1.

The type of skin lesion

D I A G N O S I S 2. The color

3. Margination
Skin Lesions 4. Consistency 5. Shape

6. Arrangement
7. Distribution of lesion

DERMATOLOGIC DIAGNOSIS

DIAGNOSTIC PROCESS

Type of skin lesions

Macule : Flat, circumscribed skin

discoloration that lacks surface elevation or depression Examples : caf au lait, Vitiligo, Freckle, Junctional nevi, Ink tattoo

Macular depigmentation

Multiple hyperpigmented patches and plaques, cutaneous T-cell lymphoma

Papule : Elevated, solid lesion < 0.5 cm in diameter Examples : Acrochordon (skin tag), Basal cell carcinoma, Molluscum contagiosum

Skin-colored papule with overlying telangiectasias, trichoepithelioma

Hyperpigmented macule, papule, lichenification

Lues II : makula eritema, papula

Acral small blue papule, blue nevus

Plaque : Elevated, solid confluence of

palules (> 0.5 cm in diameter) that lacks a deep component. Examples : Bowens disease, Mycosis fungoides, Psoriasis, Eczema, Tinea corporis

Erythematous plaques studded with sheets of pustules, pustular psoriasis

Nodule : Elevated, solid lesion > 0.5 cm in diameter; a large, deeper papule Example : Rheumatoid nodule, Tendon xanthoma, Erythema nodusum, Lipoma, Metastatic carcinoma

Eritema nodusum : nodul kemerahan, nyeri +

Nodule

Nodule

Wheal (urtica) : Firm, edematous

plaque that is evanescent and pruritic; a hive Examples : Urticaria, Dermographism, Urticaria pigmentosa

Urtikaria : urtika

Multiple wheals and dermatographism , urticarial vasculitis

Vesicle : Papule that

contains clear fluid; a blister. Examples : Herpes simplex, Herpes zoster, Dyshidrotic eczema, Contact dermatitis

Bulla : Localized fluid collection > 0.5 cm in diameter; a large vesicle Examples : Pemphigus vulgaris, Bullous pemphigoid, Bullous impetigo

Vesicle / Bulla

Herpes simpleks : vesikula bergerombol, krusta

Eksantema bulosa (erupsi obat)

Bulla

Pustule : papule that contains

purulent material. Examples : Folliculitis, Impetigo, Acne, Pustular psoriasis

Cyst : Nodule that contains fluid or

semisolid material. Examples : Acne, Epidermal inclusion, Trichilemmal cyst

Cyst

Crust : A collection of cellular debris,

dried serum, and blood; a scab. Antecedent primary lesion is usually a vesicle, bulla, or pustule.

Crust

Dermatitis atopik : pergelangan tangan kanan-kiri, makula eritema, papulae, likenifikasi, ekskoriasi, krusta

Scale (squama) : Thick stratum

corneum that results from hyperproliferation or increased cohesion of keratinocytes

Scale/Squama

Scale/Squama

Erosion : A partial focal loss of

epidermis; heals without scarring

Erosion

Ulcer : A full-thickness, focal loss of

epidermis and dermis; heals with scarring

Penile ulcer with a purulent base, chancroid

Ulcer

Fissure : Vertical
loss of epidermis and dermis with sharply defined walls; crack in skin

Excoriation :
Linear erosion induced by scratching

Fissure

Excoriation

Excoriation

Scar : A collection of new connective tissue; may be hypertrophic or atrophic. Scar implies dermoepidermal damage

Scar

Scar

Scalp plaque with scarring alopecia hyperpigmentation and depigmentation, discoid

Atrophy : thinning of the epidermis,

dermis, or subcutis (fat). Epidermal atrophy leads to a fine cigarettepaper wrinkling of the skin surface, whereas dermal and fat atrophy cause a depression in the skin surface.

Characterization of Identified Lesion

Color : pink, red, purple Margination : well-defined , ill-defined Shape : round, oval, polygonal, polycyclic, annular (ring-shape), iris, serpiginous (sbakeline), umbilicated Palpation : consider 1. consistency : soft, firm, hard, fluctuant 2. deviation in temperature (hot, cold) 3. mobility

Evaluation of arrangement, patterns, and distribution

Number : single or multiple lesions Arrangement : multiple lesion may be : 1. grouped : herpetiform, linear, etc 2. disseminated : scattered discrete lesions Confluence : yes or no Distribution : 1. Extent : isolated, localized, generalized, etc 2. Pattern : symmetric, exposed areas, etc

Special Description of Skin Lesion

Outline of Dermatologic Diagnosis

1. History 2. Physical examination 3. Special Clinical and Laboratory Aids to Dermatologic Diagnosis

History
1. Constitutional symptoms 2. History of skin lesions 3. General history of present illness as indicated by clinical situation, with particular attention to constitutional and prodromal symptoms 4. Past medical history 5. Family medical history 6. Social history 7. Sexual history

Physical Examination
1. Appearance 2. Vital Signs 3. Skin : Learning to Read Dermatologic diagnosis : 1. type of skin lesion 5. shape 2. the color 6. arrangement 3. margination 7. distribution 4. consistency 4. Type of skin lesions

Special Clinical and Laboratory Aids to Dermatologic Diagnosis

Special techniques used in clinical examination Clinical Tests Microscopic Examination of Scales, Crusts, Serum, and Hair Biopsy of the skin

Key points : skin lesions and diagnosis

A patient and thorough approach to the evaluation decreases the risk of making an incorrect diagnosis or overlooking another diagnosis Knowledge and appropriate use of dermatology terminology are fundamental Recognition of disease patterns requires repeated patient encounters The history is indispensable in elucidating complex diagnoses

 The entire mucocutaneous surface, as well as the hair and nails, should be examined whenever reasonable Morphologic characteristic derived from cell type in skin must be carefully scrutinized Diseases have characteristic morphology and distribution Common pitfalls in dermatologic diagnosis exist and can be avoided

Thank You

Thank You