1. Physical Examination of the Skin, Hair, and Nails

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

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

4. Skin Anatomy

5. Skin Appendages

6. Hair

7. Nails

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

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

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

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

12. Examination Ruler Lighting Penlight Gloves Magnifying glass Woods lamp

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

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

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

16. Morphology

17. MACULE PATCH

18. Morphology

19. PLAQUEWHEAL

20. NODULES

21. Morphology

23. VESICLE BULLA

24. PUSTULECYST

25. Morphology

26. CRUSTING SCALING

27. Morphology

28. EXCORIATION EROSION

29. FISSUREULCER

30. ATROPHY LICHENIFICATION

31. HYPERTROPHIC SCAR KELOID

32. Configuration

33. Distribution

34. EXAMINATION NAILS

35. Spooning - kiolonychia

36. EXAMINATION NAILS

37. 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.

38. 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.

39. 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.

40. 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.

41. 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.

42. Consider the Following 2500 dermatologic diagnoses 10 - 15 most common comprise 50% 50 most common comprise 95%