Approach to the Dermatology Exam (Stanford Medicine 25)

Approach to the Dermatology Exam (Stanford Medicine 25)


[Music] hi i’m dr. justin cohen clinic chief of medical dermatology at Stanford medicine today we’ll be talking about a general approach to the dermatological nation to describe skin lesions first we have to learn the language of dermatology it’s the common language that we share to describe skin lesions and this is something we call morphology which is describe the general appearance of a skin lesion without any regard to its pathogenesis where its underlying etiology the first thing that we have to do is we have to identify the primary lesion we’re going to go through and talk about the different primary lesions and provide some clinical examples and images of each a Mac you Elizabeth less than one centimeter lesion and a petechiae is an example of a Mac you’ll if you were to take a Mac Ewell and increase its size to greater than one centimeter we would have a patch vitiligo is a perfect example of the patch a raised patch something that you could feel that’s raised above the surface of the skin is called a plaque psoriasis is a is a great example of a plaque if you were to take a Mac you’ll make it palpable it’s still less than one centimeter we have a papule and a papule is something that we see to provide by a cherry angioma or a wart in addition you can have a large papule something greater than two centimeters which is dome-shaped and you call that a nodule at the dermal inclusion cyst is a commonly encountered nodule that we see in the skin a vesicle is a clear fluid filled lesion herpes is an example of a vesicle if we have something that looks like a vesicle but that’s instead filled with pus or purulent material we call that a pustule and we see pustules in acne and certain kinds of drug eruptions a large vesicle greater than one centimeter is called a bulla and we see bulla in friction war in blistering conditions like bullous pemphigoid so after we choose the appropriate now you have to fill it out with some adjectives we can talk about the size of a lesion we can talk about whether or not its borders are clearly defined in other words its demarcation well demarcated lesions such as we see an era syphilis alternatively regions can be not well demarcated such as in cellulitis we can also talk about its color and in dermatology there’s a lot of conditions which have characteristic colors to them one example is we see the white of vitiligo a loss of pigmentation we can also see a bright red of a drug eruption or a viral example in addition purple sometimes connotes a vascular process like Kaposi sarcoma we can also see things in the skin that are granulomatous appear brown in color yellow sometimes makes us think of as anthelmintics lesions or fatty lesions in addition we can sometimes see black as being necrotic skin or eschar we also see blue as a deep pigmentation for example in something called a blue Nevis in addition to the primary morphologies we oftentimes have secondary wear overlying morphologies some of these examples include serum which is dried crust we can see this in potato or we can see this in acute or subacute eczema fissuring is something that we can see which is a splitting of the skin as a result of hand or foot psoriasis we can also see like kenefick ation by kenefick ation is the thickening of the skin and accentuation of skin lines as a result of chronic rubbing or scratching erosions are partial loss of the epidermis and sometimes we see this as a result of scratching or injuring the skin ulcerations are full thickness loss of the epidermis and sometimes these are frictional ii derived or as a result of other primary processes it’s important to consider the distribution of skin lesions throughout the body as they can help you with the diagnosis for example lesions on the extensor surfaces of arms and legs can be seen in psoriasis generalized distributions occur in certain drug reactions we could see a photo distributed rash and connective tissue diseases such as lupus order madam is itis that was a lot of information so let’s quickly review the important parts whenever you are attempting to describe a skin problem remember the primary lesion mer morphology size demarcation color secondary morphology and distribution what you’ll need for a skin examination is a well-lit room a ruler a magnifying glass a handheld source of light and an open and curious mind we have a patient here today who’s going to help us go through some of the important considerations for a dermatological examination hello sir thanks for coming in thank you doctor so using some of what we just discussed let’s practice by describing our patient trash so the first thing we want to do is we want to carefully choose our primary lesion I’m going to choose this area here when I touch it I feel that it’s raised above the surface of the skin it’s larger than a centimeter in size so the appropriate primary lesion term would be a plaque after we choose our now we want to think about some other descriptive terms that help us fill out some of the adjectives this is probably a few centimeters in size well demarcated it’s color is probably dully red I would describe as in regards to secondary morphology we see that it has some crusting which is dried serum or dried blood we can also see superficial erosions where areas that the skin has been disrupted and also we notice some subtle scaling so taken all together this is consistent with a diagnosis of psoriasis this air feminists plaque with overlying scale excoriation serum crusts and different lesions and stages of evolution are consistent with this diagnosis on extensor surfaces of the body one of the other things that we can do sometimes is perform special tests sometimes what we do with scaly lesions like this is if we were to peel off some of the scale we can see if we see an off Spitz sign which is signs of focal bleeding from blood vessels that are high up in the surface of the skin the other thing that we notice about this stepping back from the primary lesion is the distribution of the lesion and looking at the legs it tends to be on the extensor surfaces of the body so we see that these plaques are distributed only mainly on the legs here but also when we look above we see some areas of hyperpigmentation further up on the legs also given that psoriasis can involve other areas one of the areas we want to examine is the scalp in addition we want to examine the year including the contrl Bowl and the extra external auditory meatus as well as the retro auricular area other areas we want to examine include the medial and lateral canthus the LR groove the LR rim under the chin the anterior neck you also want to make sure we examine and traditionally always announce what body part you’ll be examining next and ask permission before doing so I hope you enjoyed our discussion about an approach to the dermatological and please visit the Stanford 25 website for more info the preceding program is copyrighted by the Board of Trustees of the Leland Stanford junior University please visit us at med.stanford.edu [Music]

11 Comments

Leave a Reply

Your email address will not be published. Required fields are marked *