Escolar Documentos
Profissional Documentos
Cultura Documentos
27, 2010
The diagnosis and treatment of dermatologic disease rests on AugustLift
a fold of skin and note ease with which it is moved (mobility)
the physicians ability to recognize the basic and sequential
& speed with which it returns to place (turgor)
lesions of the skin
Faster return means better hydration for the patient
Skin lesions: visible and accessible
Increase in turgor if it remains elevated
o Advantage: since it is accessible, an intervention such as a
Hair
biopsy can be performed easily
Facial,
axillary & pubic hairs dependent on presence of sex
o Disadvantage: There are thousands of skin diseases that
hormones,
thus, affected by sex & age of patient
for some (especially first-timers) would look the same
If with excessive hair, suggestive of endocrine disease
(thus, one must be keen enough to distinguish)
Alopecia areata - balding
Physicians: must learn to read skin for clues to underlying
systemic disease
Nails
** sometimes a history is no longer needed in order to make a
May provide a clue to certain systemic disease
diagnosis
o Psoriasis vulgaris (oil spots, onycholysis, loosening of nail,
crumbling of nail, little pits on nails)
Detailed Examination of the Integumentary System
Renal disease Half & half nails (proximal white & distal
Skin
pink/brown)
Hair
Hemochromatosis
Nails
o Spoon nails (koilonychia)
Mucous membranes
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o
o
o
o
Dermatomal
Trunks
Lower extremities
Exposed areas
o
o
o
o
o
Borders unstable
Allergic response
dermographism when there is scratching an
elevated lesion will occur at the site due to
histamines effect on the skin
Warm
Skin asthma, ectopic dermatitis
Vesicle
0.5 - <1cm
Circumscribed lesion that contains fluid
Herpes simplex lesions, dermatitis, dyshydrophic eczema
Arise from cleavage at various skin levels
Bulla
> 0.5 1cm, contains fluid
Burns, insect bites (for allergic patients); pemphigus
vulgaris (autoimmune disease, needs high dose of
corticosteroids)
Pustule
Hallmark of infection
Circumscribed raised lesion with purulent exudates
Pus
o Leukocytes, cellular debris
Furuncle (deep necrotizing folliculitis)
o Deep necrotizing folliculitis
Carbuncle
o Coalescing furuncles
*folliculitis furuncle carbuncle
* increase incidence of folliculitis during the summer heat
aggravates Staph infections
Secondary Lesions
Crust
Results when serum, blood or purulent exudates dries on
the skin surface
Characteristic of injury & pyogenic infections
o Yellow dried serum
o Green/ yellow green purulent exudates
o Brown/ dark red- blood
o Honey-colored impetigo
Fissure
Linear cleavages or cracks in the skin
Painful
Anal; angles of mouth, heels
Excoriation
Superficial excavations of epidermis
May be linear or punctuate
Result from scratching
Atopic dermatitis (childhood 2-7 years old)
Lichenification
Thickening of the skin as a consequence of persistent,
prolonged, vigorous rubbing
Accentuation of normal skin markings
Hyperpigmentation
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Induration
E.g., Lichen Simplex Chronicus
Erosion
Moist circumscribed lesion resulting from loss of epidermis
Rupture of vesicles and bullae
Do not scar unless infected
Atrophy
Diminution or thinning of the skin
Scleroderma autoimmune
Stria Gravidum
Ulcer
Hole or defect that remains after an area of epidermis and
part of dermis is destroyed
Dermis heals with scarring
Venous ulcer medial mallelous; presents with varocities in
upper legs
Decubitus ulcers in prolonged immobility/bedrest
Scar
Fibrous tissue replacement
Consequence of healing at site of prior ulcer or wound
Hypertrophic or atrophic
Hypertrophy remain in the area
Keloid claw-like spread to adjacent areas
Atrophic depression
Scales
Abnormal shedding or accumulation of epidermis in
perceptible flakes
Psoriasis
Keratotic plug upper arm and thigh
o Pityriasiform branny
o Psoriasiform micaceous
o Icthyosiform fish scales
o Keratotic horny masses
o Follicular keratotic plugs
Clinical Tests
Dimple Sign
Dermatofibroma
Apply pressure feels like a button/depression [(+) test]
Nikolskys sign
Sheetlike removal of epidermis by gentle traction
positive when slight rubbing of the skin results in exfoliation
of the skin's outermost layer and gravitation of fluid
towards the opposite side
if intradermal (+); if subdermal (-)
Pemphigus vulgaris/ TEN
Dariers sign
Development of urticarial wheel in uticaria pigmentosa
Stroking of skin development of urticaria
Auspitz sign
Pinpoint bleeding after removal of scale in psoriasis
Additional Slides: (Puro pictures to e, kaso di nya binigay
ppt..)
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References:
Lecture and Notes from Dr. Medel
Ultimate Mafia Trans
Trans by: Relloras, Revelo, Reyes
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