Approach to Rash & Basics of Skin Descriptions

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Layers of skin include epidermis, dermis and hypodermis

Skin appendages come from the epidermis and help maintain the body’s homeostasis (sebaceous glands, sweat glands, hair, nails, etc)

Approach to the Skin examination

  1. Use good lighting
  2. Vary distance of inspection
  3. Examine patient’s entire mucocutaneous surface
  4. Palpate lesion firmly and compare to normal skin
  5. Examine patient lying down and standing
  6. Look at patient again in 1 week

Rash Descriptors:

  • Blanching.
    • Erythema (blanching) connotes capillary dilation
    • Petechia or purpura (nonblanching) implies hemorrhage.
  • Skin phototype (varies by amount of melanin). Look for increased pigmentation or loss of pigmentation.
  • Look for dryness, sweating, oiliness, roughness/smoothness. Look at hair and nail closely as well.
  • Temperature- generalized or local warmth or coolness.
  • Distribution, especially if over sun-exposed surfaces.
  • Macule vs Patch (>1cm). Circumscribed area of change in skin color without elevation or depression.
  • Papule vs Plaque. Papule is a solid lesion < 0.5cm, while a plaque is > 0.5cm.
  • Nodule is a deeper, palpable, solid, round or ellipsoidal lesion.
  • Vesicle vs Bulla. A vesicle is a circumscribed, elevated, fluid containing cavity < 0.5cm and a bulla is > 0.5cm.
  • Pustule is a circumscribed, superficial cavity containing purulent exudate.
  • Cyst is a cavity containing liquid or semisolid materials and maybe superficial or deep.
  • Wheal is a rounded or flat-topped, pale red papule or plaque that disappears in 24-48 hours.
  • Crusts develop when serum, blood or purulent exudate dries on the skin surface.
  • Fissures result from marked drying, skin thickening and loss of elasticity
  • Erosion involves the loss of the epidermis and can heal without scar. An ulcer extends into the dermis or deeper.
  • Atrophy can be epidermal (wrinkling and shiny appearance) or dermal (leads to depression).
  • Lichenification has thickening of the epidermis and accentuation of natural skin lines.
  • Scar is the fibrous tissue replacement of the tissue by previous ulcer or a wound. Scan can keloid, hypertrophy or atrophy.