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