Western+Diagnosis+-+Dermatology

Dermatitis Contact Dermatitis Atopic Dermatitis Seborrheic Dermatitis Impetigo Erysipelas Folliculitis Furuncles Carbuncles Dermatophytes Candidiasis Scabies Pediculosis Acne Rosacea Psoriasis Nevi Skin Tags Lipomas Basal Cell Carcinoma Squamous Cell Carcinoma Malignant Melanoma

I. Anatomy and Physiology A. epidermis 1. 2 layers a. outer horny layer of dead keratinized cells b. inner cellular layer where keratin and melatonin are formed 2. no blood vessels B. dermis 1. highly vascularized 2. connective tissue, sebaceous glands, some hair follicles C. subcutaneous tissues 1. fat, sweat glands, remainder of hair follicles II. History A. itching, dryness B. sores, rashes C. growths, lumps D. temperature or color changes E. hair or nail changes III. Physical A. performed throughout rest of exam B. inspection 1. color, vascularity, bruising 2. edema 3. lesions a. color b. type i. macule - flat discolored spot < 10 mm ii. patch - macule > 10 mm iii. papule - solid elevated lesion < 10 mm iv. plaque - papule > 10 mm v. nodule - palpable solid lesion > 5 mm vi. tumor - nodule > 20 mm vii. vesicle - circumscribed elevated lesion < 5mm containing serous fluid viii. bulla (blister) - vesicle > 5mm vix. pustule - superficial elevated lesion containing pus x. wheal (hive) - transient elevated lesion from local edema xi. telangiectasia - dilated superficial blood vessels xii. scales - heaped up particles of horny epithelium xii. crust (scab) - dried serum, blood, or pus xiii. erosion - loss of part or all of epidermis xiv. ulcer - loss of epidermis and part of dermis xv. excoriation - linear or hollowed out crusted area caused by scratching, rubbing, or picking xvi. lichenification - thickened skin with accentuated skin marking xvii. atrophy - paper thin, wrinkled skin xviii. scar - fibrous tissue replacing normal skin structures after destruction of some of the dermis c. grouping i. clustered, linear, annular d. distribution i. localized, generalized C. palpation 1. moisture 2. temperature 3. texture 4. thickness 5. edema 6. mobility 7. turgor IV. Special Studies A. biopsy B. skin scrapings 1. esp for fungi C. cultures D. Wood’s light exam E. cytology F. immunofluorescence G. patch tests