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The Dermatological Exam

The dermatologic examination involves thorough examination for rashes or skin lesions affecting the hands, face, scalp, trunk, abdomen, pelvis, arms and legs. The morphology of these lesions can aid in identifying their cause.

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...

Mackender D, Talley N. Cutaneous signs of systemic disease. Part 1. Nail abnormalities and disorders of pigmentation. Current Therapeutics. 1999;40:83-89. Talley N, Mackender D. Cutaneous signs of systemic disease. Part 2. Characteristic lesions of common diseases. Current Therapeutics. 1999;40:83-7.

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