BY DR PRIYANKA SUSRUTH

1. EXAMINATION OF SECONDARY
SKIN LESION AND ITS APPLIED
ASPECT
Under the valuable guidance of all the faculty members of panchakarma dept

2. MANAGEMENT OF DERMTOLOGICAL
CASES
SKIN
DISEASES
HISTORY TAKING
CLINICAL
EXAMINATION
INVESTIGATIONS-
IF NEEDED
TREATMENT

3. HISTORY TAKING
PERSONAL
HISTORY
Name for
indentificat
ion
Age and
sex- certain
diseases
can occur
in certain
age and sex
Occupation
- skin
exposed to
external
environme
nt
Residence-
endemic
disease
such as
leprosy and
leshmanias
is

4. CHIEF COMPLAINT
Complaint- may be
disfigurement,
itching or burning
sensation
Onset- acute,
chronic, or acute
exacerbation on
chronic illness
Course-
progressive,
stationary, or
regressive

5. Past history-
important in
recurrent disorders
Family history-
important in
congenital and
infestation disorders.
Drug history- drugs
taken before
appearance of
disease

6. When did it start?
First episode
Where on the body
it start?
Pattern of spreading
Aggravating factors
Previous treatments
and response

7. • GENERAL EXAMINATION- skin disorders
associated with systemic diseases, like diabetic
carbuncle
• LOCAL EXAMINATION
• INSPECTION-
Entire skin surface
Scalp, hair, nails
Mucous membrane
of mouth, eyes,
anus and genitals

8. EXAMINATION OF THE SKIN-
Examination from distance-
distribution
Distributions of lesions may be
Discrete distribution- multipple
lesions separated by normal skin
Unilateral distribution- lesions
involving only onside of the body
Generalised distribution- lesions
involving more than 50% of body
surface area.
Linear distribution- lesions are
arranged along a line-it may be
koebners phenomenon which is
appearance of isomorphic lesions
along the site of blunt trauma

10. Zosteriform
distribution:lesions
are restricted to
dermatome
Follicular
distribution-
lesions are
arranged along
hair follicle
Grouped
distribution-
lesions are
restricted to a
localized area

11. Close up examination shows the
border of the lesions- that may be:
Well defined border-
marked sepparation
between the edge of the
lesion and normal skin
Ill defined border- difficult to identify
the separation line between the
lesion and the normal skin
Circinate border- the lesions
increases in size by peripheral
extension and healing at the
centre.

12. EXAMINATION OF SKIN APPENDAGES
• EXAMINATION OF MUCUS MEMBRANE
• Check for any erosion, ulceration, plaque, pigmentation,
white streaks
• EXAMINATION OF NAILS
• Nail pitting
• Nail discolouration
• Nail fol swelling
• Nail dystrophy
• EXAMINATION OF HAIR
• Hair loss either-
• Diffuse hair loss
• patchy or alopecia- ciatrical or non ciatrical
• Hair growth in abnormal sites(hirsuitism)

13. WHEN DESCRIBING A SKIN LESION ITS IMPORTANT
TO NOTE THE FOLLOWING FEATURES:
Size
Type
Shape and symmetry
Colour and pigmentation
Surface area
Distribution over the body surface

14. TYPES OF SKIN LESIONS
Primary
Secondary
special

15. Primary lesion- basic reaction patterns of
skin with definite morphology
Secondary skin lesion- develop during
the evolutionary process of skin disease
or are created by scratching or infection
Special- specific for certain skin disease.

16. SECONDARY SKIN LESION
Scale Crust
Excoriati
on
Lichenifi
ction
Fissure
Erosion Ulcer Sinus Scar Keloid
Atrophy stria

17. SCALING• Scaling is the abnormal
Thickening of the skin surface
and formation of scaly white
lamellae from the accumulation
of horny cell layers
• Excess dead epidermal cells
that are produced by abnormal
keratinization and shedding
• Fine branny- ptriasis versicolor
• Greasy-sebborhic dermatitis
• Lamellar –psoriasis
• Fish scales-icthyosis
• Horny(kerotic)-discoid lupus
erythematous

18. TYPES OF SCALES
• FINE TO STRATIFIED
• Erythema craquele-
dense scale
• Psoriasis -silvery scales

19. • Ichthyosis vulgaris(fish
like scales)
• Tinea versicolor-fine
scales

20. • Scaling in sheets
• In scarlet fever
• Staphylococcal scaled
skin syndrome

21. • Kawasaki syndrome

22. SPECIAL TESTS FOR PSORIASIS
candle –
grease sign
auspitz sign
koebners
phenomena

23. CRUSTING
• Crust is solidified keratin and exudate that forms on
an erosion or an ulcerous skin.
• Dried exudates of body fluids
• Crust are a sign of pyogenic infections
• Applied aspects-impetigo- with honey coloured crust.
• Tinea capitis/herpes tonsurans-fungal infection

25. EROSION
Erosions are loss
of epidermis
They may occur
after a vesicle
formation and
the top peels
Applied-toxic
epidermal
necrolysis,
Tinea pedis,
Candidiasis,
Ezcema,
herpes simplex

27. ULCER
If an erosion involves the dermis it is an ulcer
An area of skin from which the whole of epidermis
or atleast the upper part of dermis has been lost
Applied- pyoderma gangrenosum,
traumatic ulcers, stasis
ulcers,chanchroid, decubitus

28. • Pyoderma gangrenosum • Decubitus ulcer

29. EXCORIATION
• Superficial
excavation of the
epidermis that
results from
scratching.
• Applied- linear
excoriation in atopic
dermatitis

30. FISSURE
• A slit shaped deep ulceration
• Fissure means- a groove,
deep furrow, elongated cleft
in various parts of body
• Applied- irritant dermatitis of
hands ad foot
• Cause- skin dryness
• Ichthyosis is genetic disorder
where there is often severe
skin cracking
• eczema(fingertips)
• intertrigo

31. • Intertrigo• Finger fissure in
eczema

32. ATROPHY
• Epidermal atrophy results from
a decrease in epidermal cell
layers
• Dermal atrophy results from a
decrease in the dermal
connective tissue.
• In skin, it may appears as
depression , appears as shiny,
delicate, wrinkled lesions
• Appiled- steroid induced
atrophy,
• leprosy,
• Atrophoderma
• lipoatrophy

34. LICHENIFICATION
• A distinctive thickening of
skin that is characterized
by prominent skin fold
markings.
• Skin thickening is the
result of chronic rubbing
leaading to accentuation
of normal skin
• Applied – In atopic
dermatitis

35. SCAR
• It is a replacement of normal skin
by fibrous tissue in the process of
healing of damaged skin
• Scars are of 2 types:
• Hypertrophic
• Atrophic
• Eg,acne, burns, herpes zoster

36. KELOID
• Keloid is a benign
overgrowth of the
connective tissue of the
skin
• keloid can cause serious
aesthetic and occasionally
functional disabilities.
• It’s a result of an
overgowth of ganulation
tissue at the site of
healed skin injury.
• Keloid scar is benign not
contagious
• Seldom itching, pain and
changes in texture are
seen
• severe – effect the
movement of skin
• Dd- hypertrophic scars

38. SINUS
• A cavity or channel that
permits the escape of pus
or fluid
• Applied- pilonidal sinus,
periauricular sinus, sinus
caused by dental abscess.

39. STRIAE
• A streak like linear, pink,
atrophic, purple or white lesion
that cause changes in the
connective tissue.
• Applied- cushings syndrome ,
pregnancy induced
• Caused by tearing of the
dermis, which over time
may diminish, but wont
completely dissappear.
• Result of the rapid
stretching of the skin
associated with rapid
weight changes
• Also influenced with
hormonal changes
associated with puberty ,
pregnancy, body building,
hormone replacement
therapy.

41. INVESTIGATIONS
• WOODS LIGHT • It’s a special uv light
which if thrown to-
• Normal skin- reflects
deep violet colour
• Pityriasis versicolor-
golden yellow colour
• Erythrasma-reflects
deep red colour.
• Tinea capitis- reflects
brilliant green colour

42. POTTASSIUM HYDROXIDE TEST
• SKIN SCRAPING-Used for differential diagnosis
of fungal infection
• Skin is scratched by scalpel,the resulted scales
are placed on glass slide,then 10%f KOH is
added and examined under microscope)

43. PATCH TESTING
• A aluminum strip with multipple
holes is fixed on the back.
• The antigens are placed each in
one hole.
• The another aluminium strip is
placed over the previous one and
left for 48 hours.
• On removal of the strip,we
examine the sites of different
allergen for erythema and vesicles
if present the test is positive.
• For differential diagnosis of contact
dertemitis

44. GRAM STAIN AND CULTURE WITH
SENSITIVITY TEST
• Helps to Identify the organism responsible
for an underlying infection with effective drug
identification.

45. SKIN BIOPSY AND HISTOPATHOLOGY
• Removal of a piece of skin by shave,punch, or
excision technique for a microscopic study of
the skin to determine the histology of cells to
rule out malignancy and to establish an exact
diagnosis.