skin examination
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Skin Examination. Pharmacy Practice 742: Physical Assessment. The Skin: History. Three important aspects to seek out: symptoms attributed to the skin lesion chronology of appearance, change, and disappearance of the lesions - PowerPoint PPT PresentationTRANSCRIPT
Skin Examination
Pharmacy Practice 742:Physical Assessment
The Skin: History Three important aspects to seek out:
symptoms attributed to the skin lesion chronology of appearance, change, and
disappearance of the lesions conditions of exposure, injury, or
medication that may have induced or altered the disease
The Skin: History Original lesion
exact site duration appearance distribution progression
Symptoms local
pruritis pain burning
Setting & Timing of Attacks occupation topical agents drug history season of year environment
Skin: Physical Examination Three categories of observation
should be made in sequence: First, anatomic distribution of the
lesion Second, configuration of groups of
lesions Third, the morphology of the
individual lesions
Skin: Physical Examination Inspection
natural lighting preferred, need complete exposure of all skin surfaces.
remember to scan nails, hair, mucous membranes
Location and Distribution exact, measure, symmetry?
Skin: Physical Examination Inspection
Color: variation common, even within same person. Melanin
maybe diffuse or localized increased: Addison’s Disease,
hyperthyroidism, pregnancy, sunlight exposure
decrease: albinism and vitiligo Erythema
appearance of increased amounts of oxygenated blood in dermal vasculature
Skin: Physical Examination Inspection
Color: Cyanosis
blue tint from venous blood (deoxygenated hemoglobin) seen associated with congestive heart failure, pneumonia
Extravasation of blood products ecchymosis, petechiae
Pallor decrease hemoglobin in vessels close to skin
secondary to anemia, shock
Skin: Physical Examination Inspection
Color: Depositions of abnormal pigments
Jaundice from bilirubin Carotenemia from carotene (diabetes, excess
ingestion of yellow vegetables (carrots) Gray from heavy metals (Au-gold, Ag-silver,Bi-
bismuth) Blue-gray from amiodarone
Configuration arrangement or position of lesions with each other
(grouped, linear, annular)
Skin: Physical Examination Inspection
Morphological structure primary lesions
flat elevated -- serous filled -- pus filled -- solid
Skin: Physical Examination Inspection
Morphological structure secondary lesions
loss of skin -- erosion -- ulcer -- fissure build-up of skin -- scale -- crust -- lichenification -- scar
Skin: Physical Examination
Morphology - Definitions Macules
localized changes in skin color. Areas may be small or large; occur in many shapes and colors.
Not palpable may be associated with desquamation or
scaling examples;
rubeola, rubella, secondary syphilis, rose spots of typhoid fever, drug eruptions, petechiae, purpura, first degree burns, systemic lupus erythematosus, pityriasis rosea and vitiligo
Skin: Physical Examination
Morphology - Definitions Maculopapules
slightly elevated macules commonly seen in pityriasis rosea, erythema
multiforme, fixed drug eruptions and exanthemas Papules
lesions are solid and elevated and defined as less than 5 mm in diameter.
Borders and tops may be in various forms pointed or acuminated -- insect bites, acne and
physiologic gooseflesh flat topped -- psoriasis, atopic eczema
Skin: Physical Examination
Morphology - Definitions Papules
Borders and tops may be in various forms round or irregular --senile angiomas,
eczematous dermatitis, secondary syphilis pedunculate -- neurofibromas
Plaques any elevated area of greater than 5mm,
usually formed from confluent papules. Red scaling plaques -- psoriasis, pityriasis rosea
Skin: Physical Examination
Morphology - Definitions Plaques
Yellow -- xanthomas brown -- seborrheic warts
Nodules solid and elevated, distinguished from
papules by extending deeper into the dermis or even the subcutaneous tissue.
Usually greater than 5 mm in diameter
Skin: Physical Examination
Morphology - Definitions Nodules
depth may be inferred by palpation…when below the dermis skin slides over them, lesions within the dermis move with the skin
Wheals caused by edema of skin, areas are
circumscribed, irregular, and relatively transient
color varies from red to pale, depending on amount of fluid in the skin.
Skin: Physical Examination
Morphology - Definitions Wheals
examples: urticaria and insect bites
Vesicles accumulation of fluid between the upper
layer of the skin produces an elevation covered by a translucent epithelium that is easily punctured to release the fluid
less than 5 mm examples: acute eczematous dermatitis, second-
degree burns
Skin: Physical Examination
Morphology - Definitions Bullae
Accumulation of fluid between layer of the skin, larger than 5 mm in diameter.
Examples: contact dermatitis, second-degree burns, bullous impetigo
Pustules Vesicles or bullae that become filled with
pus and tiny abscesses in the skin contents appear milky, orange, yellow, or
green depending somewhat on the infecting organism
Skin: Physical Examination
Morphology - Definitions Pustules
frequently arise from hair follicles or sweat glands
examples: acne, furuncles, and bromide and iodide eruptions
Cysts elevated lesions containing fluid or viscous
material appear as papules or nodules distinction is made by puncturing to
examine their contents and depth examples: sebaceous and epidermal cysts
Skin: Physical Examination
Secondary or Consecutive Erosions
moist surface uncovered by the rupture of vesicles or bullae or by laceration from rubbing
Fissures cleavage of the epidermis extending into
the dermis examples: common in trauma to thickened, dry,
inelastic skin
Skin: Physical Examination
Secondary or Consecutive Ulcers
depressed lesions results from loss of epidermis and the papillary layer of the dermis
examples: traumatic ulcers, burns, and stasis ulcers
Gangrene extensive destruction of the skin -- may
leave many dead cells that become blackened
Skin: Physical Examination Palpation
Temperature localized hyperthermia from increased
blood flow due to cellulitis or injury generalized hyperthermia due to fever of
systemic infection, hyperthyroidism localized hypothermia caused by
peripheral arteriosclerosis, Raynaud’s disease
generalized hypothermia due to shock
Skin: Physical Examination Palpation
Moisture sweat - nervous (hypothermia) or thermal
(hyperthermia) in origin Texture
quality character
rough dry (hypothyroidism) smooth (hyperthermia)
Skin: Physical Examination Palpation
Elasticity decreases with age Decreased skin turgor - dehydration edema - accumulation of fluid in interstitial
spaces under the skin. Congestive heart failure
Cancer Malignant Melanoma ABCD’s
Asymmetry Border irregularity Color variation Diameter greater than 6 mm
Inquire and observe for ominous changes in color, shape, elevations, texture, surrounding skin, sensation, and consistency.
Malignant Melanoma
Bullous Impetigo
Carbuncle
Drug Eruption