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Classification of Lesions

  • Flat Lesions

    Macule / patch

  • Solid Lesions

    Papule / plaque / nodule / wheal

  • Fluid-Filled Lesions

    Vesicle / bulla / cyst / pustule

  • Depressed Lesions

    Erosion / ulcer / fissure

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

  • The Arms

    Erythema, scratch marks, nodules

  • The Neck

    Cervical lymph nodes

  • The Scalp

    Oily, dry, erythematous, excoriated

  • Hair

    Follicles, alopecia, hirsutism, hypertrichosis

  • 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

References

 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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