Dermatologic Dermatologic ExaminationExaminationDermatologic Dermatologic ExaminationExamination

dr.Eddy Karta, SpKKDepartemen Ilmu Kesehatan Kulit dan KelaminFKUI/RSCM

Objective?Objective?Objective?Objective?

Skin lesion Skin lesion examinationexaminationSkin lesion Skin lesion

examinationexamination• LocationLocation• Type of skin lesionType of skin lesion• NumberNumber• Color Color • SizeSize• BorderBorder• Shape and arrangement skin lesionShape and arrangement skin lesion• Distribution Distribution

Type of skin lesionType of skin lesionType of skin lesionType of skin lesion

• Flat lesion (Usually in the plane of Flat lesion (Usually in the plane of the skinthe skin ))

• Elevated lesion (Above the plane of Elevated lesion (Above the plane of the skin)the skin)

• Depressed Lesion (below the plane of Depressed Lesion (below the plane of skin)skin)

Flat lesionFlat lesion Flat lesionFlat lesion

• MaculeMacule• InfarctInfarct• SclerosisSclerosis• TelangiectasiaTelangiectasia

Elevated lesionElevated lesion Elevated lesionElevated lesion

• PapulePapule• PlaquePlaque• NoduleNodule• whealwheal• Vesicle and Vesicle and

BullaeBullae• PustulePustule

• AbscessAbscess• cystcyst• Exudate Exudate

(crust)(crust)• ScaleScale• ScarScar• LichenificationLichenification

Depressed lesion Depressed lesion Depressed lesion Depressed lesion

• AtrophyAtrophy• SclerosisSclerosis• ErosionErosion• ExcoriationExcoriation

• ScarScar• UlcerUlcer• SinusSinus• GangreneGangrene

Primary Primary lesionlesion

MaculeMacule

• A macule is a circumbscribed, flat A macule is a circumbscribed, flat lesion that differs from surrounding lesion that differs from surrounding skin because of its color.Macules skin because of its color.Macules may have any size and shape. They may have any size and shape. They may be result of hyperpigmentation, may be result of hyperpigmentation, hypopigmentation, vascular hypopigmentation, vascular abnormalities, erythema (capillary abnormalities, erythema (capillary dilatation) or purpura (extravasated dilatation) or purpura (extravasated red blood cells).red blood cells).

PapulesPapules

• A papule is small, solid, elevated A papule is small, solid, elevated lesion generally smaller than half lesion generally smaller than half centimeter (Oblique lighting with a centimeter (Oblique lighting with a flashlight in a darkened room is often flashlight in a darkened room is often necessary to detect slight elevation).necessary to detect slight elevation).

NodulesNodules• A nodule is palpable, solid, round or A nodule is palpable, solid, round or

ellipsoidal lesion. Depth of ellipsoidal lesion. Depth of involvement and/or substantive involvement and/or substantive palpability, rather than diameter, palpability, rather than diameter, differentiate a nodule from a papule.differentiate a nodule from a papule.

PlaquesPlaques• A plaque is mass like elevation that A plaque is mass like elevation that

occupies a relatively large surface occupies a relatively large surface area in comparison with its height area in comparison with its height above skin level. Plaque are often above skin level. Plaque are often formed by a confluence of papules.formed by a confluence of papules.

WhealsWheals

• A wheal is a rounded or flat topped A wheal is a rounded or flat topped oedema that is characteristically oedema that is characteristically evanescent, disappearing within evanescent, disappearing within hours.hours.

Vesicle and BullaVesicle and Bulla• A vesicle is a circumscribed, elevated A vesicle is a circumscribed, elevated

lesion that contains fluid. Often the lesion that contains fluid. Often the vesicle walls are so thin that they are vesicle walls are so thin that they are translucent and the serum, lymph, translucent and the serum, lymph, blood or extra cellular fluid is visible. blood or extra cellular fluid is visible.

• A vesicle with a diameter greater A vesicle with a diameter greater than 0,5 cm is a bulla.than 0,5 cm is a bulla.

PustulesPustules• A pustule is a circumscribed, raised A pustule is a circumscribed, raised

lesion that contains a purulent lesion that contains a purulent exudate.exudate.

TelangiectasiaTelangiectasia• Telangiectases are permanent Telangiectases are permanent

dilatation of capillaries that may or dilatation of capillaries that may or may not disappear with application may not disappear with application of pressureof pressure

Secondary Secondary lesionlesion

LichenificationLichenification• Lichenification is proliferation of Lichenification is proliferation of

keratinocytes and stratum corneum, keratinocytes and stratum corneum, in combination with changes in the in combination with changes in the collagen of the underlying dermis, collagen of the underlying dermis, causes lichenified areas of skin to causes lichenified areas of skin to appear as thickened plaques with appear as thickened plaques with accentuated skin markings.accentuated skin markings.

AbscessAbscess• An abscess is a localized An abscess is a localized

accumulation of purulent material so accumulation of purulent material so deep in the dermis or subcutaneous deep in the dermis or subcutaneous tissue that the pus is usually not tissue that the pus is usually not visible on the surface of the skin. It is visible on the surface of the skin. It is red, warm and tender.red, warm and tender.

CystsCysts• A cyst is a sac that contain liquid or A cyst is a sac that contain liquid or

semisolid material (fluid, cell and cell semisolid material (fluid, cell and cell product).product).

CrustsCrusts• A crusts are hardened deposits that A crusts are hardened deposits that

result when serum, blood or purulent result when serum, blood or purulent exudate dries on the skin surface.exudate dries on the skin surface.

• Crusts may be thin, delicate and Crusts may be thin, delicate and friable or thick and adherent.friable or thick and adherent.

ScalesScales• A scales is an abnormal shedding or A scales is an abnormal shedding or

accumulation of stratum corneum in accumulation of stratum corneum in perceptible flakesperceptible flakes..

ScarScar• A scar occurs wherever a wound or A scar occurs wherever a wound or

ulceration has taken place and ulceration has taken place and reflect the paterns of healing in the reflect the paterns of healing in the affected area.affected area.

• Scar may be atrophic or Scar may be atrophic or hypertrophic.hypertrophic.

KeloidKeloid• Hypertrophic scar that become Hypertrophic scar that become

pathologic, because it grow passed pathologic, because it grow passed the margin of wound and tend to get the margin of wound and tend to get biggerbigger

AtrophyAtrophy• An Atrophy is diminution or thinning An Atrophy is diminution or thinning

of the skin . It may be limited to the of the skin . It may be limited to the epidermis or the dermis or may occur epidermis or the dermis or may occur simultaneously in both.simultaneously in both.

ErosionsErosions• An erosion is a moist, circumscribed, An erosion is a moist, circumscribed,

usually depressed lesion that result usually depressed lesion that result from loss of all or portion of the from loss of all or portion of the viable epidermis.viable epidermis.

• After the rupture of vesicles or After the rupture of vesicles or bullas, the moist areas remaining at bullas, the moist areas remaining at the base are called erosion.the base are called erosion.

ExcoriationsExcoriations• Excoriations are superficial Excoriations are superficial

excavations of epidermis that may excavations of epidermis that may be linear or punctate and result from be linear or punctate and result from scratching.scratching.

AnetodermaAnetoderma• The loss of skin elasticity or atrophic The loss of skin elasticity or atrophic

without any significant changes at without any significant changes at other part of skinother part of skin

SclerosisSclerosis• Sclerosis refers to a circumsribed or Sclerosis refers to a circumsribed or

diffuse hardening or induration in the diffuse hardening or induration in the skin, it is detected more easily by skin, it is detected more easily by palpation than by inspection.palpation than by inspection.

VerrucousVerrucous• Warty surfaceWarty surface

COLORCOLOR• ErythemaErythema

• HypopigmentationHypopigmentation

• HyperpigmentationHyperpigmentation

• Others : brown, yellow, etc.Others : brown, yellow, etc.

SIZESIZE• MilliarMilliar

LenticularLenticularNummularNummularPlaquePlaque

• CentimeterCentimeter• Comparison with such as eggs, Comparison with such as eggs,

peanuts, coins, etc.peanuts, coins, etc.

Shape and Arrangement of Shape and Arrangement of LesionsLesions

• LinearLinear• Annular Annular • NummularNummular• DiscoidDiscoid• ArciformArciform• PolycyclicPolycyclic• GroupGroup• IrisformIrisform

• HerpetiformHerpetiform• ZosteriformZosteriform• CorymbiformCorymbiform• ReticularReticular• SerpiginousSerpiginous• RoundRound• OvalOval• IrregularIrregular• PedunculatedPedunculated

Border of Lesion or RashBorder of Lesion or Rash

Distribution of Skin LesionsDistribution of Skin Lesions

• LocalizedLocalized• RegionalRegional• BilateralBilateral

• GeneralizedGeneralized• UniversalUniversal• SymmetricalSymmetrical