modul 1 syndrome and symptom

8/12/2019 Modul 1 Syndrome and Symptom

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Module 1Overview of Skin Changes

Competency Component :

1. Student be able to defne skin lesions

2. Student understand or basic mechanism o skin lesion3. Student be able to recognize the clinical pictures o skin lesions4. Student understand or approach to dermatologic diagnosis (physical

examination history special clinical and laboratory aids!

Learning Objective :"e able to recognize and place the clinical pictures o the most common

skin diseases related to skin changes syndrom and symptom and kno#s

ho# to ac$uire more inormation on it

Suggested e!erences :1. %itzpatrick&s 'ermatology in eneral )edicine 2*122. +ndre#&s 'iseases o the Skin 2**,3. %itzpatrick&s 'ermatology in -olor 2*124. %itzpatrick&s -olor +tlas Synopsis o -linical 'ermatology 2**,

"# Structure and $unction of Skin

1# Structure and $unction of Skin

+ccurate diagnosis o skin diseases is critically dependent on the

recognition o key physical signs and the ability to relate this inormationto underlying pathological processes. /his re$uires a good #orking

kno#ledge o the anatomy and pathophysiology o normal and diseased

skin.

Skin is a complex organ that protects its host rom its en0iroment at

the same time allo#ing interaction #ith the en0ironment. t is much more

than a static impenetrable shield against external insults. ather the skin

is a dynamic complex integrated arrangement o cells tissues and

matrix elements that mediates a di0erse array o unctions skin pro0ides

a physical permeability barrier protection rom inectious agentsthermoregulation sensation ultra0iolet (5! protection #ound repair and

regeneration and out#ard physical appearance. /hese 0arious unctions

o skin are mediated by one or more o its ma6or regions7the epidermis

dermis and hypodermis. /hese 0i0idions are interdependent unctional

units8 each region o skin relies upon and is connected #ith its surrounding

tissue or regulation and modulation o normal structure and unction at

molecular cellular and tissue le0els o organization.

9hereas the epidermis and its outer stratum corneum pro0ide a

large part o the physical barrier pro0ided by skin the structural integrity

o the skin as a #hole is pro0ided primarily by the dermis and hypodermis.

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+ntimicrobial acti0ities are pro0ided by the innate immune system and

antigen7presenting dendritic cells o the epidermis circulating immune

cells that migrate rom the dermis and antigen7presenting cells o the

dermis. :retection rom 5 irradiation is pro0ided in great measure by the

most superfcial cells o the epidermis. n;ammation begins #ith thekeratinocytes o the epidermis or immune cells o the dermis and sensory

apparatus emanates rom ner0es that initially tra0erse the hypodermis to

the dermis and epidermis ending in specialized recepti0e organs or ree

ner0e endings. /he largest blood 0essels o the skin are ound in the

hypodermis #hich ser0e to transport nutrients and immigrant cells. /he

cutaneous lymphatics course through the dermis and hypodermis ser0ing

to flter debris and regulate tissue hydration.


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/he unction o skin presented in table 1.

(able 1# $unctions of Skin

$)*C("O* ("SS)' L+,' SOM' +SSOC"+('- -"S'+S'S

:ermeability barrier eprosy

:ruritusltra0iolet protection


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$ig# .# Skin "mmune System

(able Cellular and %umoral Component of Skin "mmune System

C'LL)L+ %)MO+L

Aeratinocyte>angerhans& -ell)acrophage)ast -ell/ >ymphocyte

ranulocyte


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+c$uire 7


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$ig# 6# Spongiform

.# Skin Signs and Symptom

n some cases the appearance o skin signs or skin lesions or skin

changes may be so distincti0e that the diagnosis is clear at a glance. n

other cases sub6ecti0e symptoms (pruritus painul skin disorder! and

clinical signs in themsel0es are inade$uate and a complete history and

laboratory examinations including a biopsy are essential to arri0e at a

diagnosis. /ypically most skin diseases produce or present #ith lesions

#ith more or less distinct characteristics. /hey may be uniorm or di0erse

in size shape and color and may be in diDerent stages o e0olution or

in0olution. /he original lesions are kno#n as the primary lesions and

identifcation o such lesions is the most important aspect o thedermatologic physical examination. /hey may continue to ull

de0elopment or be modifed by regression trauma or other extraneous

actors producing secondary lesions.:rimary skin lesions include macules #heals papules 0esicles

pla$ues bullae patches pustules nodules and cysts.Secondary skin lesions are o many kinds8 the most important are

scales crusts erosions ulcers fssures and scars.

""# (he Structure of Skin Lesions

1# (ype of Skin Lesion

Ence the component o the skin aDected by a pathologic process is

determined to the extent possible by clinical examination the lesion or

lesions should be assessed in terms o their type shape arrangement

and distribution. /ypes o Skin >esions

)acule (>atin macula FspotG!+ macule is a circumscribed area o change in skin color #ith out

ele0ation or depression. t is thus not palpable. )acules may be o any

size or color. 9hite as in 0itiligo or capillary dilatation due toin;ammation (erythema!. :ressure o a glass slide (diascopy! on the

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border o a red lesion is a simple and reliable method or detecting the

extra0asion o red blood cells. the redness remains under pressure

rom the slide the lesion is purpuric8 i the redness disappears the

lesion is due to 0ascular dilatation.

:apule (>atin papula FpimpleG!+ papule is a superfcial solid lesion generally considered H *., cm in

diameter. + papule is palpable. t may be #ell7or ill defned. + rash

consisting or papules is called a papular exanthem. :apular exanthems

may be grouped (FlichenoidG! or diseminated (dispersed!. -on;uence

o papules leads to the de0elopment o larger usually ;at7topped

circumscribed plateau7like ele0ations kno#n as pla$ues.

Macule /apule

:la$ue+ pla$ue is a plateau7like ele0ation abo0e the skin surace that

occupies a relati0ely large surace area in comparison #ith its height

abo0e the skin. t is usually #ell defned. %re$uently it is ormed by acon;uence o papules as in psoriasis. >ichenifcation is a less #ell7

defned large pla$ue #here the skin appears thickened and the skin

markings are accentuated. >ichenifcation occurs in atopic

dermatitis psoriasis and mycosis ungoides.

Codule (>atin nodulus Fsmall knotG!+ nodule is a palpable solid round or elipsoidal lesion that is longer

than a papule and may in0ol0e the epidermis dermis or

subcutaneous tissue. /he depth o in0ol0ement and the size

diDerentiate a nodule rom a papule. Codules result rom

in;ammatory infltrates neoplasma or metabolic deposits in the

dermis or subcutaneous tissue. Codules may be #ell7defned

(superfcial! or ill7defned (deep!8 i localized in the subcutaneous

tissue they can oten be better elt that seen.

Plaque Nodule

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9heal (rtica!+ #heal is a rounded or ;at7topped pale red papule or pla$ue that

is characteristically e0anescent. t is due to edema in the papillary

body o the dermis. 9heals may be round gyrate or irregular #ith

pseudopods7changing rapidly in size and shape due to shiting

papillary edema. + rash consisting o #heals is called an urticarial

exanthem or urticaria.

5esicle7"ulla ("lister! (>atin 0esicula Flittle bladderG8 bulla

FbubbleG!+ 0esicle (H *., cm! or a bulla (I *., cm! is a circumscribed

ele0ated superfcial ca0ity containing ;uid. Eten the roo o a

0esicle @ bulla is so thin it is transparent and the serum or blood in

the ca0ity can be seen. 5esicles containing serum are yello#ish8those containing blood rom red to black. 5esicles and bullae arise

rom a clea0age at 0arious le0els o the superfcial skin8 the

clea0age may be subcorneal or #ithin the 0isible epidermis (i.e.

intraepidermal 0esication! or at the epidermal7dermal interace (i.e.

subepidermal!. + rash consisting o 0esicles is called a 0esicular

exanthem8 a rash consisting o bullae a bullous exanthem.

7heal 8esicle 9ulla

:ustule (>atin pustula8 FpustuleG!+ pustule is a circumscribed superfcial ca0ity o the skin that

contains a purulent exudate #hich may be #hite yello# greenish7

yello# or hemorrhagic. /his process may arise in a hair ollicle or

independently. :ustules may 0ary in size and shape. :ustules are

usually dome7shaped or can be multicentric. %ollicular pustules

ho#e0er are al#ays conical and usually contain a hair in the center.

-yst+ nodule that contains ;uid or semisolid material

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/ustule Cyst

-rusts (>atin crusta Frind bark shellG!-rusts de0elop #hen serum blood or purulent exudate dries on the

skin surace. -rusts may be thin delicate and riable or thick and

adherent. -rusts are yello# #hen ormed rom dried serum8 green or

yello#7green #hen ormed rom purulent exudate8 or bro#n dark

red or black #hen ormed rom blood. Superfcial crusts occur as

honey7colored delicate glistening particulates on the surace and

are typically ound in impetigo.

Scales (s$uames! (>atin s$uama FscaleG!


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-olor :ink red puple (purpuric lesions do not blanch #ith pressure

#ith a glass slide (diascopy! #hite tan bro#n black blue grey

yello#. /he color can be uniorm or 0ariegated.

)argination 9ell7defned (can be traced #ith the tip o a pencil! ill7

defned. Shape ound o0al polygonal polycyclic annular (ring7shaped!

iris serpiginous (snakelike! umbilicated.

:alpation -onsider (1! consistency (sot frm hard ;uctuant

boardlike!8 (2! de0iation in temperature (hot cold!8 and (3! mobility.

Cote presence o tenderness and estimate the depth o the lesion

(i.e. dermal or subcutaneous!

3. $orming Sentences and )nderstanding the (et : 'valuation

of +rrangement= /atterns= and -istribution >$ig# ?@

Cumber Single or multiple lesions +rrangement )ultiple lesions may be (1! grouped herpetiorm

arciorm annular reticulated (net7shaped! linear serpiginous

(snakelike!8 or (2! disseminated scattered discrete lesions.

-on;uence Kes or no

'istribution -onsider (1! extent isolated (single lesions! localized

regional generalized uni0ersal and (2! pattern symmetric

exposed areas sites o pressure intertriginous area ollicular

localization random ollo#ing dermatomes or "laschko&s lines.

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$ig# ?# Special -escription of Skin Lesion

"""#Outline of -ermatologic -iagnosis

n contrast to other felds o clinical medicine patients should be

examined beore a detailed history is taken because patients can see their

lesions and thus oten present #ith a history that is ;a#ed #ith their o#n

interpretation o the origin or causes o the skin eruption. +lso diagnostic

accuracy is higher #hen ob6ecti0e examination is approached #ithout

preconcei0ed ideas. )any skin eruptions are so characteristic that they

don&t re$uire history initially. =o#e0er a history should al#ays beobtained but i taken during or ater the 0isual and physical examination

it can be shaped according to the ob6ecti0e fndings.

1# %istory

a. 'emographics =istory +ge race sex etiology occupation

b. -onstitutional symptoms i. F+cute illnessG syndrome headaches chills e0erishness

#eakness

ii. F-hronic illnessG syndrome atigue #eakness anorexia #eightloss malaise

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c. =istory o skin lesions. Se0en key $uestions 1! 9henL (Enset!2! 9hereL (Site o onset!3! 'oes it itch or hurtL (Symptoms!4! =o# has it spread (pattern o spread!L (


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a. 5isual aids or dermatologic inspection i. )agnifcation #ith hand lensii. 9ood&s lampiii. 'iascopyi0. 'ermoscopy

b. -linical /estsi. :atch testingii. :rick testing

c. >aboratory /estsi. )icroscopic


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Figure 2.

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Figure 3.

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modul 1 syndrome and symptom

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