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4. Skin diseases
Dermatology
S k in d iseases, p articularly in fectious sk in d iseases, are very com m on . T hey m ust be
treated in d ivid ually or collectively, but m ust also be con sid ered as in d icators of the
san itary con d ition of a p op ulation . A high p revalen ce of in fectious sk in d iseases m ay
reflect a p roblem of in sufficien t w ater q uan tity an d lack of hygien e in a p op ulation .
Dermatological examination
– Observe the typ e of lesion : 4
• Macule: flat, n on p alp able lesion that is d ifferen t in colour than the surroun d in g
sk in
• Papule: sm all (< 1 cm ) slightly elevated , circum scribed , solid lesion
• Vesicle (< 1 cm ), bulla (> 1 cm ): clear fluid -filled blisters
• Pustule: vesicle con tain in g p us
• Nodule: firm , elevated p alp able lesion ( > 1 cm ) th at exten d in to th e d erm is or
subcutan eous tissue.
• Erosion: loss of the ep id erm is that heals w ithout leavin g a scar
• Excoriation: erosion caused by scratchin g
• Ulcer: loss of the ep id erm is an d at least p art of the d erm is that leaves a scar
• Scale: flak e of ep id erm is that d etaches from the sk in surface
• Crust: d ried serum , blood , or p us on the sk in surface
• Atrophy: thin n in g of the sk in
• Lichenification: thick en in g of the sk in w ith accen tuation of n orm al sk in m ark in gs
– L ook at th e d istribution of th e lesion s over the bod y; observe th eir arran gem en t:
isolated , clustered , lin ear, an n ular (in a rin g). A sk if the lesion s are itchy.
– L ook for a p ossible cause: in sect bites; scabies, lice, other p arasitic sk in in fection s;
con tact w ith p lan ts, an im als, jew ellery, d etergen ts, etc.
– A sk about an y on goin g treatm en t: top ical, oral or p aren teral.
– L ook for local or region al sign s ( secon d ary in fection , lym p h an gitis, ad en op ath y,
erysip elas) an d / or system ic sign s (fever, sep ticaem ia, d istan t in fectious focus).
– C on sid er th e san itary con d ition of th e fam ily, p articularly for con tagious sk in
d iseases (scabies, scalp rin gw orm , lice).
– C heck tetan us vaccin ation status.
P atien ts w ith sk in d isease often p resen t late. A t this stage, p rim ary lesion s an d
sp ecific
sign s m ay be m ask ed by secon d ary in fection . I n th ese cases, it is n ecessary to re-
exam in e the p atien t, after treatin g the secon d ary in fection , in ord er to id en tify an d treat
the un d erlyin g sk in d isease.
97
Dermatology
S k in d iseases, p articularly in fectious sk in d iseases, are very com m on . T hey m ust be
treated in d ivid ually or collectively, but m ust also be con sid ered as in d icators of the
san itary con d ition of a p op ulation . A high p revalen ce of in fectious sk in d iseases m ay
reflect a p roblem of in sufficien t w ater q uan tity an d lack of hygien e in a p op ulation .
Dermatological examination
– Observe the typ e of lesion : 4
• Macule: flat, n on p alp able lesion that is d ifferen t in colour than the surroun d in g
sk in
• Papule: sm all (< 1 cm ) slightly elevated , circum scribed , solid lesion
• Vesicle (< 1 cm ), bulla (> 1 cm ): clear fluid -filled blisters
• Pustule: vesicle con tain in g p us
• Nodule: firm , elevated p alp able lesion ( > 1 cm ) th at exten d in to th e d erm is or
subcutan eous tissue.
• Erosion: loss of the ep id erm is that heals w ithout leavin g a scar
• Excoriation: erosion caused by scratchin g
• Ulcer: loss of the ep id erm is an d at least p art of the d erm is that leaves a scar
• Scale: flak e of ep id erm is that d etaches from the sk in surface
• Crust: d ried serum , blood , or p us on the sk in surface
• Atrophy: thin n in g of the sk in
• Lichenification: thick en in g of the sk in w ith accen tuation of n orm al sk in m ark in gs
– L ook at th e d istribution of th e lesion s over the bod y; observe th eir arran gem en t:
isolated , clustered , lin ear, an n ular (in a rin g). A sk if the lesion s are itchy.
– L ook for a p ossible cause: in sect bites; scabies, lice, other p arasitic sk in in fection s;
con tact w ith p lan ts, an im als, jew ellery, d etergen ts, etc.
– A sk about an y on goin g treatm en t: top ical, oral or p aren teral.
– L ook for local or region al sign s ( secon d ary in fection , lym p h an gitis, ad en op ath y,
erysip elas) an d / or system ic sign s (fever, sep ticaem ia, d istan t in fectious focus).
– C on sid er th e san itary con d ition of th e fam ily, p articularly for con tagious sk in
d iseases (scabies, scalp rin gw orm , lice).
– C heck tetan us vaccin ation status.
P atien ts w ith sk in d isease often p resen t late. A t this stage, p rim ary lesion s an d
sp ecific
sign s m ay be m ask ed by secon d ary in fection . I n th ese cases, it is n ecessary to re-
exam in e the p atien t, after treatin g the secon d ary in fection , in ord er to id en tify an d treat
the un d erlyin g sk in d isease.
97
