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The Dermatological Exam

Classification of Lesions

Flat Lesions
Macule / patch
Macule
Flat lesion <2cm
Patch
Flat lesion >2cm
Solid Lesions
Papule / plaque / nodule / wheal
Papule
Elevated lesion <1cm in diameter
Plaque
Flat-topped, elevated lesion >1cm in diameter
Nodule
Spherical lesion
Wheal
Papule or plaque due to underlying oedema
Fluid-Filled Lesions
Vesicle / bulla / cyst / pustule
Vesicle
<1cm, raised, clear serous fluid or blood
Bulla
>1cm, raised, clear serous fluid or blood
Cyst
Firm-walled leion with semisolid material
Pustule
Small raised lesion containing pus
Depressed Lesions
Erosion / ulcer / fissure
Erosion
Skin loss with erythematous base
Ulcer
Skin loss into the dermis or deeper
Fissure
Linear erosion or ulcer

Inspection of Lesions

Size
Using a ruler
Shape
Annular, discoid, target lesions
Colour
Flesh, hypo/hyperpigmented, erythema, purpura
Border
Well-demarcated / poorly defined, regular / irregular
Elevation
Raised / even / depressed
Number of Lesions
Distribution
Localised / generalised, flexor / extensor surfaces, pressure areas, dermatomal
Arrangement
Discrete / confluent lesions, clusters, linear

Palpation of Lesions

Consistency & Surface Texture
Smooth / rough, shiny / dull, waxy, verrucous
Fixation
To superficial / deep tissues
Blanching
On depression
Tenderness
Fluctuance

Head-to-Toe Exam

The Hands
Clubbing, xanthomata, hyperkeratosis
Fingernails
Colour, pitting, ridging, nail plate
Colour
White, yellow, green, brown, black, red, purple
Nail Plate
Thinning / crumbling / pitting
Ridging
Transverse / longitudinal
Onycholysis
Separation of nail from nail bed
Paronychia
Erythema and swelling around the fingernail
Koilonychia
Spoon-shaped nails
The Arms
Erythema, scratch marks, nodules
The Neck
Cervical lymph nodes
The Scalp
Oily, dry, erythematous, excoriated
Hair
Follicles, alopecia, hirsutism, hypertrichosis
Follicles
Scarring, folliculitis
Alopecia
Hair loss - localised or generalised
Hirsutism
Male-pattern hair growth on females
Hypertrichosis
Generalised excessive hair growth
The Face
Eyes, nose, mouth, ears
The Chest
Including axillae and underneath breasts
The Abdomen
Including inspection under skin folds
The Back
Intergluteal cleft, perianal area
The Legs
Scratch marks, erythema
The Feet
Clubbing
Toenails
Colour, pitting, ridging, nail plate

Read More...

Landis ET, Davis SA, Taheri A, Feldman SR. Top dermatologic diagnoses by age. Dermatology online journal. 2014;20:22368. Pubmed

Mackender D, Talley N. Cutaneous signs of systemic disease. Part 1. Nail abnormalities and disorders of pigmentation. Current Therapeutics. 1999;40:83-89. Link

Narayan S. Dermatological history and examination.Medicine (United Kingdom). 2013;41:321-326. Pubmed

Singh G. Nails in systemic disease. Indian journal of dermatology, venereology and leprology. 2011;77:646-651. Pubmed

Talley N, Mackender D. Cutaneous signs of systemic disease. Part 2. Characteristic lesions of common diseases. Current Therapeutics. 1999;40:83-7. Link

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