DERMATOLOGICAL DIAGNOSES

,,

1. : 7 key questions
When did it start?
Is there itching?
Where on the body did it start?
How has it spread? (pattern of spread)
How have individual lesions changed? (evolution)
Provocative factors?
Previous treatments?
2. Systemic review
3. Past medical history , , habits, atopic history
4. Social history , exposure, travel
, mucous membrane

1. (lesion) ,,,,

2. (arrangement) (annular),
(arcuate or arciform), (polycyclic),

vesicle (target or iris lesion), (linear),

(reticulate), (serpiginous),

 (zosteriform), (discrete),
(coalescence), (herpetiform)
annular granuloma annulare, tinea corporis
, herpetiform herpes simplex infection, dermatitis herpetiformis , iris lesion
erythema multiforme serpiginous creeping eruption
3. (distribution) 3
EXTENT localized, regional, generalized, segmental, unilateral, bilateral

PATTERN symmetry, exposed area, intertriginous area, covered area, palms

and soles, flexure areas
CHARACTERISTICS seborrheic dermatitis
sebaceousglands, atopic dermatitis
vital signs, ,,

(lesion)
2
1. Primary lesion ,
macule, papule, nodule, plaque, patch, tumor, wheal, vesicle, bullae pustule
2. Secondary lesion , ,
crust,
lichenification, atrophy, excoriation, fissure
specific lesion burrow, comedones, milia, telangiectasia, target lesion

PRIMARY LESION
MACULE hyperpigmentation,
hypopigmentation, vascular abnormalities, capillary dilatation (erythema) purpura (extravasated red
blood cells)
maculosquamous macule (scales)
PAPULE 1 .
NODULE 0.5 . ( 1 .)

PLAQUE
papules
PATCH macule plaque
CYST liquid semisolid nodule
WHEAL upper dermis irregular

0.5 .
VESICLE
vesicle 0.5 .
BULLAE
PUSTULE (vesicle)
SCALE (stratum corneum)
cell epidermis
SCLEROSIS
BURROW (scabies)
larva migrans
COMEDO 2 opened closed comedone
MILIA small superficial cyst
TELANGIECTASIA

SECONDARY LESION
CRUST serum,blood exudate
EROSION epidermis roof vesicle involve
dermis ULCER
FISSURE epidermis
EXCORIATION
ATROPHY 2
1. atrophy epidermis normal skin marking
2. atrophy dermis subcutaneous fat
SCAR repair tissue injury atrophic hypertrophic scar
LICHENIFICATION skin marking

1. KOH Preparation
2. Gram stain bacteria yeast
3. Cytologic smear (Tzanck smear) herpetic infection bullous disease
vesicle
roof vesicle base vesicle smear slide
Wright stain Giemsa stain herpes viral infection multinucleated giant cells
epidermal cells pemphigus
acantholytic epidermal cells cells perinuclear halo cytoplasm

4. Skin smear for AFB

5. Skin smear for dark field examination Treponema pallidum

6. Scraping for scabies

burrow

7. Wood light examination high pressure mercury arc UV 360 nm (UVA)

1. Microsporum
2.
3. Erythrasma coral red , Pseudomonas aeruginosa
4. hypopigmented macule vitiligo , Ash leaf macule tuberous
sclerosis melanin ,
nevus anemicus
catecholamine
melanin
5. porphyrin porphyria
8. culture
9. Skin biopsy evaluate
,
, vesiculobullous
pemphigus


,
direct
immunofluorescence electron microscope

Test

diascopy lesion erythema purpura

( apple jelly ) lupus vulgaris
Histamine test flare

Tuberculin test
Nikolsky's sign normal appearing skin blister new blister
extension of previously formed blister Pemphigus, Scalded skin syndrome, Toxic epidermal
necrolysis
5

Darier's sign urticaria pigmentosa

1. Andrews, George Clinton. Andrew's diseases of the skin, 7th ed. Sauders, 1982.
2. A. Rook, D.W. Wilkinson, FOG Ebling, R.H.Champion. Text book of Dermatology, 4th ed. Oxford Blackwell
Scientific publication,1986.
3. Thomas B. Fitzpatrik. Dermatology in general medicine, 3rd ed. New York. McGraw Hill, 1987.
4. Moschella, Sameul L. Dermatology, 2nd ed. Saunders, 1985.