
b. Associated with widened capillaries
(telangiectasia) in the affected area
ii. Secondary lesions (evolve from primary lesions)
1. Scale
a. Flake arising from horny layer
b. Seen in psoriasis
2. Crust
a. Dried blood / tissue fluid
b. May look like scale
c. Seen in impetigo
3. Keratosis
a. growth of keratin on the skin or on mucous
membranes
b. horn like thickening of skin
4. fissure
a. slit in the skin
5. Erosion
a. Complete or partial loss of epidermis
6. Ulcer
a. Loss of whole epidermis and part of dermis
7. Excoriation
a. Ulcer / erosion produced by scratching
b. Common in skin picking disorder
8. Lichenification
a. Thickened, leathery skin with increased skin
markings
b. Usually the result of constant scratching and
rubbing
c. Seen in actoopic eczema
9. Scar, atrophy
10. Sinus

11. Pigmentation
12. Striae
c. Description of primary / secondary lesions
i. Colour
1. Brown (Melasma)
2. Yellow (Xanthelasma)
3. Blue, grey (Naevus of Ota)
ii. Shape
1. Oval
a. Seen in Pityriasis rosea
2. Round
a. Seen in Pityriasis versicolor
3. Polygonal
a. Seen in Lichen Planus
4. Polycyclic
a. 2 or more rings or coils
b. Seen in subacute cutaneous lupus
5. Dome
a. Seen in Molluscum Contagiosum
6. Annular
a. Ring like
b. Seen in Tinea corporis
iii. Margin
1. Well defined
a. Seen in psoriasis
2. Ill defined
a. Seen in eczema
3. Rolling margin
a. Has raised borders
b. Can be traced with tip of pencil
c. Seen in basal cell carcinoma
iv. Surface
1. Dome shaped
2. Pedunculated
3. Verrucous
4. Umbilicated
5. Flat topped
6. Acuminate (spire like)
4. Distribution
a. Isolated (Single)
i. Seen in Keratocanthoma
b. Flexural
i. Seen in atopic eczema
c. Regional
i. Seen in psoriasis
d. Generalised
i. More than 90% of body surface area (BSA) affected by
erythroderma
ii. Seen in cutaneous lymphoma

e. Symmetrical
i. Seen in vitiligo
f. Sun exposed areas
i. Usually by photodermatitis (SLE, drug induced)
g. Intertriginous
i. Occurred in web spaces such as armpit
ii. Seen in Tinea cruris
h. Follicular
i. Seen in folliculitis
i. *** Diferential diagnosis of Erythroderma
i. *Erythroderma is not a diagnosis but a presentation
ii. Psoriasis
iii. Etopic eczema
iv. Seborrhic eczema
v. Cutaneous lymphoma
vi. Drug allergy
5. Configuration / arrangement
a. Reticulate / retiform
i. Net like appearance
ii. Seen in Lichen planus, Livedo reticularis
b. Zosterism
i. Seen in Herpes Zoster
c. Grouped
i. Seen in herpes labialis
d. Linear
i. Seen in contact dermatitis
e. Serpiginous
i. Seen in cutaneous larva migrans
f. Arcuate
i. Curved like
g. Nummular
i. Rounded / coin like
ii. Seen in discoid eczema
h. Annular
i. Ring like
6. Other examinations
a. Hair and nails
i. Psoriasis patients nail can present with
1. Leukonychia
2. Onycholysis
3. Separation of nail from the bed
b. Mucous membranes
i. Steven Johnson can affect mucosal membranes
c. General physical examination
i. Check the lymph nodes in lymphoma
ii. Check the joints in SLE