Transcript skin assessment

DERMATOLOGY
Anatomy
Functions
Diagnosis of
skin disease
SKIN COLOR
VARIATIONS
SKIN CHANGES WITH
AGE
SKIN FUNCTION
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to form a protective layer over the body
to keep moisture in the body (water retention)
to make vitamin D
to regulate body temperature
to excrete waste
to sense pain, itch, light touch, heat, cold, and
other sensations
• for communication
SKIN HISTOLOGY
• The outer layer of skin is the epidermis
• The inner layer is called the dermis. It
contains hair follicles, nerves (the
body's sense of touch), sweat and oil
glands and blood vessels.
• Below the dermis is the subcutaneous
tissue consisting of fat cells dispersed
in a connective tissue framework
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NORMAL SKIN
HISTOLOGY
Criteria for Cutaneous
Diagnosis
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Location
Number of Lesions
Type of lesion
Pattern
How widespread
Complaints
SKIN LESIONS
•PRIMARY
•SECONDARY
PRIMARY LESIONS
• Primary – original lesions
• Identification of such lesions is the most
important aspect of the dermatologic
examination
• May continue to full development or be
modified by regression
PRIMERY
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Macule
Papule
Plaque
Nodule
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Pustule
Vesicle
Bulla
Wheal (hive)
Ulser
MACULE
A circumscribed, flat discoloration that may be brown,
blue, red, or hypopigmented.
No elevation or depression of skin.
Brown
Blue
Red
Hypopigmented
BROWN MACULE
Becker's nevus.
This lesion contains
no pigmentation.
Becker's nevus.
A typical lesion with
macular pigmentation
and hair.
PAPULE
An elevated solid lesion up to 0.5cm in
diameter; color varies; papules may become
confluent and form plaques.
Flesh colored, yellow, or white
Red
Brown
Blue or violaceous
PAPULE
Granuloma annulare.
The dorsal surfaces of the hands
and feet and the extensor aspects
of the arms and legs are the most
common sites.
Lesions are either papular or
broad superficial plaques.
Kaposi's
sarcoma.
PLAQUE
A circumscribed, elevated,
superficial, solid lesion more than 0.5cm
in diameter, often formed by
the confluence of papules
PLAQUE
Secondary syphilis.
This is the uncommon
follicular secondary syphilis.
NODULE
A circumscribed, elevated,
solid lesion more than 0.5cm in diameter;
a large nodule is referred to as a tumor
NODULE
Metastatic carcinoma
of the breast.
Nodules appear vascular
and resemble
Kaposi's sarcoma.
PUSTULE
A circumscribed collection
of leukocytes and free
fluid that varies in size
Staphylococcal
folliculitis.
VESICLE
A circumscribed collection
of free fluid up to 0.5cm
in diameter
Herpes zoster
BULLA
A circumscribed collection
of free fluid more than
0.5cm in diameter
Bullosis
diabeticorum.
WHEAL (HIVE)
A firm edematous plaque
resulting from infiltration
of the dermis with fluid;
wheals are transient and
may last only a few hours
Dermographism
ULCER
A focal loss of epidermis
and dermis;
ulcers heal with scarring
Primary syphilis
CYST
• Closed cavity that contains liquid or semisolid
material
SECONDARY
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Scale
Crust
Atrophy
Lichenification
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Erosion
Excoriation
Fissure
Scar
Scales
Fine to stratified
Scaling in sheets (desquamation)
Excess dead epidermal cells
that are produced by abnormal
keratinization and shedding
The may be fine, as in pityriasis;
white and silvery, as in psoriasis;
or large and fish-like, as in ichthyosis.
Dominant
ichthyosis
vulgaris
CRUST
A collection of dried
serum and cellular debris;
a scab
Impetigo.
A thick, honey-yellow
adherent crust covers the
entire eroded surface.
EROSION
A focal loss of epidermis;
erosions do not penetrate below
the dermoepidermal junction
and therefore heal without scarring
Toxic epidermal necrolysis
(Nikolsky's sign)
FISSURE
A linear loss of epidermis
and dermis with sharply
defined, nearly vertical walls
Asteatotic eczema.
Excessive washing produced
this advanced case with
cracking and fissures.
ATROPHY
A depression in the skin
resulting from thinning
of the epidermis or dermis
Lichen sclerosus et atrophicus.
The epidermis is thin and atrophic
and gives the appearance
of wrinkled tissue paper
when compressed.
SCAR
An abnormal formation of
connective tissue implying
dermal damage; after injury
or surgery scars are initially
thick and pink but with time
become white and atrophic
Keloids on the chest and
extremities are raised with
a flat surface.
The base is wider than the top.
EXCORIATION
An erosion caused by scratching;
excoriations are often linear
COMEDONE
A plug of sebaceous and keratinous
material lodged in the opening of a hair follicle;
the follicular orifice may be dilated (blackhead)
or narrowed (whitehead or closed comedone)
MILIA
A small, superficial keratin cyst with no visible opening
BURROW
A narrow, elevated, tortuous
channel produced by a
parasite
LICHENIFICATION
An area of thickened epidermis induced by
scratching; the skin lines are accentuated
so that the surface looks like a washboard
TELANGIECTASIA
Dilated superficial blood vessels
PETECHIAE
A circumscribed deposit of blood less than 0.5cm in diameter
PURPURA
A circumscribed deposit of blood greater than 0.5cm in diameter
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