INTRODUCTION TO DERMATOLOGY
BY: DR. T MUNYAO
DATE: 15th/11/2016
OUTLINE: CLERKSHIP FORMAT OF A PATIENT WITH
SKIN LESIONS
Objective: Clinical evaluation of skin lesions
Pertinent lesional history
Other presenting complaints
Diagnostic formulation
Plan of management
DERMATOLOGY
Definition of dermatology
‘Derm’ skin
‘Logos’ science
Multidisciplinary inclusive of applied basic
Sciences devoted to anatomy, physiology and pathology of
the skin.
CLINICAL EVALUATION OF SKIN LESIONS
1. Physical primary lesions they have a Configuration
high predictive value Cutaneous component
Lesional morphology Anatomical distribution
Macule, patch, papule, wheal, nodule, Special anatomical areas
tumor, comedone, vesicle, bulla, Hair, nails, mucous membranes,
pustule, furuncle, erosion, excoriation, palms, soles and genitals
ulcer, atrophy, sclerosis, cyst, eczema
Color
2. Secondary lesions
Shape
Crust, scar, lichenification
Surface characteristics
Margins
Arrangement
DIFFERENT TYPES OF LESIONS
COLOR CHANGE IN THE SKIN
Color change in the skin from the normal is determined from the racial background
and the anatomical part of the body by virtue of environmental exposure
The lesion may be de-pigmented, hyper-melanotic (black or brown), erythematous or
may have different colors.
A mixture of more than 1 type of lesion is common e.g. maculo-papular eruption
Site the lesion and measure it.
An area of color change < 2 cm MACULE
An area of color change > 2cm PATCH
If precipitated and aggravated by drug ingestion e.g. septrin fixed drug eruption
SOLID ELEVATED LESIONS
Solid elevated lesions are very soft at the immunosuppressive state e.g. DM, AIDs
center e.g. in Reclinghausen’s disease (also Basal carcinoma in albinism lack of melanin
associated with Café au lait spots) predisposes to malignant transformation of skin
< 5mm in diameter PAPULE lesions due to UV light damage.
5 mm – 5 cm NODULE Papules and nodules with crusting on the
> 5cm TUMOR (not applied in the context of surface
malignant potential) Keloids arise from a scar
Verruca Vulgaris/ Common warts Cutaneous T cell lymphoma (a malignant
Well defined papules and nodules tumor due to NHL) Ulcerating nodules
Surface is velvet-like Kaposi's Sarcoma hemorrhagic tumors with
hyper-proliferation of blood vessels. They are
Usually caused by HPV
AIDs-defining
This is an OI therefore evaluate for an
PLAQUES
Slightly raised lesions (about 1-2 mm) above the skin with a large
surface area and variable surface characteristics e.g. scaling,
erythema.
They may or may not be well-defined.
These are characteristic lesions in Papulo-squamous disorders
(Psoriasis vulgaris).
Variants of psoriasis (it is currently defined as a systemic disease with
cutaneous manifestations)
Stable etc.
FLUID-FILLED LESIONS
Clear fluid in raised lesion herpertiform lesions in a zosteriform pattern
< 5 mm vesicle Erosions lesions that accrue from removal of
> 5 mm Bulla (pl. bullae) e.g. in pemphigus the blister (epidermal deficit)
vulgaris Crust debris of protein and other cellular
Therefore, vesico-bullous/blistering material after the fluid has evaporated or the
diseases present with fluid-filled lesions of exudate has dryed.
different sizes. Varicella/ Chicken pox
Grouping of vesicles herpetiform Erythematous papules, umbilicated with fluid
configuration at the tip
This is the hallmark of Herpes Virus Infection Pustules contain pus
If the grouping follows a dermatomal pattern Tendency to grouping of the lesions
zosteriform configuration
Therefore Herpes Zoster is a condition with
EPIDERMOID CYST
Fluid-filled lesion containing a paste/ semi-solid material.
Occlusion of a sebaceous gland.
TOXIC EPIDERMAL NECROLYSIS
There is extensive epidermal necrolysis with detachment.
Usually a manifestation of a drug reaction.
It is related to SJS
There is blistering, vesiclular eruption, mucositis, epidermal detachment, targetoid
lesions etc.
Mortality is related to infections, fluid loss and thermoregulatory abnormalities.
If prompt diagnosis is made, management is symptomatic and should be accurate:
Fluid replacement
Infection control
ANGIO-NEUROTIC EDEMA
Swollen, itchy lips
E.g after ingestion of penicillin
Related to urticarial
There is mast cell release of vasoactive amines VD edema
CONTACT DERMATITIS
May present as pruritus and fissuring of the palms in a person who washes
clothes most of the time for instance
ACUTE ECZEMA
Acute inflammatory condition, with erythema, vesicles, itching and a
lot of exudation
Eczema may be endogenous due to host factors or exogenous due to
external factors e.g. foot wear
HYPERMELANOSIS
This is an example of photo-dermatosis that may occur due to
sensitization by products that are activated by exposure to UV light.
The lesions are characterized by inflammation in sun-exposed areas.
Diseases that present with photosensitivity:
Collagen vascular disease
SLE
Pellagra
ERYTHRODERMA
Generalized erythema and scaling
May be exfoliative
It is associated with:
Psoriasis (erythrodermic psoriasis)
Blistering disease
Adverse drug reaction (there is a criteria for attributability)
SCLERODERMA
Very hard and fixed skin.
One of the collagen vascular diseases with marked collagenesis
in the dermis.
Localized sclerosis Morphoea
Has systemic manifestations
SQUAMOUS CELL CARCINOMA
Ulcer with crusting on the surface that is chronic and non-
healing with induration in the periphery.
PERTINENT LESIONAL HISTORY
Duration
Evolution
Anatomical spread
Associated with pruritus
Therapy (pre-, post-) onset
Atopy (asthma, allergic conjunctivitis etc.)
Exposure
Hypersensitivity states
Travel in the recent past
OTHER
PC
HPC
PMH
FSH
Occupational history
Systemic enquiry
Diagnostic formulation of the cutaneous plus other manifestation which may be systemic
Lesional characteristics are the basis of diagnosis for the clinician
Diseases with similar lesions clinical syndromes
Clinical and relevant pathological criteria define each specific disease in a clinical syndrome.
DERMATOLOGICAL SYNDROMES
Geno-dermatoses e.g. albinism, neurofibromatosis
Infections
Eczema
Vesico-bullous diseases
Papulo-squamous disorders
Adverse drug eruption
Cutaneous neoplasms
TYPED BY EFFIE NAILAH
DON’T LET BEING RIGHT TALK YOU OUT OF BEING
KIND.
