Introduction
- Wash hands (and don PPE if needed)
- Introduce yourself (name and role)
- Confirm patient’s name and DOB
- Explain what the examination involves
- Gain consent to continue and offer a chaperone if needed
- Ask if patient in any pain before continuing
General Inspection
Clinical Signs
- Age
- Sex
- Fitzpatrick skin type
- Does the patient look systemically well - sepsis or shock
- Any signs of systemic disease - diabetes, connective tissue disease, autoimmune disease
Hands
- pitting
- onycholysis
- subungal hyperkeratosis
- nail fold changes
- palmar changes
Other areas to check
- examination of arms, scalp (behind ears, occipital scalp particularly), face, torso and legs (including feet).
- It is important to also examine mucous membranes.
Describe a rash or lesion
S2CAM2
- Size
- Shape
- Colour
- Associated secondary change (eg lichenification caused by excessive rubbing)
- Morphology
- Margin
ABDCE - for melanoma
- Asymmetry
- Borders - irregular, poorly defined
- Colour - multiple
- Diameter - >6mm scary ahhh
- Evolution - changed recently
Palpate a rash or lesion
- Surface
- Consistency
- Mobility
- Tenderness
- Temperature
Special tests
- Ask to feel for lymph nodes
To Complete the Exam
- Explain to the patient that the examination is now finished.
- Thank the patient for their time.
- Dispose of PPE appropriately and wash your hands.
- Summarise your findings.
Further Assessments and Investigations
- Set of Obs
Terminology
Configuration
| Term | Definition |
|---|---|
| Cluser | Multiple lesions in one area |
| Annular | Grouped in a ring |
| Linear | Arranged in a line due to: - Koebner phenomenon where lesions occur at the site of trauma, e.g. psoriasis, lichen planus, warts - Birthmark - e.g. epidermal naevus |
| Reticulate | Net like - usually when a pattern of subcutaneous blood vessels become visible |
Shape
| Term | Definition |
|---|---|
| Macule | Impalpable lesion |
| Papule | Palpable dome-shaped lesion (size <0.5cm) |
| Nodule | The same but size >0.5cm |
| Plaque | Elevated lesion with a flat top |
| Vesicle | Small blister <0.5cm |
| Bulla | Large blister >0.5cm |
| Pustule | Pus filled lesion (does not always mean infection) |
| Erosion | Partial loss of epidermis which will heal without scaring |
| Ulcer | Full thickness loss of epidermis and some dermis which will heal with scaring |
| Atrophy | Thinning of the epidermis or dermis. Blood vessels easily seen under skin |
| Scar | Fibrosis in the epidermis and dermis as a part of the healing process |
Colour
| Term | Definition |
|---|---|
| Erythema | Redness of the skin |
| Violaceous | Purple-red of the skin. Lichen planus, dermatomyositis |
| Purpura | Dark red, does not blanch with pressure. Due to leakage of blood into the skin |
| Hypopigmentation | Loss of pigment in the skin |
| Hyperpigmentation | Increased pigment in the skin |
| Yellow | Consider lipid deposit |
Surface
| Term | Definition |
|---|---|
| Scaly | Flaky surface due to shedding of the stratum corneum. Silver scale in Psoriasis |
| Hyperkeratosis | Surface build up of keratin |
| Crust | Dried exudate. Appears golden in Impetigo |
| Friable | Bleeds easily on minimal trauma |
| Pearly | Shiny when the skin is stretched |
| Verrucous | Hyperkeratotic with irregular surface sometimes with fissures of projections |
| Excoriations | Traumatised surface due to scratching |
| Lichenification | Thickened skin with increased markings due to chronic scratching |