Physical Examination of
the
Skin, Hair, and Nails
Skin Hair and Nails
OUTLINE
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ANATOMY and PHYSIOLOGY
HISTORY
EXAMINATION
DOCUMENTATION
– vocabulary
– definitions
PRACTICE
Skin Function
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Protective barrier
Mechanical barrier
Temperature regulator
Sensor
Vitamin D producer
Repairer
Excreter
Expresser
Skin Anatomy
Skin Appendages
Hair
Nails
HISTORY
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Skin
– Changes
 Timing
 Associated
symptoms
 Location
 Alleviating/aggravating
 Treatment(s)
 Exposures
History
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Hair
– Changes
 Timing
 Associated
symptoms
 Nutrition
 Alleviating/aggravating
 Treatment(s)
 Exposures
History
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Nails
– Changes
 Timing
 Associated
symptoms
 Nutrition
 Alleviating/aggravating
 Treatment(s)
 Exposures
History
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Past Medical History
– previous problems
– systemic disease
 Family History
– skin CA, psoriasis, allergy, infestations and
infections
 Psychosocial
– personal habits
– exposures
Examination
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Ruler
Lighting
Penlight
Gloves
Magnifying glass
Woods lamp
Examination (exposure!)
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Inspection
– Color
– Uniformity
– Thickness
– Hygiene
– Lesions
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Palpation
– Moisture
– Temperature
– Texture
– Turgor
– Mobility
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Sequence
– Regional
– System
Normal and Benign Variants
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Birthmarks, freckles, bruising, color
variations
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Nevi, hemangiomas, corns and calluses,
skin tags, keloids, warts, acne, etc
Lesion Description
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Size, Shape, Color
Edges
Texture
Elevated or depressed
Exudates
Configuration
Location&Distribution
PICTURE!!
Morphology
MACULE
PATCH
Morphology
PLAQUE
WHEAL
NODULES
Morphology
Morphology
VESICLE
BULLA
PUSTULE
CYST
Morphology
SCALING
CRUSTING
Morphology
EXCORIATION
EROSION
FISSURE
ULCER
ATROPHY
LICHENIFICATION
HYPERTROPHIC SCAR
KELOID
Configuration
Distribution
EXAMINATION
NAILS
EXAMINATION
NAILS
Spooning - kiolonychia
EXAMINATION
NAILS
Example Documentation
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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.
Example write-up
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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.
Example write-up
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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.
Example write-up
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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.
Example write-up
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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.
Consider the Following
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2500 dermatologic diagnoses
10 - 15 most common comprise
50%
50 most common comprise 95%