Diagnosis of Dermatology With Specific Disease
Using the same general principle of clinical diagnosis makes the diagnosis of skin disease. It begins by taking history, physical examination, and laboratory investigations when needed.
A proper skin examination should be performed in good light; preferably in daylight. Ideally the whole skin should be examined.
While describing skin lesions, the following features should be identified:
Sites involved and distribution: - if lesions are affecting both sides of the body symmetrically, it probably could have an endogenous origin (e.g. eczema, psoriasis, acne...) but if it involves predominantly one side of the body, usually it could be of external cause (e.g. bacterial, fungal, contact eczema).
Primary lesions
Macule: flat lesion due to a localized color change only; the surface is normal (size <1cm)
Patch: similar to a macule but the size (> 1cm)
Nodule: any elevated lesion (> 1cm diameter) which has a round surface (i.e. the thickness is similar to the diameter): often due to dermal pathology
Plaque: (size > 1cm) a raised lesion where the diameter is much greater than the thickness
Vesicle: (size < 1cm) a fluid filled lesion (blister)
Bullae: blister which is > 1cm in size
Pustule when a vesicle contains pus and the size is < 1cm and if it is more than 1cm it is called abscess.
Secondary lesions
Erosion: partial loss of epidermis, which will heal without scaring
Ulcer: full thickness loss of epidermis and some dermis, which will heal with scaring
Atrophy: depression of the surface due to thinning of the epidermis or dermis. There are often fine wrinkles and blood vessels easily seen under the skin.
Fissure: linear split in the epidermis or dermis at an orifice (angle of the mouth or anus), over a joint or along a skin crease.
Erythematous or non erythematous . Erythematous lesions are usually indicative of acute inflammation.
Surface features
Normal/ smooth : the surface is not different from the surrounding skin and feels smooth
Scaly : dry/flaky surface due to abnormal stratum corneum with accumulation of or increased shedding of keratinocytes.
Exudate : serum, blood, or pus that has accumulated on the surface.
Friable : surface bleeds easily after minor trauma
Crust : dried serum, pus or blood
Excoriation : localized damage to the skin due to scratching.
Lichenification : thickening of the epidermis with increased skin markings due to persistent scratching.
Umblicated ; surface contains a round depression in the centre, characteristics of molluscum contagiosum or herpes simplex.
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