Rehab109

Laboratory
Integumentary PT
Assessment of the Skin
General Symptoms and Signs
Related to the Skin
 Cutaneous Symptoms
•Pruritus • Hyperesthesia
•Pain • Burning
•Anesthesia • Tingling
•Hypoesthesia • Formication
 Cutaneous Signs
Primary lesions
• Visible to the naked eye
• Refer to the lesions
appearing for the first time
Secondary Lesions
• When the primary lesions
progress or undergo
modification by recovery,
injury, or other external
factors
Primary Lesions

Macule
• Circular or oval shapes without elevation or
depression
• Their borders can be well defined or fade out
into the surrounding skin
Primary Lesions

Papule
• Small, solid elevation of the skin with
diameters <5 mm
• Can be flat, dome-shaped, pointed or
depressed center
• Present in the epidermis or upper dermis
around sebaceous glands or openings of hair
follicles
• With inflammation, can form vesicles,
pustules, or ulcers
Primary Lesions

Nodule
• Similar to papules but diameters are >5 mm
• Can invade any layer of the skin
• an intermediate form between papules and
small tumors
• Lesions appear on the dermis or subcutaneous
fat layers
Primary Lesions

Bulla
• Diameter= > 1cm
• Seen in bullous pemphigoid and pemphigus
Primary Lesions

Vesicle
• Small blisters less than 1 cm in diameter.
• Observed in varicella or herpes zoster
Primary Lesions

Pustule
• Pus-filled blisters
Primary Lesions

Cyst
• Epidermal nodules containing fluid or
semisolid materials
Primary Lesions

Wheal
• Temporarily developed papules or plaques
caused by urticaria or allergic reaction.
• Observed in red or white
Primary Lesions

Plaque
• Elevated skin with 2 cm in diameter
• Can be considered as grown papules
• Occur in psoriasis or mycosis fungoides
Secondary Lesions

Scale
• Aggregates of keratin debris in the stratum
corneum
• Very small in pityriasis
Secondary Lesions

Excoriation
• Are small lesions with punctate or linear
shapes
• Caused by mechanical traumas or repetitive
scratching
• Covered with red or yellow, dried blood
components
• Inflammatory annulus fibrosus is frequently
formed around it
Secondary Lesions

Erosion
• Occur by bursting of vesicles resulted in
epidermal loss and cutaneous depression
making the skin humid and glossy.
Secondary Lesions

Ulcer
• Skin loss extending through the epidermis
and part of the dermis, which leads to a
breach in epithelial continuity
• d/t impaired or restricted blood supply or
nutrition 2⁰ PVD
Secondary Lesions
Fissure
• linear cleavages of the skin which sometimes
extend into the dermis
• Frequently developed in the following areas:
a) flexural side of finger joints
b) finger tips
c) palms of the hands
d) Lateral sides of the fingers and toes
e) oral angles
f) nostrils
g) Auricles
h) anus
Secondary Lesions

Crust
• Dried layers of serum, blood, or
purulent exudate and are composed
of bacteria and epidermal debris.
Secondary Lesions

Scar
• Replace the damaged skin tissues
• Thin atrophic scars
➢Observed in syphilis and lupus
erythematosus
• Keloids
➢Occur by overgrowth of the scar tissue
Secondary Lesions

Atrophy
• Decrease in cell size due to the loss of
organelles and substances
• Causes:
a) Decreased blood supply
b) Chronic inflammation
c) Loss of stimulation by endocrine hormones
d) Loss of innervation
e) Malnutrition
f) Aging
Secondary Lesions

Lichenification
• Part of the dermis thickens
• Frequently observed in chronic pruritus such
as chronic simplex nuchae, atopic dermatitis,
and prurigo nodularis
 Assessment of the Skin
Cutaneous Symptoms in Systemic
Diseases
Pruritus
Most typical symptom among the
dermatologic diseases
Eczema
• Term for several types of
dermatitis
a) Acute phase
➢Small blisters with pruritus,
erosion, erythema, and edema
b) Chronic phase
➢Less edema & vesicles
➢Marked by lichenification,
squama, and hyperchromatism
Erythroderma
• Aka “pityriasis rubra pilaris” or
“exfoliative dermatitis”
• appears as the secondary symptom
when exposed to toxins or chemicals
Erythroderma
• Causes:
a) psoriasis g) adverse drug
b) atopic dermatitis reactions
c) seborrheic h) lymphoma
dermatitis i) leukemia
d) eczema j) internal
e) scabies malignancies
f) lichen planus
Urticaria
• Skin vascular reaction to an irritant
• Marked by glossy, pale, red, raised, and
itchy bumps.
• Oval or irregular shape in many different
sizes
• Accompanied by severe pruritus
Nodule
• About 25 % of the nodules are related to
cancers
• Size: 2-10 mm in diameter
Vascular Lesion
• Intravascular lesions
that are related to
malignant tumors
include bleeding
point, ecchymosis,
and pressure purpura
Flush
• Results from carcinoid
syndrome, adverse drug
reactions, and
hyperthyroidism.
Flush
• Symptoms appear on the
face or neck and last for 10–
30 min.
a) Redness
b) Edema
c) Excessive secretion of tears
and saliva
d) Tachycardia
e) Hypotension
Vesicle and Bulla
• Present simultaneously in the case of the
following:
a) Lymphoma in the small intestine
b) Herpes zoster
c) AIDS infection
d) Leukemia
e) Systemic infections
Hypertrichosis &
Hirsutism
• Vellus hair grows excessively
• Related to malignant diseases of the
following:
a) Adrenal gland
b) Ovary
c) Lung
d) Large intestine
e) Cystic duct
f) Uterus
Acanthosis
Nigricans
• Marked by melanotic
macules in body folds and
creases like armpits and
groin
• D/t drug abuse or endocrine
diseases
Acquired
Ichthyosis
• A hereditary keratosis
characterized by dry, and “fish-
scale” skin.
• 2⁰ thickening of the stratum
corneum d/t hyperkeratosis or
molecular defects in keratin
Acquired
Ichthyosis
• When it develops in an adult,
lymphatic tumors, solid tumors,
pityriasis rotunda,
hepatocellular carcinoma, and
leprosy must be suspected.
Assessment of the Skin
Dermatologic Diagnosis
 General
Diagnosis
a) Chief complaint
b) Past Medical Hx
c) Social Hx &
Occupational Hx
d) Family Hx
e) Drug Hx
 Physical
Examination
a) Visual Inspection
b) Palpation
a) Skin Turgor
b) Skin Indentation
Diseases According to Skin Color
Skin Color Cause Distribution Typical Disease
Increase in melanin Systemic Diseases in hypophysis, adrenal gland, and liver
Brown concentration Topical Phacomatosis and neurofibroma
Absence of melanin Systemic Albinism
White Topical Vitiligo
Increase in erythrocyte Systemic Fever, hives, rash, polycythemia
Red concentration Topical Inflammation
Increase in bile pigment Systemic Liver diseases
Yellow Increase in carotenoid Systemic Hypothyroidism & excessive intake of carotene
pigment
Decrease in oxidized Hgb Systemic Anemia & chronic renal dse
Blue Increase in Hgb concentration Lip, mouth, nail Cardiovascular dse & pulmonary dse
caused by hypoxia bed
 Skin Tests with
Diagnosis Supporting
Devices

Dermoscopy
• 3.5-5x magnification= Allows
detailed evaluation of fine
wrinkles, pigmentation,
comedo, & acne
• 7x magnification= helps
diagnosing erythematosus
lupus, lichen planus, basal cell
carcinoma, and melanoma
 Skin Tests with Diagnosis
Supporting Devices

Wood’s Lamp Examination

• Used for determining the size of
vitiligo, observing varied skin types
and a hypopigmented macule of
tuberous sclerosis, diagnosing
microbial infection and tinea capitis,
and testing urine samples from
patients with porphyria or pityriasis
versicolor.
 Skin Tests with
Diagnosis Supporting
Devices

Diascopy
• used for examining brown
papule and nodule in
sarcoidosis,
scrofuloderma,
lymphoma, and
granuloma annulare and
differentiating the causes
of erythema and purpura
 Microbiological Examination

KOH Test (potassium

hydroxide)
• The purpose is to compensate
the error of the Gram staining
procedure, switching between
Gram (+) and Gram (-)
microorganisms.
 Microbiological Examination

Gram Staining
• Most typical method in
bacteriological examination
• Used to differentiate bacteria
into two groups
• To test whether a pustular
disease is bacterial or abacterial
 Microbiological Examination

Tzanck Smear
• Used to confirm herpes zoster virus or
chickenpox virus
 Microbiological Examination

Scabies Test
 Microbiological Examination

Dark-Field Examination
• Enables the direct observation of an
ulcer
• A useful method of diagnosing syphilis
 Microbiological Examination

Culture Test
• Used to identify skin diseases related
to fungus, bacteria, and virus
Skin Biopsy
• Means to gather
information by examining
skin tissue samples
collected by a scalpel blade
or a punch instrument
a) Punch biopsy
b) Incisional biopsy
c) Shave biopsy
Immunofluorescence
Test
• Measures and detects
autoantibodies
• Often used to
diagnose pemphigus,
pemphigoid, bullous
diseases (e.g., Herpes
dermatitis), and lupus
erythematosus.
 • Rarely used
Electron • Useful in diagnosing rare skin
diseases such as histiocytosis X
Microscopy and several subtypes of
epidermolysis.
 Skin
Reaction Test
Patch Test
• used to check whether
the patient’s skin is
allergic to contact with
certain biological or
chemical substances
 Skin
Reaction Test
Photo Test
• Examines photosensitivity
reactions of patients’ skin by
measuring the decrease of
minimal erythema dose after
the illumination with UV light or
visible light.
Photopatch Test
• Used together with patch test
for skin disease diagnosis
 Skin
Reaction Test
Tuberculin Test
• Used to diagnose tuberculosis
 Skin
Reaction Test
Immediate Type Skin Test
• Examines the presence of ige
responding to allergens
• 3 types:
a) Prick test
b) Scratch test
c) Intradermal test
Immediate Type Skin Test
Prick Test
• The skin is pricked with a
needle after a solution
with suspected allergens
is applied
Immediate Scratch test
• Performed by
Type Skin inspecting the
specimen obtained by
Test scratching superficial
lesions
Immediate Type Skin Test
Intradermal test
• Carried out by injecting
0.1 ml of suspected
allergen solution with a
26–27 gauge needle, and
the result comes out after
14–20 min
Skin Reaction Test

Other Allergy Tests

a) RAST (radioallergosorbent test)
b) ELISA (enzyme‐linked immunosorbent assay)
c) MAST (chemiluminescence test)
d) ImmunoCAP system (fluorescent enzyme
immunoassay)
Oral Provocation Test

• Used to diagnose the exact cause of skin rash

 Assessment of the Skin
PT Diagnosis & Evaluation Methods
Examination
 Examination
Medical History
a) Family Hx
b) Birth records
c) Past health status
d) Occupational Hx
e) Marital Hx
f) Pregnancy
g) Menstruation
h) Previous & current illnesses
i) Injuries
j) Surgeries
k) Medication
 Examination

Systemic Review
a) Emotional status
b) Learning type
c) Communication & Communicative competence
d) Cognitive status
e) Integumentary system
f) Musculoskeletal system
g) Nervous system
h) Cardiovascular system
 Examination

Test and Measurement

• Pathophysiology
• Damages
• Functional restrictions
• Disorders
• Risk factors
• Prevention
• Physical health
• Mental health
 Examination
Assessment
• Disease’s progress
• Phases of S/Sx
• Stability of the disease
• Correlation between
the involved system
and damaged sites
Examination
Diagnosis
• Information about the final
result of examination and
evaluation
• A process of classifying the
category of skin-related
diseases and syndromes
Examination
Prognosis
• Process of figuring out the
possible results of a patient’s
current status based on the
collected data regarding the
treatment of the patient or
other patients with similar
symptoms
Examination
Prognosis
• Determined by consideration
of the patients’ health
status, disease risk factors,
response to intervention,
safety of the patients, needs,
therapeutic goals, Dx, Ax
results, suspected dse, and
progress of dse
 Plan of Care
Examination • List of suggested intervention
methods and their frequency and
duration
Examination
Intervention
• Various approaches and
techniques of PT
designed to improve
the pts’ medical
condition
• Determined by the PT-
pt. Interaction, Ax, Dx,
and Prx
Examination

Re-examination
• Carried out to
detect the changes
after the
treatment.