Physical Examination Of The Skin

PHYSICAL EXAMINATION OF THE SKIN Anatomy and Physiology Skin: heaviest single organ, 16% of body weight, 1.2-2.3 meters squared Layers of the Skin epidermis - outer horny layer - inner cellular layer dermis subcutaneous tissue

Crust

scale

Miscellaneous: • lichenification – thickening and roughing of the skin with increased visibility of the normal skin furrows • atrophy – thinning of the skin with loss of normal skin furrow

Lichenification • • •

atrophy

excoriation – scratch mark scar – replacement of destroyed tissue by fibrous tissue keloid – hypertrophied scar

Pigments • melanin (brown) • carotene (golden yellow) • oxyhemoglobin • deoxyhemoglobin Inspect and Palpate • Color: brown, grayish/bronze, blue, reddish blue, red, jaundice • Moisture • Temperature • Mobility/ Turgor • Texture • Lesions

Excoriation

scar

keloid

Primary circumscribed, flat, non- palpable lesions 1. Macule – small up to 1 cm 2. Patch - > 1 cm

Lesions • Anatomic location: generalized, localized

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Patterns and shapes: linear, clustered, annular, dermatomal

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Appearance/type of skin lesion: macules, papules, vesicles, pustules Color Measurement or dimension Tenderness

• • •

Secondary lesions: • Loss of skin surface • Erosion – loss of superficial epidermis • Ulcer - deeper loss of the skin surface • Fissure - linear crack of the skin

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Material on skin surface Crust = dried residue of serum, pus or blood • Scale = thin flakes of exfoliated epidermis •

patch

Macule

Palpable, elevated masses 1. Papule – up to 0.5 cm 2. Plaque - > 0.5 cm 3. Nodule – 0.5 to 1-2 cm; deeper & firmer 4. Tumor - > 1 to 2 cm 5. Wheal – irregular, relatively transient, superficial area of a localized skin edema

2.

nodule

Papule

plaque

Tumor

• •

• •

wheal

bulla

Acyanosis

spots

Mongolian

Lanugo fine, downy hair mostly on the shoulders and back • shed within 2 weeks 6. Vernix caseosa • cheesy white material composed of sebum and desquamated epithelial cells 7. Milia a. pinhead-sized, smooth, white, raised areas without surrounding erythema b. common in the nose, chin and forehead 5.

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Comedo – “blackhead”, plugged opening of a sebaceous gland Telangiectasia – dilated small blood vessels Nevus – “mole”; flat to slightly elevated, round, evenly pigmented lesion

milia 8.

Comedo

telangiectasia

a

Acrocyanosis blueness of the hands and feet if it won’t disappear within 8 hours, rule out CHD 4. Mongolian spots • blackish-blue areas located over the buttocks and skin of the scrotum • due to pigmented cells of the deeper layers of the skin 3.

Circumscribed, superficial, elevated, formed by free fluid in a cavity: 1. Vesicles – up to 0.5 cm 2. Bulla - > 0.5 cm 3. Pustule – filled with pus

Vesicles pustule

Harlequin dyschromia one side of the body is red & the other pale – border separates the 2 sides • transient: Unknown etiology •

nevus

Infancy: 1. Cutis marmorata • mottled appearance • common on the trunk, arms and legs • secondary to vasomotor changes of the dermis and SQ • response to cooling or chronic exposure to radiant heat • prominent among pre-terms, cretin and Trisomy

Lanugo

vernix caseosa

Miliaria rubra

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scattered vesicles on an erythematous base usually on the face and trunks

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secondary to the obstruction of ducts of sweat glands • disappear spontaneously in 1-2 weeks 9. Erythema toxicum

• • •

usually appear on the 2nd-3rd day of life erythematous macules with central urticarial wheals or vesicles disappear spontaneously within a

week

Miliaria rubra toxicum

erythema

10. Capillary hemangioma, nevus flammeus, nevus vasculasus, telangiectatic nevus • found on the nape “stork’s beak” mark • upper eyelid, forehead and upper lip “angel kisses” • disappear about 1 year of age

11. Portwine stain • larger, darker, more sharply demarcated • may involve the mucosa of the mouth or vagina • if there is involvement of the skin innervated by the ophthalmic portion of the trigeminal nerve --vascular network of the meninges and ocular orbit may also be affected -- meningeal calcifications, seizures, hemiparesis,mental retardation & glaucoma= Sturge- Weber Syndrome