Paediatric-History taking & Physical examination of patient with Skin Lesion

Paediatric-History taking & Physical examination of patient with Skin LesionCreated OnApril 30, 2020Last Updated OnApril 30, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of patient with Skin Lesion < All Topics Table of Contents Terminologies in Dermatology: Primary skin lesions Macule: Small, flat, non-palpable lesion (<1 cm). Non-palpable. Patch: Large, flat, non-palpable lesion (>1 cm Papule: Small, elevated, palpable lesion (<1 cm). Papule: Elevated, solid lesion <1 cm in diameter Plaque:Large, elevated, palpable lesion (>1 cm). Flat and broad surface in contrast to a nodule. Nodule: Similar to papule, but >1 cm in diameter. Rounded surface in contrast to a plaque. Tumor: similar to nodule but implies a neoplasm rather than an inflammatory process Vesicle: Small fluid-containing lesion (<1 cm). Bulla: Large fluid-containing lesion (> 1 cm). Pustule: Pus-filled lesion, often with erythema in surrounding area Wheal: Pink, edematous papules/plaques with different size and configuration and transient nature resolving within 1 day Secondary skin lesions Crust: Dried collection of serum and cellular debris Scale: Results from abnormal keratinization Erosion: Loss of the superficial epidermis Ulcer: Deeper depression with loss of the entire epidermis into dermis; heals with scarring Atrophy: Thinning of epidermis with shiny surface Sclerosis: Hardening of affected skin Lichenification: thickening of epidermis with exaggeration of normal skin line or marking due to rubbing Excoriation: Superficial linear erosion that is caused by scratching Fissure: Crack or split of skin History Taking: Ask about identification of patient – age, gender, residential area Ask about history of presenting illness Skin problem/lesion – Onset Describe the initial appearance and progression / evolution Body location Pattern of spread Associated symptoms Itching (common in eczema, pityriasis rosea, erythema infectiosum, tinea infections) Stinging, pain, discharge, warmness Aggravating factors Heat, cold, sun, exercise, travel, medications, pregnancy, season Exposure to known allergen Exposure to new objects – medications, skin products, environment etc Prior treatments used, any improvement Impact of the skin problems to patient’s life Fever (more likely with rosoela, erythema infectiosum or scarlet fever) Constitutional symptoms Weakness, fatigue, night sweats, anorexia, weight loss Ask about past Medical History Atopic history (asthma, hay fever, eczema) any acute or chronic medical conditions Ask about family History Enquire on family history of skin disorders or skin malignancy Psoriasis, atopy, melanoma Ask about drug history prior treatment, recent drug exposure, drug allergies, over the counter medications or herbal therapies Ask about social history – Recent travelling history or exposures, hobbies, pet Ask about other paediatric histories as indicated – birth history, immunization history, nutrition history and developmental history. Physical examination: General well-being – well or ill looking child, uncomfortable, toxic, colour, nutritional status Vital signs – pulse rate, respiratory rate, temperature and blood pressure are noted Description of skin lesion – includes inspection, palpation and other additional tests by Wood’s lamp or dermatoscope Inspection must also include mucous membranes, nail, hair, genital and anal regions. Proper and complete description of a dermatologic lesion should include Morphology of lesion – size, shape, texture (verrucous, lichenification, indurated, umbilicated, xanthomas)...

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