Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, Seventh Edition

APPROACH TO DERMATOLOGIC DIAGNOSIS

There are two distinct clinical situations regarding the nature of skin changes:

I.  The skin changes are incidental findings in well and ill individuals noted during the routine general physical examination

• “Bumps and blemishes”: many asymptomatic lesions that are medically inconsequential may be present in well and ill persons and are not the reason for the visit to the physician; every general physician should be able to recognize these lesions to differentiate them from asymptomatic but important, e.g., malignant, lesions.

• Important skin lesions not noted by the patient but that must not be overlooked by the physician: e.g., atypical nevi, melanoma, basal cell carcinoma, squamous cell carcinoma, café-au-lait macules in von Recklinghausen disease, and xanthomas.

II. The skin changes are the chief complaint of the patient

• “Minor” problems: e.g., localized itchy rash, “rash,” rash in groin, nodules such as common moles and seborrheic keratoses.

• “4-S”: serious skin signs in sick patients

SERIOUS SKIN SIGNS IN SICK PATIENTS

• Generalized red rash with fever

• Viral exanthems

• Rickettsial exanthems

• Drug eruptions

• Bacterial infections with toxin production.

• Generalized red rash with blisters and prominent mouth lesions

• Erythema multiforme (major)

• Toxic epidermal necrolysis

• Pemphigus

• Bullous pemphigoid

• Drug eruptions

• Generalized red rash with pustules

• Pustular psoriasis (von Zumbusch)

• Drug eruptions

• Generalized rash with vesicles

• Disseminated herpes simplex

• Generalized herpes zoster

• Varicella

• Drug eruptions

• Generalized red rash with scaling over whole body

• Exfoliative erythroderma

• Generalized wheals and soft-tissue swelling

• Urticaria and angioedema

• Generalized purpura

• Thrombocytopenia

• Purpura fulminans

• Drug eruptions

• Generalized purpura that can be palpated

• Vasculitis

• Bacterial endocarditis

• Multiple skin infarcts

• Meningococcemia

• Gonococcemia

• Disseminated intravascular coagulopathy

• Localized skin infarcts

• Calciphylaxis

• Atherosclerosis obliterans

• Atheroembolization

• Warfarin necrosis

• Antiphospholipid antibody syndrome

• Facial inflammatory edema with fever

• Erysipelas

• Lupus erythematosus


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