1/23/23, 12:01 AM Dermatology Exam: Learning the Language | Stanford Medicine 25 | Stanford Medicine

Approach to Multiple Rashes (Stanford Medicine 25)

Introduction to the Dermatology Exam

Before you can make a diagnosis of any skin lesion, it's important to be able to accurately describe the skin lesion. The purpose of this page is to cover the
fundamental knowledge you will need to do this. 

Learn the Language of the Dermatology Exam

1. Primary Morphology
a. Macule - flat lesion less than 1 cm, without elevation or depression
b. Patch - flat lesion greater than 1 cm, without elevation or depression
c. Plaque - flat, elevated lesion, usually greater than 1 cm
d. Papule - elevated, solid lesion less than 1 cm
e. Nodule - elevated, solid lesion greater than 1 cm
f. Vesicle - elevated, fluid-filled lesion, usually less than 1 cm 
g. Pustule - elevated, pus-filled lesion, usually less than 1 cm
h. Bulla - elevated, fluid-filled lesion, usually greater than 1 cm 
2. Size
3. Demarcation
a. Well-demarcated
b. Not well-demarcated
4. Color
a. White
b. Red
c. Purple
d. Brown
e. Yellow
f. Black
g. Blue
5. Secondary Morphology

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a. Serum (Dry crust)

b. Fissure
c. Lichenification
d. Erosion
e. Ulceration
f. Scaling
6. Distribution
a. Extensor
b. Generalized
c. Photodistributive 

Primary Morphology

Macule
Example: Petechiae

Patch
Example: Vitiligo

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Plaque
Example: Psoriasis

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Papule
Examples: Angioma, Wart

Nodule
Example: Epidermal Inclusion Cyst

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Vesicle
Example: Herpes

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Pustule
Example: Acne

Bullae
Example: Bullous pemphigoid

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Size
How Small?
Example: Superficial Spreading Melanoma

How Large?
Example: Acral Lentiginous Melanoma

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Demarcation
Clearly Defined?
Example: Erysipelas

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Not Well Defined?

Example: Cellulitis

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Consult the Expert

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Justin Ko
Dr. Justin Ko is a Clinical Assistant Professor, Dermatologist and Clinic Chief and Director of Medical Dermatology at Stanford.

Clinical Pearl

 A good dermatology exam requires a well lit room and sometimes a hand held light. Sometimes, you may need a ruler and
magnifiying glass. Remember that sometimes the palpation of skin lesions can be just as important as what you see.”

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Color

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White
Example: Vitiligo

Red
Example: Drug Eruption

Purple
Example: Kaposi Sarcoma

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Brown
Example: Sarcoidosis

Yellow
Example: Xanthelasma

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Black
Example: Black Eschar

Blue
Example: Blue Nevus

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Secondary Morphology

Serum (Dried Crust)

Example: Impetigo

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Fissure
Example: Psoriasis

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Lichenification
Thickening of skin. Note the accentuation of skin lines

Example: Chronic Rubbing, Lichen simplex chronicus

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Erosion
Partial loss of epidermis.

Example: Scratching, minor skin injury

Ulceration
Full thickness loss of epidermis. 

Example: Pyoderma gangrenosum, Pressure/Decubitus ulcer

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Scaling
Example: Psoriasis (picture), Ichthyosis

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Distribution

Extensor surfaces
Example: Psoriasis

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Generalized
Example: Viral, Drug reaction

Photodistributive
Example: Lupus / Dermatomyositis

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Applying What We Learned

Based on the above image, here's how we'd describe this skin lesion:

1. Primary morphology -> plaque, 

2. Size -> a few centimeters 
3. Well-Demarcated
4. Color -> Dully red
5. Secondary morphology -> Dry serum/crusting, erosions and scaling
6. Distribution -> Extensor surface of leg

Diagnosis is consistent with psoriasis given the above description.

 

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