1 lcd efloresensi dr. ps 2014.ppt

8/18/2019 1 LCD Efloresensi dr. PS 2014.ppt

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dr. NM Dwi Puspawati, SpKKBag/SMF I. Kes. Kulit & KelaminFK Unud/RS Sanglah Denpasar


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The art of Diagnosis in General :

• Anamnesis

• Physical Examination

• Laboratory finding


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GENERAL HISTORY

1. Race, geograhical

!. "ocial bac#gro$nd, ethnic tradition, dietary habits

%. Past medical history : allergy to medication, asthma,ast ma&or illness or oeration

'. "ocial ( occ$ational history: tra)el abroad, hobbiesand details of the tye of *or#, s$bstances in contact


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History of present illness : d$ration, date ( site of onset,details of sread, e)ol$tion of rash ( original morhology,symtoms s$ch as itchiness, ain, b$rning sensation, n$mbness,reciitating and relie)ing factors s$ch as climate, s$nlightetc.

Past history of skin disorders : history of s$nb$rn

Faily history of skin disorders : e.g. s#in cancers and atoic

disorders+stigmata atoic

!r"#s : incl$de herbs, toical, systemic, atient initiated orhysician rescribed

SPE$IAL HISTORY


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E%A&INATION OFTHE S'IN


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1. Ade$ate ri)acy

!. Good lighting

%. -agnifying glass and transarent glass slide for diascoy

t is a good ractice if affordable to ha)e thoro$ghexamination of the *hole body esecially for ne*cons$ltation and for the elderly

Do not s#i examination of the nail, scal and oral m$co$smembrane beca$se there may be )al$able cl$es, find theatoic stigmata


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EFFLORES$EN$E :A s#in lesion is an abnormal gro*th or an area of s#in that

does not resemble the s#in s$rro$nding it /normal s#in0b&ecti)e aearance

!ETAIL !ES$RI(E! OF S'IN LESION :1.Tye of s#in lesion!.2haracteristic of lesion : colo$r, m$ltile or soliter,shae, margin, si3e, s$rface characteristics, temerat$reand smell

%.Arrangement and config$ration'.Distrib$tion


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)* Type of skin lesion :1.1. Primary lesion :•

-ac$la• Pa$le• Pla$e• 4esicle• P$st$le

1.!. "econdary lesion :• "cale

• 2r$st• 5lcer• Erosion• Excoration

• 6od$l• 5rtica• 7$la• 2yst

• Lichenification

• Atrohy• "car• 8iss$re


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!. $hara+teristi+ of skin lesion :

• 2olo$r salmon9in#, erythemato$s,

hyerigmented, s#in colo$r, yello*• -$ltile or soliter

• "hae geometric shae, o)al

• -argin sharness of edge, ill9defined

• "i3e diameter, $nctata, n$m$ler

• "$rface characteristics dome9shaed, $mbilicated,

si#e li#e• Temerat$re and smell *arm on alation, mo$syodor


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%. Arran#eent and +onfi#"ration :• Gro$ed as in dermatitis heretiformis, heressimlex• Ann$lar or arciform as in gran$loma ann$lare, tinea

circinata• Linear attern as in lichen lan$s, lichen striat$s


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,* !istri-"tion :

• symmetrical, asymmetrical• exosed area, s$n exosed area• scal region, hand• extensor asect, flexor asect


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PR-AR LE"6

Primary lesions are the first toaear and are d$e to thedisease or abnormal state


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A* &A$.LE

flat, nonalable circ$mscribed area of color changein the s#in. -ac$les are ; 19! cm in si3e.

-ac$les may be the res$lt of

/A0inflammatory )asc$lar dilation+hyeremia/70bleeding+hemorhagia+$r$ra

/20change of s#in igmentation


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A*)* Hypereia /0as+"lar dilatation1

/Latin hyer9 < o)er= 9emia < related to blood0 is atemorary s#in redness d$e to increased blood flo*. Thelesion blanch $on ress$re /diascoy0.

1. Roseola /> 1cm+nail late0!. Erytemato$s /? 1 cm0

%. Telengictasis : dilated

s$erficial blood )essels


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A purpura (Latin purpura = purple) is a small (3mm– 1 cm) purplish bruise/ violaceous color due toextravasations of blood into the tissue. t does notblanch on appl!in" the pressure.1.#etechia $ (Latin petecchia (plural = petechiae) =spot on s%in) is a small (& 3 mm)'.ibises3.cchimoses (lar"e* + 3 mm)

A*2* Heorha#ia3p"rp"ra


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A*4* $han#e of skin pi#entation

1. @yerigmentation increase of igmentationo. -elasma gra)idar$m

o. -ongolian sot

!. @yoigmentation decrease of igmentationo. Pithyriasis )ersicolor

o. Le$coderma

%. Deigmentasi no igmento. 4itiligo


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@ierigmentation

@ioigmentation

http://www.pediatrics.wisc.edu/derm/tuta/03.html


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• "mall solid ele)ation of s#in generally ; ,B cm in diameter.

• Pa$les may be flat9toed, dome shaed, or sic$lar

• Pa$les may res$lt from locali3ed hyerlasia of dermal oreidermal cell$lar elements

(* PAP.LE

PL E


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alable, latea$9li#e ele)ation of s#in, $s$ally more than !cm in diameter and rarely more than B mm in height. ftenformed by a con)ergence of a$les, as in soriasis.

$* PLA5.E

Cell9defined, reddish,

scaling la$es

http://dermnetnz.org/common/image.php?path=/scaly/img/ps3.jpg


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4esicles are raised lesions less than 1 cm in diameter

that are filled *ith clear fl$id. 4esicle *alls can be sothin that the contained fl$id is easily seen. 8l$id can beacc$m$lated *ithin or belo* the eidermis.

!* 6ESI$LE

http://www.dermnet.com/image.cfm?passedArrayIndex=15&moduleID=21&moduleGroupID=307


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E (.LA /(LISTER1


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7$la /Lat. b$lla < b$bble0 is a )esicle that exceeds 1 cm in si3e

circ$mscribed, ele)ated lesion that is ? 1 cm in diameter, containingsero$s /clear0 fl$id.

E* (.LA /(LISTER1

F P.ST.LE


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s$erficial, ele)ated lesion that contains $s /$s in ablister0. P$st$les may )ary in si3e and shae. P$s is

comosed of le$#ocytes *ith or *itho$t cell$lar debris. tmay also contain bacteria or may be sterile.

F* P.ST.LE


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6od$le is a solid, ro$nd, or ellisoidal alable lesion that has a

diameter larger than ,B cm. 6od$les can in)ol)e any layer of the s#in.7ased on the anatomical comonents in)ol)ed, there are fi)e tyes ofnod$les: eidermal, eidermal9dermal, dermal, dermal9s$bdermal, ands$bc$taneo$s.

G* NO!.LE

H $YST


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An encas$lated or eithelial

lined ca)ity containing li$id orsemisolid material /fl$id, cells,and cell rod$cts0. A shericalor o)al a$le or nod$le may be a

cyst if, *hen alated, isresilient /feels li#e an eyeball0.

/A0 eidermal cysts, lined bys$amo$s eitheli$m and rod$ce#eratino$s material. /70 Pilarcysts, lined by m$ltilayeredeitheli$m

H* $YST


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Transitory, comressible a$le

or la$e of dermal edema.

The a$le or la$e is $s$allyro$nded or flat9toed, ande)anescent, disaearing *ithinho$rs. The borders of a *healare shar, b$t not stable

I* 7HEAL OR .RTI$A


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An er"ption of 8heals is tered "rti+aria and"s"ally it+hes


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, 2omedo

acne9 Telengiectasion9 7$rro* scabies

9* SPE$IAL LESION


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"E26DAR LE"6

Res$lt from the nat$rale)ol$tion of rimary lesions


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"cale acc$m$lation or abnormal shedding of horny

layer #eratin /strat$m corne$m0 in ercetiblefla#es. "cales $s$ally indicate inflammatory changeand thic#ening of the eidermis. They may be fine,*hite and sil)ery, or large and fish9li#e, as inichtyosis

A* S$ALE


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circ$mscribed area of s#in lossextending thro$gh the eidermisand at least art of the dermis/aillary0.

7asically, its a Fhole in the s#inF.5lcers $s$ally res$lt from theimairment of )asc$lar andn$trient s$ly to the s#in.

(* .L$ER


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• Dried ser$m, blood, or $s

on the s$rface of s#in.-ay be thin, delicate, andfriable or thic# andadherent.

• 2r$sts are yello*, if fromser$m= green or yello*9green

if from $s= or bro*n ordar# red if formed fromblood.

• 2r$sts that occ$r ashoney9colo$red, delicate,glistening artic$lates aretyical of 9 metigo.

$* $R.ST


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Erosion: oist +ir+"s+ri-ed sli#htly

depressed areas of skin d"e to loss of allor part of the epideris*

!* EROSION ; E%$ORATION

E


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2hronic thic#ening of the s#in along *ith increased s#inmar#ings. Res$lts from scratching or r$bbing.

E* LI$HENIFI$ATION


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Paer9thin, *rin#led s#in

*ith easily )isible )essels.Res$lts from loss ofeidermis, dermis or both."een in aged, some b$rns,and longterm $se of highlyotent toicalcorticosteroids.

/A0 Dermal atrohymanifests as a deressionin the s#in. /70 Eidermal

atrohy manifests as thinalmost transarent s#in=may not retain normal s#inlines

F* ATROPHY

G $ R


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Relacement of normal

tiss$e by fibro$s connecti)etiss$e at the site of in&$ryto the dermis. "cars may behyertrohic, atrohic,sclerotic or hard d$e tocollagen roliferation.

/A0 @yertrohic or /70atrohic scar

G* S$AR

@yertrohicscar

H FI .RE /RHAGA!E1


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A fiss$re is linear clea)age of s#in *hich extendsinto the dermis.

H* FISS.RE /RHAGA!E1


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"@APE, ARRA6GE-E6T

A6D 268G5RAT6


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Annular = Ring shaped

Granulomaannulare,tineacorporis,erythemaannulare centrifugum

Numular/discoid = Coin

shaped with uniformmorphology from theedges to the center.

Nummular eczema,

plaue!typepsoriasis,discoid lupus

"olycyclic = formed fromcoalesing circle

#rti$aria,su%acutecutaneus


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Arcuate = arc shape,result from incomplateformation of an annular

lesion

#rti$aria,su%acutecutaneus lupuseritematosus

&inear = straight line

'ca%ies %urrow,

poison i(y dermatitis,lichen nitidus, lichenplanus)lesi multipel

Reticular = net!li$e &i(edo reticularis


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'erpiginous = sna$e!li$eCutaneus lar(amigrans

*argetoid = target!li$e +rytema multiforme

horled = li$e mar%elca$e

-ncontinentia pigment


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Irregularldistri!uted

"erpeti#$rmis

%esi$ns lustered t$gether'e.g. herpes simple()

Sattered


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D"TR75T6 8 "6

LE"6


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E%A&INATION OF

THE HAIR


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• valuate hair -uantit! and -ualit! its len"th* densit!* colour and texture

• Loo% for associated s%in conditions*especiall! those aectin" the scalp

• air loss associated 0ith excessive

sheddin"

positive air pull test


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A #2LL 4

• 5rasp a loc% of hairs to determine if an!can be extracted 0ith 6rm pull

• 7ormall! 8,' telo"en hairs can be

extracted$ these are hairs in the restin"phase* identi6ed usin" ma"ni6cation b! arounded bulb at the proximal end

• An elon"ated or tapered end indicates

ana"en hair ("ro0in" phase). Ana"en hairsextracted b! the "entle hair pull test arepatholo"ic.


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*hinned $r a!sent hair

• hinnin" hair or baldin" (alopecia) ma! be localised ordiuse.

• Localised alopecia ma! aect a sin"le or multiple areas.

• valuate $

1. ound/oval* 9moth,eaten: or linear bald patches

'. 4hort hairs$ these ma! be tapered at the tip (normalre,"ro0th)* 9exclamation mar%: (hairs tapered nearscalp)* bro%en,o* sin"ed or cut

3. 7e"ative or positive hair pull test;. 4carrin" (cicatricial alopecia) i.e. no follicles* or non,

scarrin" alopecia (follicular ori6ces present)


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Localised alopecia areata4carrin" alopecia

Locali>ed alopecia

ufted folliculitis


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?iuse alopecia

?iuse alopecia is most often due to pattern baldin"*and more

prominent over the vertex of the scalp

Pattern !alding'male)

Pattern !alding'#emale)


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Salp s+in

• valuate the appearance of the scalp oil! or dr!

• Loo% for locali>ed lesions and in@ammator! s%indiseases.

• valuate$1. ?iuse* patch! or perifollicular er!thema

'. ?iuse* patch! or follicular @a%in" or scalin"

3. ollicular or non,follicular papules* erosions or

pustules;. 7its (louse e"" cases)


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pit!riasis amiantacea #erifollicular er!thema$frontal 6brosin" alopecia


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(essi-e hair

• xcessive hair ma! be due to localised or diuseh!pertrichosis or in 0omen* hirsutism* 0hichrefers to an adult male pattern of hair "ro0th.

• !pertrichosis describes localised or diuseexcessive hair on face* arms* le"s or trun%. t ma!be due to increase in lanu"o (soft* 6ne and blond)

or terminal hair.


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lsewhere

• A complete examination inspection of terminalhair of the e!ebro0s* e!elashes* beard* axilla Bpubic area

• n adolescents

note sta"e of pubertaldevelopment (anner "ro0th charts)

• #remature pubarche appearance of pubic hair0ithout other si"ns of pubert! $

, & C !ears in bo!s, & D !ears in 0hite "irls

, & E !ears in blac% "irls


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E%A&INATION OF THENAILS

I t d ti


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Intr$duti$n

7ails are a specialisedform

of stratum corneumand are

made predominantl! of%eratin. heir primar!

functions are forprotection*

scratchin" and pic%in"up

small obFects.


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xamination of the nails evaluate $

• Abnormalities of nail plate surface

•7ail plate discolouration• Abnormalities of the cuticle and nail fold

• Abnormalities of nail shape

• Gomplete loss of nails

• Lesions around nails

!n$rmalities $# the nail plate


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!n$rmalities $# the nail platesur#ae

7ail plate abnormalities are often due to

in@ammator! conditions aectin" the matrix or

nail bed. 4peci6c dia"noses ma! be made from

characteristic appearances* 0hich are "enerall!

self,explanator!


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PI**IN

c>ema* psoriasis* Alopesia

areata

*RNS0RS RIDIN

#soriasis* trauma* acute

s!stemic illness

%1NI*UDIN%


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%1NI*UDIN% RIDIN 2%1NI*UDIN% SP%I**IN

A"in"* trauma* lichen planus*

psoriasis

%1NI*UDIN%R110

G!st or tumour of matrix*

rauma

1nh$grph$sis 'thi+


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1nh$grph$sis 'thi+hard ur-ed nail plate)

A"ein"* #soriasis* rauma

Nail plate thinning

Lichen #lanus* trauma


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Nail platerum!ling

#soriasis*Hn!chom!cosis

Distal lamellar

splitting3 !rittlenails

Iater/deter"entdama"e* 7ail

polish removers* raumaticremoval or

arti6cial nails

R$ugh nailsLichen planus* 0ent! 7ail?!stroph!

Dis$l$urati$n $# nails


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Dis$l$urati$n $# nails

4ell$w Jello0 nail s!ndrome*

Hn!chom!cosis* #soriasis

4tainin" from nail enamel

white $r ell$w distall

#soriasis* dermatitis*lichen planus* 7ailinfection


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reen

nfection

Br$wn $r !la+

4tainin"* ?ru"s nfection*

elanoc!tic naevus*elanoma acial

5utile and nail #$ld


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a!n$rmalitiesRagged utiles &

telangietases

rauma$ han" nailGonnective tissue disease

Distal digital in#arts

asculitis

Di t l ! l


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Distal su!ungualhper+erat$sis

#soriasis* Hn!chom!cosis*

7or0e"ian scabies

Par$nhia

%esi$ns ar$und nails


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%esi$ns ar$und nails


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E%A&INATION OF THE&.$OSA


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xamination of the mucosa $

1.ucosa oral

'.ucosa "enetalia

(aminati$n $# mu$sa $ral


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• Hbserve the color B its consistenc!

• he presence or absence of saliva in the @oor of mouth• he ton"ueKs appearance distinct on the dorsal*

ventral and lateral aspect

• he dentition and 0hether there are "rossl! cariousteeth

• he use of removable prosthesis

• Hbserve $ lesion* ulcer


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Dis$rder $# the $ral mu$sa

ranul$mat$sa 5heilitisFissured t$ngue


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e$graphi t$ngue"air t$ngue


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Mu$eler$si$n $n lips, t$ngue

and palate


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Kap$si sar$maphth$us uler

(aminati$n $# mu$sa


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genitalia

Lesion of the ucosa "enitalia ma! be an! of thefollo0in" $

• 7ormal variant

• anifestations of 4?

•?ermatoses that ma! be "enerali>ed or found at extra,"enital site but that have a predilection for the"enitalia

• ?ermatoses that are spesi6c to the "enitalia

7 l i


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7ormal variant

Pearl penile papulesSe!ae$us gland

pr$minene


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Mani#estati$n $# S*D

Ul+us durum

"erpes genitalis

Dermat$ses with a


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Dermat$ses with apredileti$n #$r the genitalia

Ps$riasis%ihen planus

P i i l d


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Primar genital dermat$ses

%ihen sler$sus

S6uam$us ellarin$ma


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1 lcd efloresensi dr. ps 2014.ppt

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