SKIN ASSESSMENT

 SKIN ASSESSMENT
 History and Physical Examination
 Signs and Symptoms
 Primary and Secondary Lesions
 SKIN ASSESSMENT
Demographic Data
 Age
 Sex
 Race and nationality

HISTORY
Current Health Problem
 When did the patient notice the skin problem?
 Where on the body did the problem begin?
 Has the problem gotten better or worse?
 Has a similar skin condition ever occurred before? If so, describe the typical
course and treatment.
 Is it seasonal or recurrent?
 Is the problem associated with any of the ff: itching, burning, stinging,
numbness, pain, fever, nausea and vomiting, diarrhea, sore throat, cold, stiff
neck, new food, new soap or cosmetic products, new clothing or bed linens,
or stressful situations?
 Does anything seem to make the problem worse?
 Does anything seem to make the problem better?

Medication History
 Is the patient allergic to any systemic or topical medication? What was the
reaction?
 What drugs has the patient taken recently? Prescribed drug or over-the-
counter? Initial dose and last dose taken? Dosage and frequency?
Past Medical History
 Does the patient have any current or previous medical problems?
 Has the patient undergone any recent or previous surgical procedures or
blood transfusion ?

Family history
 Is there any family tendency toward chronic skin problems?
 Do any members of the immediate family have recent skin complaints?

Personal and Social History

 Occupation
 Recent travel
 Recreational activity
 Food preference
 Living condition
 Sexual practice
PHYSICAL EXAMINATION
 Daylight is the ideal illumination
 A magnifying lens may aid in examination of minute lesions
 The use of Ultraviolet light passed through Wood’s filter maybe used to
diagnose certain diseases
 Cameras/pictures
 Wood’s lamp

Inspection
 Location and distribution of lesions
 Affected body parts
 Protected or sun-exposed area
 Single or multiple
 Random or patterned
 Unilateral or bilateral
 Symmetric or asymmetric

 Configuration/Pattern
~ Arrangement of lesions with respect with one another
 Linear
 Annular
 Nummular/Circinate/coin-shaped/Discoid
 Circumscribed
 Clustered
 Coalesced
 Target/Bull’s eye/Iris
 Serpiginous
 Reticulated
 Diffused
 Universal
 Herpetiform*
 Zosteriform*

 Color
~May serve only as corroborative aid
 Red/Pink
 White
 Brown/Black
 Yellow/Yellow-orange (Jaundice)
 Blue
 Milia

Palpation
~Moisture, Temperature, Texture, Turgor
  Flat or raised lesions
 Soft and pliable or firm and solid
 Tender or non-tender
 Warm or cold (temperature)
 Scaly, velvety, lichenified, indurated, umbilicated, waxy (texture)
 Blanch with pressure
 Good or poor skin turgor

 SKIN ASSESSMENT
(Cutaneous signs)
PRIMARY LESIONS
~ lesions that appear as an initial reaction to a problem that alters one of
the structural components of the skin
SECONDARY LESIONS
~ lesions that result from changes in the appearance of the primary lesions
due to external factors such as trauma

Macule
 flat, nonpalpable lesions usually 1 cm or less in diameter, although some
apply the term to lesions of any size
 Vitiligo
Patch
 Large macule ( >1cm in diameter)
 Nevus flammeus, widespread vitiligo
Papule
 Circumscribed, solid elevations with no visible liquid, usually 0.5 cm or less in
diameter
 Two lesions that are often seen together are macules and papules. When
macules and papules occur together, the rash is referred to as maculo-
papular.
Plaque
 Broad papule (or confluence of papules)
 >0.5 cm in diameter
 Generally flat and may be centrally depressed
Nodule
 0.5-2cm
 Form of papules, but larger and deeper extending into the dermis or
subcutaneous tissue
Tumor
 >2cm
 Soft or firm and freely movable or fixed masses with various sizes and shapes
but with a tendency to be rounded
Wheal (Hives)
 Transient, edematous, elevated lesions with irregular shapes and various
sizes usually associated with pruritus
Vesicle
 Elevated, thin-walled lesions filled with clear fluid, less than 0.5 cm in
diameter
  Herpes simplex, Varicella, Herpes Zoster
Bullae
 Clear fluid-filled blisters/vesicles more than 0.5 cm in diameter
 Classic bullous diseases include pemphigus vulgaris and bullous pemphigoid
Pustule
 Elevated lesions that contain pus

Cyst
 Encapsulated
 Found in the dermis or subcutaneous

SECONDARY LESIONS

Scale
 Dried or greasy laminated masses of keratin
 Flaky exfoliation which maybe fine and delicate or coarse with large sheets

Crust
 A solid consolidation of dried serum, blood, and pus , usually mixed with
epithelial and bacterial debris
 Vary in size, thickness, shape and color according to their origin or
composition and amount of discharge
Excoriation
 Punctate or linear abrasion produced by mechanical means, usually involving
only the epidermis
 Deep scratch
Fissure
 Linear cleft or a small split or crack through the epidermis and rarely into
dermis
 Cheilosis
Erosion
 Discontinuity of the skin with loss of part or whole epidermis, usually
following rupture of vesicles or bullae
 Heals without a scar
Ulcer
 Rounded or irregularly shaped excavations that result from loss of the
epidermis and dermis
 Heal with scarring
Scar
 New formations of connective tissue that replace loss of substance in the
dermis or deeper part as a result of injury or disease
 Part of the normal reparative and healing process
Lichenification
 Palpably thickened and rough epidermis with accentuation of skin markings
 Caused by chronic rubbing and scratching
Atrophy
  Thinning of the skin surface with loss of skin markings
 Skin appears dry and wrinkled

Cutaneous Symptoms
 Pruritus
 Itching
 Most common cutaneous symptom
 Unpleasant cutaneous sensation which provokes the desire to scratch
or rub the skin
 Maybe due to dryness of the skin (xerosis)
 Associated with eczematous dermatitis, urticaria, food allergy, scabies,
pediculosis
 Pruritus ani and pruritus vulvae or scroti when the anogenital area is
involved
Other Subjective Symptoms:
 Sensation of heat (burning)
 Sensation of cold (tingling)
 Pricking
 Pain
 Numbness
 SKIN ASSESSMENT
Diagnostic Examination
 Wood’s Light
 KOH
 Culture- bacteria, fungi, virus
 Skin biopsy- punch biopsy (Dermatologic punch), shave biopsy,
excisional biopsy