skinphysicalexam - THE SKIN PHYSICAL EXAMINATION INTRODUCTION Among the many aspects of the physical examination the diagnosis of skin disorders


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1 THE SKIN PHYSICAL EXAMINATION INTRODUCTION Among the many aspects of the physical examination, the diagnosis of skin disorders requires a unique approach. It demands the diagnostician’s ability not only to observe and interpret but also to use new language the language of the dermatologist. The purpose of this handout is to give you the tools to perform a thorough dermatologic history and examination, to use a new set of terms to describe skin findings, and to be able to recognize some of the most common dermatologic conditions. Numerous disease states may be manifested in the skin. Pathology can be divided into two categories: 1. Abnormal findings may represent a disease process limited exclusively to skin, or 2. They may reflect a systemic illness. For example, poison ivy contact dermatitis is a process affecting the skin alone. On the other hand, a viral exanthem such as the rash of measles reflects a systemic infection affecting other organ systems in which additional findings and symptoms are present. In a more extreme case, the presence of serious systemic illness may be heralded by skin involvement, as with AIDS patients, many of whom present initially with dermatological complaints. Skin lesions present in limitless variations and in many instances may not easily be identified by even the most experienced dermatologist. But a thorough history and examination should at least help you to place your findings into one of the categories mentioned above, and help you discern a likely etiology. The skin performs many crucial functions. It acts as a protective barrier, shielding the internal organs of the body from physical trauma, noxious chemicals, microbes and cell- damaging solar radiation. It helps regulate body temperature, fluid balance, and sensory input from the environment, and functions also as part of the immune system. Skin is comprised of an outer layer called the epidermis and an inner layer, the dermis. The epidermis contains primarily keratin-producing cells which perform the major barrier function of skin. Melanocytes are another cell type found in the epidermis and they produce the pigment melanin which determines skin color. The dermis is made up of a predominantly connective tissue layer with a deeper fat layer. It contains the blood and lymphatic vessels, nerve endings, sweat and sebaceous glands, and hair follicles. Hair and nails are non-living appendages of skin and are composed of the protein keratin. HISTORY During the course of a thorough medical history and physical examination you will already have performed much of the dermatologic evaluation. However, when a patient presents with a dermatologic complaint, or when unexplained abnormal skin findings are noted during a general examination, you should proceed with a systematic, focused approach to the problem, as would be done for any other organ system.
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  • Fall '16
  • gfdsg
  • Cutaneous conditions, Contact dermatitis, papule

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