Table of Contents
Introduction
- Wash hands; Introduce self; ask Patient’s name, DOB and what they like to be called; Explain examination and obtain consent
- Get a chaperone
- Expose patient to underwear
General inspection
- Patient: well/unwell, pain/discomfort
- Describe the pattern of any rash: site, number of lesions, distribution pattern
Inspect lesions
- Distribution and size
- e.g. acral (distal), central, flexor/extensor, localised/generalised, dermatomal, follicular, seborrhoeic
- Characteristics (SEC)
- Shape, e.g. circular, linear, annular, irregular
- Edge and elevation, e.g. well-demarcated, ill-defined, raised/flat
- Colour, e.g. erythematous, depigmented/pigmented, purpuric
- Secondary features
- e.g. crust, scale, pigmentation, keratosis, lichenification, erosion, excoriation, fissure, ulceration
Definitions in dermatology
| <1 cm | >1 cm | |
| Flat | Macule | Patch Plaque (palpable) |
| <0.5 cm | >0.5 cm | |
| Raised | Papule Vesicle (fluid-filled)Pustule (pus-filled) | NoduleBulla (fluid-filled) |
Palpate lesions
- Temperature
- Texture
Close inspection
- Nails: psoriatic nail changes (pitting, onycholysis, subungual hyperkeratosis)
- Hands
- Anterior arms
- Ask patient to put hands behind head
- Posterior arms
- Axilla
- Scalp: look through hair and behind ears
- Face
- Inside mouth
- Chest and abdomen
- Back
- ‘At this point, I would also like to look at the genital region.’
- Legs
- Feet and toe nails
To complete
- Thank patient and restore clothing
- ‘To complete my examination, I would examine any suspicious moles with a dermatoscope and perform other relevant system examinations (e.g. vascular for an arterial ulcer).’
- Summarise and suggest further investigations you would consider after a full history
