//vctb//

Triage: A – Raf B – Kath C – Cara D – Cesca E – Kyla F – Michelle G – Andre

DERMATOLOGIC HISTORY AND PHYSICAL EXAMINATION

Chief Complaint: Primary lesion/s [Macule, Patch, Papule, Nodule, Plaque, Vesicle, Bulla, Pustule, Wheal, Burrow, Telangiectasia]
History of Present Illness:
Hours/Days/Months/Years prior to consult, patient noted appearance of solitary/few/multiple hypo-pigmented/skin-colored/hyper-
pigmented/erythematous macule/papule/vesicle/pustule on the [location] after (…) associated (or not) with pruritus [severity]. Patient applied or self-
medicated with [medication] every __ hours for __ days resulting to __.
In the interim, [changes in color, size number], (?) medications (?) consultations.
Persistence of lesion prompted the patient to seek consult.
Past Medical History:
BA, allergies, HPN, DM, PTB, skin diseases, others
Medications
Pediatrics: childhood illnesses and immunization status
Family History:
BA, allergies, HPN, DM, PTB, skin diseases, others
Personal and Social History:
Smoker (?)
Alcoholic beverage drinker (?)
Drugs (?)
Occupation
Soap/shampoo
Other skin care products: components (brand), frequency of use, duration of use
Review of Systems:
Cough, colds, fever, nausea/vomiting, dyspnea, chest pain, abdominal pain, changes in bladder and bowel habits, weight loss/gain
Physical Examination:
Vital signs if warranted

Number Border Color Primary Secondary Size Location

Solitary Ill-defined Depigmented Macule <0.5 cm Scales Range in cm Specific part,
Few (<5) Well-defined Hypopigmented Patch >0.5 cm Crusts laterality
Multiple (≥5) Skin-colored Erosions
Hyperpigmented Papule <0.5 cm Ulcers
Erythematous Plaque >0.5 cm Fissures
Nodule >2 cm Scars
Atrophy
Vesicle <0.5 cm Lichenification
Pustule
Bullae >0.5 cm

COMMON DERMATOLOGIC DISEASES

Generalities Eczematous Diseases Non-Scaly Papules Skin Colored Papules Non-Scaly Nodules
Primary lesions Atopic Dermatitis Miliaria Rubra Verruca vulgaris Furuncle
Secondary lesions Allergic and Irritant CD Scabies Verruca plana Carbuncle
Dyshidrotic Eczema Acne vulgaris Molluscum contagiosum
Pediculosis
Pustular Diseases Non-Scaly Plaques Papulosquamous Diseases Other Common Conditions
Folliculitis Fixed Drug eruption Psoriasis Vitiligo
Intertrigo Cellulitis, Erysipelas Tinea Corporis Seborrheic Dermatitis
Ecthyma Impetigo Tinea Versicolor Seborrheic Keratosis
Hansen’s Disease Pityriasis Rosea Alopecia Areata
Urticaria Acrochordon (skin tag)
 Major Features (3/4) Minor Features (3/23) 16. Nipple eczema
1. Pruritus 1. Xerosis 17. IgE reactivity
2. Chronic or chronically 2. Ichthyosis vulgaris 18. Elevated serum IgE
relapsing dermatitis 3. Keratosis pilaris 19. Tendency for
4. Hyperlinear palms and cutaneous infections
3. Personal or family history of soles 20. Tendency to non-
atopic disease (asthma, 5. Perifollicular specific hand/foot
Atopic allergic rhinitis, atopic accentuation dermatitis
Dermatitis dermatitis) 6. Facial pallor/ 21. Early age of onset
4. Site of predilection: face erythema 22. Itch when sweating
and extensors in infancy, 7. Pityriasis alba 23. Food hypersensitivity
extensors in children, 8. Dennie-Morgan folds 24. Intolerance to wool and
flexural lichenification in 9. Orbital darkening lipid solvents
adults 10. Recurrent 25. Course influenced by
conjunctivitis environmental and/or
11. Keratoconus emotional factors
DDx: Seborrheic dermatitis, 12. Anterior subscapular 26. White
Irritant Contact Dermatitis, 13. Cataracts dermatographism or
Allergic Contact Dermatitis 14. Allergic shiners delayed blanch to
15. Cheilitis cholinergic agents

Irritant
Contact • Localized disease confined to areas exposed to irritants
Dermatitis • Caused by exposure of the skin to chemical or other physical agents that can irritate
the skin

Allergic • Systemic disease defined by hapten-specificT-cell-mediated inflammation

Contact • An eczematous (papules, vesicles, or pruritic) dermatitis
Dermatitis • Caused by re-exposure to a substance to which the individual has been sensitized

Dyshidrotic • Special vesicular type of hand and foot dermatitis

Eczema • Acute, chronic. or recurrent dermatosis of the fingers, palms, and soles
• Sudden onset of many deep-seated pruritic, clear "tapioca-like" vesicles

• Very common chronic dermatosis characterized by redness and scaling, which occurs
Seborrheic in regions where the sebaceous glands are most active, such as the face and scalp,
Dermatitis the pre-sternal area, and in the body folds
• Mild scalp SD causes flaking, i.e., dandruff

• A sweat retention disorder

1. Crystallina (tiny, superficial clear vesicles},
Miliaria 2. Rubra (pruritic erythematous vesicles),
3. Profunda (white papules, caused by deeper ductal occlusion)

DDx: Folliculitis, Grover's disease, or candidiasis

• Superficial epidermal infestation by the mite Sarcoptes scabiei var. hominis
• Usually spread by skin-to-skin contact and fomites
Scabies • Clinical Manifestation: pruritus often with minimal cutaneous findings, burrows

DDx: parasitosis, adverse cutaneous drug reaction, AD, ACD, metabolic pruritus
• An Inflammation of pilosebaceous units, appears on the face, trunk, and rarely buttocks

Acne vulgaris DDx: S. aureus folliculitis, pseudofolliculitis barbae, perioral dermatitis

 Pediculosis capitis Pediculosis corporis Pediculosis pubis
• Infestation of by the head • Body lice reside and lay • Infestation of hair-bearing
louse eggs in clothing regions by the crab or
pubic lice
Pediculosis DDx: hair casts, hair lacquer, DDx: AD, CD, scabies, • Pubic area; hairy parts of
hair gels, dandruff (epidermal or adverse cutaneous drug the chest and axillae;
scales), and piedra reaction upper eyelashes

Ddx: AD, CD, tinea cruris,

scabies
Verruca
vulgaris • Firm papules, 1 to 10 mm or larger, hyperkeratotic, clefted surface, with vegetations

• Firm pearly papules; often umbilicated

Molluscum • Host defense defects: large nodules with confluence
contagiosum
DDx: Flat warts, condylomata acuminate, syringoma, sebaceous hyperplasia

Furuncle • Acute, deep-seated, red, hot, tender nodule or abscess (boil) that evolves from a
staphylococcal folliculitis

• Deeper infection composed of interconnecting abscesses usually arising in several

Carbuncle contiguous hair follicles

• Begins In the upper portion of the hair follicle

• Follicular papule, pustule, erosion or crust at the follicular infundibulum, and can extend
Folliculitis deeper into the entire length of the follicle (sycosis)

DDx: Acneiform disorders, chemical irritants, acneiform adverse cutaneous drug reactions
keloidal folliculitis, and pseudo folliculitis barbae
• Inflammation of opposed skin inframammary regions, axillae, groins, gluteal folds, and
redundant skin folds of obese persons
Intertrigo • May represent inflammatory dermatosis or superficial colonization or infection

• Ulceration with a thick adherent crust

• Lesions may be tender, indurated
Ecthyma • Usually occurs at occluded sites

Fixed drug • Large blisters occur on the male genitalia commonly; evolve to painful erosion
eruption • With repeated drug exposure, blisters/erosions recur at the same site

Cellulitis • Acute, spreading infection of dermal and subcutaneous tissues

• Characterized by a red, hot, and tender area of skin

Erysipelas • Variant of cellulitis involving cutaneous lymphatics, and is usually caused by beta-
hemolytic streptococci
 • Etiology: S. aureus; GAS; honey-colored crusted erosions
• Impetigo occurs adjacent to the site of S. aureus colonization such as the nares
Impetigo • Secondary infection of (1) minor breaks in the epidermis, (2) preexisting dermatoses, (3) other
infections such as eczema herpeticum, or (4) wounds

Ddx: Excoriation, contact dermatitis, herpes simplex, epidermal dermatophytosis, scabies

• Etiology: Mycobacterium leprae
• First affects peripheral nervous system with persistent or recurrent painful paresthesias and
Hansen’s numbness without any visible clinical signs
disease • At this stage, there may be transient macular skin eruptions; blister, but lack of awareness of
trauma
• Neural involvement leads to muscle weakness, muscle atrophy severe pain, and contractures of
the hands and feet
Psoriasis vulgaris Pustular psoriasis
• Eruptive, inflammatory type with multiple • A chronic relapsing eruption limited to
small lesions and a greater tendency palms and soles
toward spontaneous resolution • Numerous sterile, yellow; deep-seated
Psoriasis • Chronic stable (plaque) psoriasis pustules that evolve nto dusky-red crusts

Psoriatic Erythroderma- entire skin

Psoriatic Arthritis
• Dermatophyte infections of the trunk, legs, arms, and/or neck, excluding the feet, hands, and
groin
• Etiology: T. rubrum, T. tonsurans, M. canis
Tinea • Scaling, sharply marginated plaques, peripheral enlargement and central clearing produce
corporis annular configuration with concentric or arcuate lesions
• Fusion of lesions produce gyrate patterns

DDx: ACD, AD, annular erythema, psoriasis, SD, pityriasis rosea, pityriasis alba, tinea versicolor,
erythema migrans, subacute lupus erythematosus
• Associated with the superficial overgrowth of Malassezia furfur and M. globosa.
• Lipophilic yeast that normally resides in the keratin of skin and hair follicles of individuals at
Tinea puberty and beyond
versicolor • Chronic, well-demarcated patches with fine scale

DDx: vitiligo, pityriasis alba, inflammatory bypopigmentation; tinea corporis, seborrheic

dermatitis, and cutaneous T cell lymphoma.
• An acute exanthematous eruption with a distinctive morphology and often with a characteristic
self-limited course
Pityriasis • Initially, a single plaque lesion develops, usually on the trunk; 1 or 2 weeks later a generalized
rosea secondary eruption develops in a typical distribution pattern

DDx: Drug eruptions, secondary syphilis, guttate psoriasis (no marginal cellarette), small plaque
parapsoriasis, erythema migrans with secondary lesions, erythema multiforme, and tinea corporis

Vitiligo • Etiology: loss of melanocytes results in depigmentation

• Clinical findings: sharply demarcated, depigmented, white macules

• Early: small, 1- to 3-mm, barely elevated papule, later a larger plaque with or without pigment
Seborrheic • Late: lesions range from small, barely elevated papules to plaques with a warty surface and a
Keratosis “stuck on” appearance, greasy

DDx: lentigo maligna and lentigo maligna melanoma

• A localized loss of hair in round or oval areas with no apparent inflammation of the skin
Alopecia • Nonscarring; hair follicle intact; hair can regrow
areata • Hair loss ranging from solitary patch to complete loss of all terminal hair

DDx: white-patch tinea capitis, trichotillomania, early scarring alopecia, pattern hair loss, secondary
syphilis
• Soft, skin-colored or tan or brown, round or oval, pedunculated papilloma (polyp)
Acrochordon
(skin tag) DDx: pedunculated seborrheic keratosis, dermal or compound melanocytic nevus, solitary
neurofibroma, or molluscum contagiosum