PE Derm + Vitals

PRIMARY LESIONS

Initial, spontaneous manifestations of disease (best for biopsy)

Macule

Flat, circumscribed area - change of the color of the skin < 1 cm

Examples of Macules

petechiae, flat nevi, freckles

Papule

An elevated, firm, circumscribed area < 1 cm

Examples of papules

wart (verruca), lichen planus

Patch

A flat, non-palpable, irregularly shaped macule > 1 cm

Examples of patch

vitiligo, tinea versicolor

Plaque

Elevated, firm, and rough lesion with flat top > 1 cm

Examples of plaques

Psoriasis, atopic dermatitis

Wheal

Elevated, irregularly shaped area of edema, transient, variable diameter

Nodule

Elevated, firm, circumscribed lesion Deep and 1-2 cm

Example of nodules

dermatofibroma, neoplasms

vesicle

Elevated, circumscribed, superficial, filled with serous fluid, < 1 cm

examples of vesicles

HSV, VZV

Bulla

Vesicle > 1 cm

example of bulla

bullous pemphigus

pustule

Elevated, superficial lesion filled with purulent fluid

example of pustule

impetigo, acne

Open comedone

black head

Closed comedone

white head

SECONDARY LESIONS

result of later evolution or trauma to a primary lesion

crust

scab

scale

Hyperkeratosis- accumulation of skin on the surface (either increased production or decreased desquamation)

Excoriation

scratch mark - exogenous injury to the epidermis

fissure

Painful, linear cleft in the skin

erosion

Partial loss of the epidermis

ulceration

Full-thickness loss of epidermis

atrophy

Epidermal: thinning of the skin Dermal: loss of dermal collagen/elastin

Lichenification

Thickening of the skin- accentuation of natural skin lines

CONFIGURATION

-

annular

ring

arcuate

curved

serpiginous

snake-like

verrucous

war/cauliflower like

reticulated

net-like, interlacing lines

retiform

net-like, vesicles occluded

pedunculated

stalk

guttate

tear drop

lichenoid

moss like

nummular

coin

keratotic

waxy/sticky

VITALS

-

underweight

<18.5

normal bmi

18.5-24.9

overweight

25-29.9

obese

30-34.9

extremely obese

>35

normal temp

37C or 98.6F

pyrexia

37C-41C or 98.6-106F

hyperpyrexia

>41.1C or 106F

hypothermia

<35 C or 95F

normal pulse

60-100 bpm

normal respirations

12-20

normal bp

<120/80

elevated bp

120-129/<80

stage 1 htn

130-139 or 80-89

stage 2 htn

>140 or >90

htn crisis

>180 and/or >120

Ch

character

L

location

O

onset

R

radiation

I

intensity

D

duration

E

events

P (+)

palliative

P (-)

provocative

A

attribution

T

temporal

ABCDE of Melanoma

A = asymmetry

B = border irregularity

C = color variation

D = diameter >6mm

E = evolution over time