Clinical Dermatology

When more than a single lesion is present, the examiner should first search for, and then focus on, the most representative lesion that can be identified. The following information regarding that lesion should be documented:

1. Lesion type: Some authorities divide these lesions into primary and secondary types
2. Color: Skin-colored, white, brown-black, yellow, or red
3. Margination: sharp or diffuse
4. Configuration: round, oval, linear, serpiginous, or annular
5. Surface characteristics: smooth, scaling, crusted, or eroded
6. Evidence of pruritus: excoriated or non excoriated
7. Consistency on palpation: soft, medium, or firm

The above information, once obtained, needs to be “assembled.” Choose the type of lesion first. Then apply the remainder of the information as a string of adjectives. Thus, in a hypothetical situation, a determination is made that the most typical lesion is a plaque. Appropriate adjectives are then added, such that the written note states: “lesions consist of sharply marginated, round, scaling, nonexcoriated, red plaques.

Having described one or more typical lesions, the examiner should turn his or her attention to the distribution and arrangement of lesions. The distrilrution of lesions may be diffuse or localized. Specific areas of localization, e.g., the palms and soles, should be specifically stated. The examiner should also indicate whether or not the hair, nails, or mucous membranes are involved. The arrangement of lesions may be random or patterned.

Typical patterns include -

(1) Clustering (or grouping) such as is seen in herpetic viral infections

(2) Linear arrangements such as occur in the presence of the Koebner phenomenon

(3) Reticular (net- or lattice-like) patterns such as are seen in livedo reticularis

( 4) Satellitosis such as in candidiasis.

The above information may sound rather extensive and formidable, but with a modicum of practice the acquisition and assembly of these data become routine and efficient. In any event, I cannot overemphasize the importance of having complete and accurate morphologic data when using” the problem-oriented in the jargon of computer enthusiasts, GIGO-garbage in, garbage out!

This entry was posted on Monday, September 24th, 2007 at 9:59 am and is filed under Lesions. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.