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Dermatological skin examination

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
FlatMacule Patch Plaque (palpable)
 <0.5 cm>0.5 cm
RaisedPapule 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
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