1. Introduction

Introduction to Dermatology
• “He who studies skin disease & fails to study the lesion first will never learn
dermatology.” Siemens(1891–1969)
 to read words, one must recognize letters;

to read the skin, one must recognize basic skin
lesions.
For Health Officer Students

Solomon H ( MD,Dermatovenereologist)
 OVERVIEW OF THE SKIN
 Dermatology is the field of medicine that deals with the
macroscopic study of skin, adjacent mucosa (oral and genital)
and cutaneous adnexa
 Skin is the largest organ in the body ~5 kg & covers 2 m2
 is a dynamic, complex, integrated arrangement of cells, tissues,

and matrix elements that mediates a diverse array of functions
 There are two types of skin :

 Glaberous skin - Non hair bearing area
 Non glaberous skin - Hair bearing area

Has three major regions:
Epidermis:
 The outermost part of the skin
 major permeability barrier, innate immune function, adhesion, and
ultraviolet protection
Dermis:
 major structural element, three types of components—cellular, fibrous
matrix, and diffuse and filamentous matrix
 also site of vascular, lymphatic, and nerve networks
Hypodermis (subcutis):
 mechanical integrity, contains the larger source vessels and nerves
 The epidermis may be divided into the ff
zones:
 Skin Appendages
 Pilosebaceous unit
 Hair follicle
 Sebaceous gland
 Arrector pilli muscle
 Apocrine glands
 Eccrine sweat glands

 Nails
 Functions of the skin
Physical barrier
Mechanical protection
UV protection
Thermoregulation
Immunological function
Sensory and autonomic function
Vitamin D synthesis
Excretion
Sociosexual function
Primary lesions ...vs... Secondary lesions
 basic/uncomplicated lesions  develop as the 10 lesion evolve
 Macule  are created by scratching or

 patch infection
 Papule  Crust
 plaque  Scale
 Nodule  fissure
 Vesicle  Erosion
 bulla  Ulceration
 Pustule,... etc.  Excoriation
 Atrophy
 Lichenification, ...etc.
Macule
 non-palpable, flat lesion,
area of variegated colour in
the skin/mucosa.
• Hyper pigmented
• Hypo pigmented
 Size:- <0.5cm
– pytriasis versicolor
– Pytriasis rosea
Patches  large macule
 flat area of the

skin/mucosa with varied
colour
 Size:- > 0.5cm
Eg:
• Vitiligo
• Melasma
Papules
 elevated solid lesion
(i.e most of its part is above
the plane)
 Size:- 0.5cm in diameter
 E.gs with d/t shape & color:

• Flat-toped…. LP
• Dome shaped…. MC
• Red papule----
Rosacea
• Purple---LP
Plaques  broad papule
 plateau-like, elevated,
superficial, solid lesion
 Size:- >0.5cm
 Often formed by the

confluence of papules
 Eg. – psoriasis
Nodules  big papule
 Circumscribed/round,
ellipsoid, elevated, solid,
palpable lesion
 Size:- >0.5cm
 Eg.
• A.vulgaris
• Melanoma
• Lipoma
 Tumour :- is large nodule

( >2cm)
Vesicles
 fluid cavity, elevated lesions
 Size:- </=0.5cm
 Eg. Herpes Zoster

Blisters/ Bullae large vesicle
 fluid cavity , elevated
lesions
 Size:- >0.5cm
 Develop from vesicles

through coalescence or
enlargement,
 Eg.
• Impetigo
• Pemphigus Vulgaris
• Bullous Pemphigoid
Pustules
 circumscribed raised cavity in
the epidermis containing pus
– collection of
leukocytes, cellular
debris +/- bacteria
 Size:- may vary
 heal w/o scarring

Abscess large pustules
 localized collection of purulent

material deep in the dermis/
subcutis
 is a pink warm, tender,

erythematous, fluctuant nodule
 Associated with systemic

symptoms
Crusts
 hard deposits of dried serum,
pus, or blood, usually mixed
with epithelial and sometimes
bacterial debris
 appearance depends on the

nature of the secretion
• Yellowish brown -serous
• Yellowish green -
purulent
• Reddish black -
hemorrhage
Scales
 Accumulation of stratum
corneum due to increased
proliferation and/or delayed
desquamation
 Size :- ranges from fine

dust-like particles to
extensive parchment-like
sheet
Fissures/cracks
 linear loss of continuity of

the skin surface or mucosae
 Result from excessive tension

or decreased elasticity of the
involved tissues
Erosions
 moist, circumscribed,
depressed lesion that
results from loss of all or a
portion of the viable
epidermis
 May result from

trauma/scratching,
maceration, rupture of
vesicle / bullae, or
epidermal necrosis
 Unless secondarily
infected, heal without
Ulcer
 “breach in the skin” in
which there has been
destruction of the
epidermis & at least the
upper dermis
 heal with scarring

Excoriation
 are surface excavations

(small superficial defect)of
epidermis that result from :
• Local trauma
 scratching
 itchy skin conditions
Lichenification
 reactive thickening of the

epidermis
 induced by repeated
rubbing of the skin
Atrophy
 Decrease in the size of a
cell, tissue, organ, or part
of a body
– thinning of the epidermis,

leading to wrinkling and a
shiny appearance( paper
thin )
Striae
 Are linear depression of
the skin
 Result from changes of

the reticular dermis that
occur with rapid
stretching of the skin
 1st appear as pink to red

in colour & raised, later
become paler & flat
Scars
 abnormal
proliferation of
fibrous tissues that
replaces previously
normal collagen
 Usually follows
ulceration, surgery
or infection
breaching the
reticular dermis
keloid vs Hypertrophic
scar
Approach to Patient
History Taking
1. Identification( name, age, sex, address,
occupation, etc)
2. Chief compliant with duration 4. Past/known medical Illnesses
*medical,
3. HPI
*surgical,
• Elaboration of c/c
*psychiatric,
• Onset of lesion( site & progress)
*oncologic,
• Periodicity
*gynecologic/obstetric,
• recurring/remitting condition?
*autoimmune diseases
• Prior Dx & biopsy result
• Aggravating/relieving factors
5. Personal ,Family & social Hx
• +ve/-ve pertinent Hx
( specific & nonspecific 6. Review of systems
symptoms) * HEENT, LGS, RS, CVS, Abd, GUT, MSS, IS,
• Medication Hx ( previous Rx & NS
response)
Physical Exam( inspection & palpation)
 GA (initial clinical impression)
 V/S ( BP, PR, RR, Temp)
 from Head –to- Toe  Complete cutaneous exam
includes:
* Entire Skin surface
 In practice many prefer, * Mucous membrane
brief Hx initially Perform P/E * Hair
then more detailed Hx . * Nail
 Current Recommendations,
brief P/E initially obtain Hx
then return to more focused
P/E
Four cardinal features in complete P/E
1. Morphology of skin lesions( i.e. the

types)
2. Shape/configuration of lesions
3. Arrangement of lesion
4. Distribution of lesions
1. Morphology of skin lesions
types(either 1ry or 2ry) for each lesions
 Palpation of the lesions:  Three major xics:

 Simple palpation 1. Colour
2. Consistency
3. Anatomy of the skin primarily
 Blunt pressure affected
 Squeezing/pinching
 Check also:
 Deviation in temperature
 Stretching
 Mobility
 Presence of tenderness
 Rubbing  Margination

2.Shape/configuration of individual lesions
 Annular/ring-like --- T.corporis
 Discoid/nummular---NE,
Psoriasis
 Polycyclic---- Urticaria
 Umblicated------MC
 Linear ---- LP
 Serpinigous ----Larva migrans
 Targetoid---- EM
3. Arrangement of lesions
 Grouped/
Herpetiform---HSV
infections
 Scattered/discrete
 Guttate-----Guttate
psoriasis
4. Distribution of lesions
 Dermatomal/ Zosteriform---
HZ
 Lymphangitic---Sporotrichosis
 Symmetry--- psoriasis
 Flexor----AD,
 Extensor---psoriasis
 Acral --- melanoma
 Truncal--- p.roesa
 Universal---Vitiligo
 Localised --- LCL

Appropriate Investigations
Common Laboratory tests as needed
 Hematologic tests
 Chemistries
 Serologic tests
 Stool tests
 Urinary tests
 Histology of skin biopsy
 Bacteriology & mycology, etc
Skin tests as needed
 Imaging modalities as needed

THANK YOU!!!

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Introduction to Dermatology

 to read words, one must recognize letters;

For Health Officer Students

 Skin is the largest organ in the body ~5 kg & covers 2 m2

 is a dynamic, complex, integrated arrangement of cells, tissues,

 There are two types of skin :

 Non glaberous skin - Hair bearing area

 Eccrine sweat glands

 basic/uncomplicated lesions  develop as the 10 lesion evolve

 Macule  are created by scratching or

 flat area of the

 Size:- > 0.5cm

 Size:- 0.5cm in diameter

 E.gs with d/t shape & color:

 Often formed by the

 Tumour :- is large nodule

 Eg. Herpes Zoster

 Develop from vesicles

 Size:- may vary

 heal w/o scarring

 localized collection of purulent

 is a pink warm, tender,

 Associated with systemic

 appearance depends on the

 Size :- ranges from fine

 linear loss of continuity of

 Result from excessive tension

 May result from

 heal with scarring

 are surface excavations

 reactive thickening of the

– thinning of the epidermis,

 Result from changes of

 1st appear as pink to red

1. Morphology of skin lesions( i.e. the

 Palpation of the lesions:  Three major xics:

 Serpinigous ----Larva migrans

 Acral --- melanoma

 Localised --- LCL

Skin tests as needed

 Imaging modalities as needed

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