Physical Examination of the Skin, Hair, and Nails

Skin Hair and Nails OUTLINE ANATOMY and PHYSIOLOGY HISTORY EXAMINATION DOCUMENTATION –vocabulary –definitions PRACTICE

Skin Function Protective barrier Mechanical barrier Temperature regulator Sensor Vitamin D producer Repairer Excreter Expresser

Skin Anatomy

Skin Appendages

Hair

Nails

HISTORY Skin –Changes Timing Associated symptoms Location Alleviating/aggravating Treatment(s) Exposures

History Hair –Changes Timing Associated symptoms Nutrition Alleviating/aggravating Treatment(s) Exposures

History Nails –Changes Timing Associated symptoms Nutrition Alleviating/aggravating Treatment(s) Exposures

History Past Medical History –previous problems –systemic disease Family History –skin CA, psoriasis, allergy, infestations and infections Psychosocial –personal habits –exposures

Examination Ruler Lighting Penlight Gloves Magnifying glass Woods lamp

Examination ( exposure!) Inspection –Color –Uniformity –Thickness –Hygiene –Lesions Palpation –Moisture –Temperature –Texture –Turgor –Mobility Sequence –Regional –System

Normal and Benign Variants Birthmarks, freckles, bruising, color variations Nevi, hemangiomas, corns and calluses, skin tags, keloids, warts, acne, etc

Lesion Description Size, Shape, Color Edges Texture Elevated or depressed Exudates Configuration Location&Distribution PICTURE!!

Morphology

MACULE PATCH

Morphology

PLAQUEWHEAL

NODULES

Morphology

VESICLE BULLA

PUSTULECYST

Morphology

CRUSTING SCALING

Morphology

EXCORIATION EROSION

FISSUREULCER

ATROPHY LICHENIFICATION

HYPERTROPHIC SCAR KELOID

Configuration

Distribution

EXAMINATION NAILS

Spooning - kiolonychia

EXAMINATION NAILS

Example Documentation No abnormalities - General Statement about overall skin assessment: –Skin is warm, smooth and well hydrated. Full hair distribution on scalp, axilla, and genitalia. Nails are neatly trimmed and without deformity. No discrete lesions noted.

Example write-up A wide variety of lesions are seen on the face, shoulders, and back. Pustules on an inflammatory base are most predominant. Inflammatory pustules are seen on the forehead, lower cheeks, and chin. Large abscesses and cysts are seen on the shoulders and upperback. Numerous scars are present.

Example write-up There are multiple large oval plaques with well defined borders and silvery scale symmetrically present on the elbows, knees and scalp. Examination of the nails reveals pitting. The hair is of normal texture.

Example write-up A diffuse erythematous maculopapular patch is present on the trunk. Few excoriations are present on the shoulders and chest. The hair and nails are unremarkable.

Example write-up There is a bright red 6 cm linear eruption of edematous papules and bulae along the lateral aspect of the left leg. There are no lesions on the palms or soles or in the mouth.

Consider the Following 2500 dermatologic diagnoses most common comprise 50% 50 most common comprise 95%