Skin examination

Ensure patient is in a gown without socks
- Important for full skin exam to inspect areas like between toes
- For full skin examination:
- No bra, underwear can remain on
Use proper lighting for effective examination
- Tools: measuring tape, magnifying glass, or derma scope
- Dermatologists utilize a dermatoscope for detailed inspection, especially for potential melanoma
Obtain verbal consent before examining sensitive areas (genitalia/breasts)
- Always have a chaperone present during the exam for safety and ethics
- Important to develop the habit of this practice in OSCEs (Objective Structured Clinical Examinations)
Wash hands before examination
Wearing gloves considerations:
- Often not required in dermatology, but maintain a clean approach

Establishing a routine is key:
- Consistent method prevents missing important information
Start all physical exams with a general survey
- Focus on inspection first, followed by palpation
Areas to inspect include:
- Scalp
- Hair texture and distribution
- Skin color changes (check for blanching)
- Blanching: color returns after pressure, indicating healthy blood flow
- Non-blanching: persists after pressure, indicating possible issue
- Lesions on the scalp, eyebrows, eyelids, etc.
- Certain diseases (e.g., endocrine disorders) may influence hair appearance

Key terms to recognize in skin conditions:
- "Curly, pink lesion, nodular, telangiectasia"
- Common sites for skin cancer include exposed areas (e.g., eyelids, nose, ears)
Skin turgor as a hydration assessment:
- Pinch skin; if it remains tented, indicates possible dehydration

Most commonly diagnosed cancer in the U.S.
- Notably highlights need for awareness and early detection
Types of skin cancer:
- Basal Cell Carcinoma: slowest growing, non-melanoma, rarely fatal
- Squamous Cell Carcinoma: potentially more aggressive than basal cell
- Melanoma: most lethal; capable of metastasizing
Risk Factors for Skin Cancer:
- Ultraviolet (UV) radiation exposure (e.g., sunburn, tanning beds)
- Genetic predisposition: fair-skinned individuals at higher risk
Importance of early detection and monitoring:
- Regular skin checks recommended

Significant concern in healthcare particularly for elderly populations
- Impact of immobilization on skin integrity leading to ulcers
Staging of pressure injuries:
- Stage 1: skin intact but reddened and irritated
- Stage 2: partial thickness loss, involving epidermis and possibly part of dermis
- Stage 3: full thickness loss, exposing adipose tissue
- Stage 4: extensive damage reaching muscle, tendons, or bone
- Unstageable: covered with eschar, making assessment impossible

Differentiating cellulitis from abscess:
- Both can present with inflammation, tenderness, and warmth
- Cellulitis: generalized infection without pus; marked by redness and tenderness
- Abscess: localized collection of pus—feels fluctuance on palpation
Treatment protocols may involve antibiotics, ultrasound for abscess identification

Types of hair in adults:
- Vellus hair: short, fine, unpigmented
- Terminal hair: pigmented, thicker (e.g., scalp, beard, brows)
Alopecia: types and causes:
- Androgenic alopecia: hereditary pattern baldness
- Telogen effluvium: temporary hair shedding post-trauma or stress
- Alopecia areata: autoimmune disorder causing patchy hair loss
- Traction alopecia: caused by tight hairstyles
Nail changes as indicators:
- Inspect for deformities, nutritional deficiencies, or infections

Melanoma can appear under the nail (subungual) or on skin, requiring precise biopsy
Mohs surgery widely used for cancer removal
- Process: remove lesion, pathological review for clear margins
- Important for areas sensitive to loss of tissue (e.g., face, eyelids)
- Discuss signs of trauma or any significant history during patient examination
Importance of monitoring nail health and appearance post-injury

Regular skin and hair assessments can help with early detection of issues
Stay informed about skin conditions, understand normal and abnormal changes
Educate patients about skin health, preventive measures, and awareness of changes in appearance