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Charmaine S. Bolusan, MD Clerks and Interns Monitor AY 2021-2022

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>1 cm May be spherical, dome-shaped or ovoid May be firm, soft, boggy or fluctuant Can have a solid or cystic component

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Loss of continuity in the skin surface More common on the palms and soles

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Epidermis: Shiny with cigarette wrinkly appearance Dermis: depressed lesion

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Thickened epidermis Accentuation of skin markings

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Linear erosions caused by scratching or picking

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Partial loss of epidermis Heals without scarring

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Full thickness loss of epidermis, may extend to dermis or  subcutis Heals with scarring

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Coalescing circles, rings or incomplete rings

Arc-shaped Incomplete formation of annular lesion

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Marble-like 2 distinct  colors  interspersed in a wavy pattern

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Unilateral and lying in the distribution of a single spinal afferent nerve root

Following lines of skin cell migration during embryogenesis

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Over flexor muscles Antecubital  & popliteal fossa

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Chief complaint Primary lesion Evolution of lesions Secondary lesion Associated s/s Medications taken Consult done

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Number Borders Color Primary lesion Secondary lesion Measurement Area

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WHEN? WHERE? HOW DID IT SPREAD? HOW DID INDIVIDUAL LESIONS CHANGED? PROVOCATIVE FACTORS?

PRURITUS/PAIN/NUMB/ BLEED/DISCHARGE RELIEVED BY, IF ANY TIMING OF SEVERITY

PRODROME FEVER JOINT PAINS MUSCLE WEAKNESS PALLOR

MEDICATIONS ONGOING/PREVIOUS ILLNESSES ALLERGIES (DRUGS, ATOPY)

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Simplest, most rewarding diagnostic technique Minor surgical procedure Local  anesthesia : 1%  Lidocaine  +/- Epinephrine Reasons: Uncertainty of clinical diagnosis Poor response to therapy Exclude other conditions Investigate symptoms in the absence of clinically recognizable disease

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Quick and inexpensive Detect presence of mycelia Specimen:  Advancing borders (scales) Hair (plucked) Nail clippings KOH 10-20% solution Microscopy: Long branching hyphae Short hyphae and spores Pseudohyphae  and budding yeasts

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Cytologic  technique Herpesvirus  infections Specimen: Early vesicle (base) Stains: Giemsa ,  Wright’s, methylene blue Microscopy: Multinucleated giant cells (10-20 nuclei)

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Pressing a microscopic slide over a skin lesion Red  colored  lesions: Blanches on pressure (Erythema) Does not blanch ( Purpura ) Granulomatous lesions → “Apple-jelly”  color

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UV long-wave light 360nm (“black light”) (+)  Flourescence : C.  minutissimum  – coral pink M.  canis  – yellow Pseudomonas – pale blue Vitiligo  – white (accentuated)

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Document sensitivity to a specific antigen Suspected allergens are applied using Finn chambers Left under occlusion for 48 hours (+) DTH reaction:  papular  vesicular lesion

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MCV-1,2 Umbilicated   papules Spontaneously  resolves within 1 year Molluscum  extraction, topical  retinoids

DERMATOLOGY