diagnosis of skin diseases

8/14/2019 Diagnosis of Skin Diseases

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Diagnosis of skinDiagnosis of skin

diseasesdiseasesByBy

Zeinab abdel azimZeinab abdel azim

MD dermatologyMD dermatology

www.mansfans.comwww.mansfans.com


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SkinSkin

Flexible membranous tissueFlexible membranous tissue that formsthat forms

the external covering of the bodythe external covering of the body

Skin makes up about 18% of an adult'sSkin makes up about 18% of an adult'sweight and approximate total area of 1.5weight and approximate total area of 1.5

2 m 2 m

It operates as a complex organ ofIt operates as a complex organ of

numerous structuresnumerous structures ((sometimes calledsometimes called

the integumentary systemthe integumentary system)) performingperforming

vital protective and metabolic functionsvital protective and metabolic functions..

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Functions of the skinFunctions of the skinProtection:Protection:

Mechanical protection of deeper structures.Mechanical protection of deeper structures. Protection against lightProtection against light

Protection against invasion by microorganismsProtection against invasion by microorganismsHeat regulation through:Heat regulation through:

Evaporation of sweat.Evaporation of sweat.

The skin is rich in blood vessels, through their constriction orThe skin is rich in blood vessels, through their constriction ordilatation heat loss is decreased or increased.dilatation heat loss is decreased or increased.

Fat in subcutaneous tissue is poor conductor and prevents heatFat in subcutaneous tissue is poor conductor and prevents heatloss.loss.

ExcretionExcretion of certain substances through sweat.of certain substances through sweat. e.g.e.g.

Na Cl, lactic acid, ammonia and some drugs.Na Cl, lactic acid, ammonia and some drugs.Formation ofFormation ofvitamin Dvitamin D:: from ergosterol by UVR.from ergosterol by UVR.

perception ofperception ofsensationssensationsas heat, cold, pain and touch.as heat, cold, pain and touch.

Reflection ofReflection ofinternal feelinginternal feeling e.g., fear, shame ande.g., fear, shame andanger.anger.

ImmunologicalImmunological functions.functions.


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DiagnosisDiagnosis

Initial historyInitial history

ExaminationExamination

Follow up historyFollow up history

investigationsinvestigations



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Initial historyInitial history

PersonalPersonal

ComplaintComplaint

Present historyPresent history

DurationDuration OnsetOnset

Mode of onset: acuteMode of onset: acute(within hours), rapid (within days)(within hours), rapid (within days)or gradual (within weeks or months).or gradual (within weeks or months).

Site of onset.Site of onset.

Course:stationary, progressive, regressive orCourse:stationary, progressive, regressive orrecurrent.recurrent.

Symptoms:itching, burning, pain, anaesthesia orSymptoms:itching, burning, pain, anaesthesia ordisfigurement.disfigurement.


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ExaminationExamination

Skin examination must be done in goodSkin examination must be done in good

light.light.

It should involve oral mucous membrane,It should involve oral mucous membrane,

hair, nails and lymph nodes.hair, nails and lymph nodes.

The following points should be noticedThe following points should be noticed

during examination:during examination:

DistributionDistribution

ConfigurationConfiguration

Morphology of individual lesionMorphology of individual lesion



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LocalizedLocalized:: Affecting oneAffecting oneanatomical areaanatomical area

Generalized:Generalized: affectingaffectingmore than one anatomicalmore than one anatomical

area.area.Special sites:Special sites: e.g. pressuree.g. pressureareas such as elbows &areas such as elbows &knees, sun exposed areasknees, sun exposed areasor intertriginous areas.or intertriginous areas.

Distribution may beDistribution may besymmetrical orsymmetrical orasymmetrical.asymmetrical.


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LinearLinear


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CircinateCircinate


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)Polycyclic) Geographic)Polycyclic) Geographic


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GroupedGrouped


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DiscreteDiscrete


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Macule& patchMacule& patch CircumscribedCircumscribed

change in skin colorchange in skin colorup to 0.5cm .up to 0.5cm .

Larger lesion is aLarger lesion is apatch They may be:patch They may be:

HyperpigmentedHyperpigmented

HypopigmentedHypopigmented

RedRed ErythemaErythema

PurpuraPurpura


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MaculeMacule


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MaculeMacule


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MaculeMacule


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NoduleNodule

Nodule: palpable, solid

lesion > 0.5cm . Nodules

may be located in theepidermis (B) or extend

into the dermis or

subcutaneous tissue (A).



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cystcyst

A cyst is a sac thatA cyst is a sac that

contains liquid orcontains liquid or

semisolid materialsemisolid material



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PlaquePlaque

Circumscribed areaCircumscribed area

of abnormal skinof abnormal skin

formed by extensionformed by extension

or coalescence ofor coalescence ofeither papules oreither papules or

nodulesnodules..



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PlaquePlaque


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Vesicle& BullaVesicle& Bulla

A vesicle is localizedA vesicle is localized

visible collection ofvisible collection of

fluid up to 0.5 cm influid up to 0.5 cm in

diameterdiameterA bulla is a vesicleA bulla is a vesicle

larger than 0.5 cm.larger than 0.5 cm.


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Vesicle& BullaVesicle& Bulla


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PustulePustule

localized visiblelocalized visible

collection of pus.collection of pus.



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Morphology of individual lesionMorphology of individual lesionPustulePustule


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CrustCrust

Crusts result whenCrusts result when

serum, blood, orserum, blood, or

purulent exudatepurulent exudate

dries on the skindries on the skinsurface and aresurface and are

characteristic ofcharacteristic of

injury and pyogenicinjury and pyogenic

infections.infections.


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CrustCrust


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ScaleScaleFlat plate of horny layer formedFlat plate of horny layer formed

by accumulation of excessby accumulation of excess

keratin.keratin.


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scalescale


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WhealWhealEvanescent elevated oedematous erythematous lesion.Evanescent means that lesion does not persist > 48 hrs


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BurrowBurrowSuperficial tunnel in skin caused by mitethat appears as black dot at end ofburrow. It is tortuous, straight or S shaped,skin coloured or grayish and 0.5-1.5cm in

length. It is the 1ry lesion of scabies.


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Non scarring alopeciaNon scarring alopecialoss of hair from a normally hairy area.Non scarring: with visible follicularopening.


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Scarring alopeciaScarring alopecia

Scarring alopeciaalopecia : devoid of follicularopening.


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Morphology of individual lesionMorphology of individual lesionErosion:Localized loss of epidermis above basal

layer. It heals without scar.


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ErosionErosionLocalized loss of epidermisabove basal layer. It healswithout scar.

M h l f i di id l l i


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UlcerUlcerLocalized loss of epidermis and dermis. Ulcer may

extend into SC fat. It heals with scar.

M h l f i di id l l iM h l f i di id l l i


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UlcerUlcer

Localized loss of epidermis and dermis. Ulcer mayextend into SC fat. It heals with scar.




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ExcoriationExcoriation

Scratch that removes skin. It may be linear orcircumscribed; superficial or deep.


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ExcoriationExcoriation




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FissureFissurelinear gap or slit in skin )crack in epidermis and dermis.


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FissureFissure



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LichenficationLichenfication

Thickened skin eexagerated skin

marking in response to

prolonged rubbing or itching



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LichenficationLichenfication



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LichenificationLichenification


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AtrophyAtrophy



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Hypertrophic ScarHypertrophic Scar

healing of injured skin by fibrous tissuehealing of injured skin by fibrous tissueformation. Atrophic scar with thin skin.formation. Atrophic scar with thin skin.

Hypertrophic scar with elevated skin.Hypertrophic scar with elevated skin.



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p gyp gy

Hypertrophic ScarHypertrophic Scar

M h l f i di id l l iMorphology of individual lesion


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Atrophic ScarAtrophic Scar

Morpholog of indi id al lesionMorphology of individual lesion


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SclerosisSclerosis Circumscribed or diffuse hardening orinduration in the skin

Detected more easily by palpation thanby inspection.


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Family HFamily H

Medical HMedical H

General symptomsGeneral symptoms

Social HSocial HRelation of skin condition toRelation of skin condition to

FoodFood

DrugDrug

SeasonSeason

Physical factorPhysical factor

H of drug intakeH of drug intake


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Social H:Social H:

Emotional stressEmotional stress

Skin exposure H. inSkin exposure H. in

hand eczemahand eczema

BirthplaceBirthplace

HobbiesHobbies

Economic stateEconomic state



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Pathological TermsPathological Terms

Hyperkeratosis:Hyperkeratosis:Increased thickness of horny layer.Increased thickness of horny layer.

Parakeratosis:Parakeratosis: Immature keratinization resulting inImmature keratinization resulting in

retention of nuclei in cells of horny layer.retention of nuclei in cells of horny layer.

Acanthosis:Acanthosis: Increased thickness of prickle cell layer.Increased thickness of prickle cell layer.

Acantholysis:Acantholysis:Loss of coherence between epidermal orLoss of coherence between epidermal or

epithelial cells. Primary acantholysis occurs amongepithelial cells. Primary acantholysis occurs among

unaltered cells as a result of dissolution of theunaltered cells as a result of dissolution of the

intercellular substance, e.g., pemphigus. Secondaryintercellular substance, e.g., pemphigus. Secondary

acantholysis occurs among altered or damaged cells,acantholysis occurs among altered or damaged cells,e.g. impetigo, viral vesicles.e.g. impetigo, viral vesicles.

Spongiosis:Spongiosis: Intercellular oedema in prickle cell layer.Intercellular oedema in prickle cell layer.



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Hyperkeratosis+Parakeratosis+Acanthosis


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http://upload.wikimedia.org/wikipedia/commons/9/9d/Spongiotic_dermatitis_%282%29_Dyshidrotic_.JPG


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SpongiosisSpongiosis

http://upload.wikimedia.org/wikipedia/commons/9/9d/Spongiotic_dermatitis_%282%29_Dyshidrotic_.JPGhttp://upload.wikimedia.org/wikipedia/commons/9/9d/Spongiotic_dermatitis_%282%29_Dyshidrotic_.JPGhttp://upload.wikimedia.org/wikipedia/commons/9/9d/Spongiotic_dermatitis_%282%29_Dyshidrotic_.JPG


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WoodlightWoodlight


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Woodlight

InvestigationsInvestigations


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InvestigationsInvestigations

Culture of fungusCulture of fungus



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Patch test


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Topical TherapyTopical Therapy

Active agentActive agente.g.,e.g., antibioticsantibiotics

Vehicle (base)Vehicle (base)e.g. liquid, powders,e.g. liquid, powders,creams or ointments.creams or ointments.

Liquids: in acute weeping diseasesLiquids: in acute weeping diseases

(Solutions(Solutions ,,Lotions,Tincture,Paint).Lotions,Tincture,Paint). Creams: semisolid emulsion of oil in waterCreams: semisolid emulsion of oil in water

used in subacute condition.used in subacute condition.

Ointments: greasy base for dry hyperkeratoticOintments: greasy base for dry hyperkeratotic

or lichenified skin.or lichenified skin. Gels: Non greasy transparent, semisolidGels: Non greasy transparent, semisolid

emulsions that liquify on contact with skinemulsions that liquify on contact with skinsuitable for treating hairy parts of the bodysuitable for treating hairy parts of the body



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diagnosis of skin diseases

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