dermatology basics (skin, hair, nails) exam

why do we care about skin, hair and nails?

it is the largest organ, indicator of internal health

what are skin functions?

protection from the environment, containment of tissues, organs, and vital substances (H2O), heat regulation, sensation, vitamin D, storage (energy adipose tissue)

what are the layers of the skin?

epidermis, dermis, and hypodermis

epidermis

stratified (layered) epithelium with tough outer surface composed of keratin

dermis

dense layer of collagen and elastic fibers that give skin its strength, living layer, with blood vessels

hypodermis

subcutaneous tissue, adipose- skin ligaments, determines mobility over underlying fascia

OLDCARTS

Onset, location, duration, C (itch, burn, pain, warmth), Alleviating/aggrevating, radiation (rash spread), treatment/travel, S - how bad is it, limiting function?

dermatologic history includes

PMH, FH, medications, allergies, SH

documentation is important because

it describes the location relative to a common anatomic landmark with appropriate medical terminology for future reference

proximal

close to origin

distal

further away from origin

describe a skin lesion using categories:

primary and secondary morphology, size, border/demarcation, color, shape, distribution

primary morphology

general size and shape

macule

non-palpable, lesion less than 1 cm, different color than surrounding skin, petechiae

patch

non-palpable lesion greater than 1 cm, different color than surrounding skin, eg. cafe au laid spot

papule

elevated solid lesion less than 1 cm ie. verruca (wart)

plaque

elevated flat/plateau like solid lesion greater than 1 cm (ie. Psoriasis)

nodule

elevated domed solid lesion greater than 1 cm example: lipoma, sebaceous cyst

vesicle

elevated fluid filled lesions less than 1 cm ie. chicken pox

bulla

elevated fluid filled lesion, greater than 1 cm ie. diabetic bullae (bullosis diabeticorum)

blister

inclusive synonym for bulla or vesicle (be specific)

pustule

vesicle filled with pus (ie acne vulgaris)

furuncle

larger pus filled lesion (ie. abscess)

carbuncle

larger area with multiple draining points

abscess

occlusion of drainage results in pus filed cavity within dermis and/or subcutaneous fat (fluctuant mass) treatment is incision and drainage

how to document size

at least 2 dimensions unless it is round or linear (laceration)

border

demarcation, regular circular, irregular borders =abnormal

vitiligo

white

hemangioma

red

karposi sarcoma

purple

melasma

brown

xanthelesma

yellow

blue nevus

blue

eschar

black

leukoderma

white/vitiligo

erythema

distinct area of redness

petichiae

blood in the skin, less than 4 mm

purpura

blood in skin 4 to 10 mm

eccymoses

greater than 10 mm, bruise

annular

circle with central clearing

gyrate

whirling in a circle

curvilinear lesion

half circle

discoid

round, nummular, coin shape

Lyme disease

bullseye, target

serpiginous

serpent

reticular rash

lace like

serum

dried crust, exude blood plasma

fissure

crack

excoriation

Skin sore or abrasion produced by scratching or scraping

ulcer

open sore or lesion in the skin or mucous membrane- usually from lack of blood flow, hole from tissue decay

scaling

dry skin

Pedunculated

small neck and bigger in middle, like a skin tag

umbilicated

central depression (belly button)

extensor surfaces

Skin of the elbows, knees hands and feet that is on the outside of the joint, ie that is stretched when the joint is flexed.

Photodistrubuted

sunburn

Dermatomal

referring to a lesion that follows a nerve or segment of the body. shingles

Acral

pertaining to the extremities

truncal

occurring on the trunk or central body

morbiliform rash

a rash that looks like measles

the rash consists of macular lesions that are red and usually 2-10 mm in diameter but may be confluent in places

cyanosis

Blue skin color - low oxygenation of hemoglobin

Pallor (blanching)

pale

icteris

jaundice (yellowing)

Diaphoretic

Characterized by light or profuse sweating. cold, clammy, appearing unwell

onchodystrophy

Pour nourishment and development of the nail

Pitting nails

punctate depressions of the nail plate caused by defective layering of the superficial nail plate by the proximal nail matrix; may be seen with psoriasis, Reiter's syndrome, sarcoidosis, alopecia areata, and localized atopic or chemical dermatitis.

Onychoschizia

splitting or lamination of the nail plate into layers that flake off

Koilonychia

Spoon nails

clubbing

bulbous enlargement of distal phalanges of fingers and toes that occurs with chronic cyanotic heart and lung conditions

subungual

pertaining to under the nail

alopecia

hair loss

hirsutism

excessive hair growth over the body, male pattern

palpate

to examine by touch

percussion

tapping on a surface to determine the difference in the density of the underlying structure

head circumference

a measurement that should be obtained on each visit until a child reaches 2 years of age.

Molding

Shaping of the fetal head during movement through the birth canal.

subdural hematoma

collection of blood under the dura mater

Subgaleal hemorrhage

bleeding into the subgaleal compartment, forceps during birth

Sternocleidomastoid

flexes neck; rotates head

Trachea

windpipe, midline

neck lymphatics

lumps, "swollen glands" (lymphadenopathy), goiter, neck pain or stiffness

axillary lymph nodes

concentrated in armpit, receive lymph from upper limb and female breast

inguinal lymph nodes

located in the inguinal (groin) area of the lower abdomen