Table of Contents
Assessing 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) | Nodule Bulla (fluid-filled) |
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
Hands
- Nails
- Psoriatic nail changes (pitting, onycholysis, subungual hyperkeratosis)
- Hands
Upper limbs
- Anterior arms
- Ask patient to put hands behind head
- Posterior arms
- Axilla
Head and neck
- Scalp: look through hair and behind ears
- Face
- Inside mouth
Torso
- Chest
- Abdomen
- Back
- ‘At this point, I would also like to look at the genital region.’
Lower limbs
- 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
Try some questions
What is Nikolsky’s sign?
Oops! This section is restricted to members.
What are the skin findings in dermatomyositis?
Oops! This section is restricted to members.
What is the definition of erythroderma?
Oops! This section is restricted to members.
What are the different types of psoriasis?
Oops! This section is restricted to members.