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A 23-year-old young woman comes to your office with a rash. The rash started as red, round, pruritic bumps on the abdomen approximately 1 week before presentation and has spread. More recently, 1.5-cm round scaly patches and plaques have developed on the trunk and extremities.

  • What additional questions regarding personal and family history would you ask?
  • What types of social or occupational exposures may be relevant to this case?
  • What specific questions about the location of the eruption may help in making a diagnosis?

Dermatologists are not the only physicians who assess and treat patients with skin disorders. The results of the National Ambulatory Medical Care Survey (1990–1994)1 showed that US dermatologists saw only 40% of patients with diseases of the skin, hair, or nails. In the primary care setting, 25% of all visits were found to involve skin disorders. Data from both the United States and Canada reveal a continued undersupply of dermatologists, resulting in the need for nondermatology physicians and physician extenders to provide primary care of skin disease.2,3 These data support the importance of a fundamental understanding of the skin to all healthcare professionals.

As the body's most accessible organ, the skin is too important to be ignored. A close inspection of the skin can afford important insight into the presence and nature of cutaneous and internal disease.

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Primary lesions
 BullaA circumscribed, elevated lesion that measures ≥ 1 cm and contains serous or hemorrhagic fluid (ie, a large blister).
 MaculeA circumscribed, nonpalpable discoloration of the skin that measures < 1 cm in diameter.
 NoduleA palpable, solid, round or ellipsoidal lesion measuring ≥ 1 cm; it differs from a plaque in that it is more substantive in its vertical dimension compared with its breadth.
 PapuleAn elevated, solid lesion that measures < 1 cm.
 PatchA circumscribed, nonpalpable discoloration of the skin that measures ≥ 1 cm.
 PetechiaeNonblanching reddish macules representing extravascular deposits of blood, measuring ≤ 0.3 cm (less than the size of a pencil eraser).
 PlaqueA palpable, solid lesion that measures ≥ 1 cm.
 PurpuraNonblanching reddish macules or papules representing extravascular deposits of blood, measuring > 0.3 cm.
 PustuleA lesion that contains pus; may be follicular (centered around a hair follicle) or nonfollicular.
 VesicleA circumscribed, elevated lesion that measures < 1 cm and contains serous or hemorrhagic fluid (ie, a small blister).
 WhealA round or annular (ring-like), edematous papule or plaque that is characteristically evanescent, disappearing within hours; may be surrounded by a flare of erythema (ie, a hive).
Secondary lesions
 AtrophyA depression in the skin resulting from thinning of the epidermis, dermis, and/or subcutaneous fat.
 CrustA collection of dried blood, serum, and/or cellular debris.
 ErosionA focal loss of epidermis; does not penetrate below the dermal–epidermal junction and, therefore, can heal without scarring.
 LichenificationThickening of the epidermis resulting from repeated rubbing, appearing as accentuation of the skin markings.
 ScaleExcess dead epidermal cells; scale may be fine, ...

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