TY  - CHAP
M1  - Book, Section
TI  - Approach to the Patient with a Skin Disorder
A1  - Yancey, Kim B.
A1  - Lawley, Thomas J.
A2  - Jameson, J. Larry
A2  - Fauci, Anthony S.
A2  - Kasper, Dennis L.
A2  - Hauser, Stephen L.
A2  - Longo, Dan L.
A2  - Loscalzo, Joseph
PY  - 2018
T2  - Harrison's Principles of Internal Medicine, 20e
AB  - The  challenge  of  examining  the  skin  lies  in  distinguishing  normal  from  abnormal  findings,  distinguishing  significant  findings  from  trivial  ones,  and  integrating  pertinent  signs  and  symptoms  into  an  appropriate  differential  diagnosis.  The  fact  that  the  largest  organ  in  the  body  is  visible  is  both  an  advantage  and  a  disadvantage  to  those  who  examine  it.  It  is  advantageous  because  no  special  instrumentation  is  necessary  and  because  the  skin  can  be  biopsied  with  little  morbidity.  However,  the  casual  observer  can  be  misled  by  a  variety  of  stimuli  and  overlook  important,  subtle  signs  of  skin  or  systemic  disease.  For  instance,  the  sometimes  minor  differences  in  color  and  shape  that  distinguish  a  melanoma  (Fig.  52-1)  from  a  benign  nevomelanocytic  nevus  (Fig.  52-2)  can  be  difficult  to  recognize.  A  variety  of  descriptive  terms  have  been  developed  that  characterize  cutaneous  lesions  (Tables  52-1,  52-2,  and  52-3;  Fig.  52-3),  thereby  aiding  in  their  interpretation  and  in  the  formulation  of  a  differential  diagnosis  (Table  52-4).  For  example,  the  finding  of  scaling  papules,  which  are  present  in  psoriasis  or  atopic  dermatitis,  places  the  patient  in  a  different  diagnostic  category  than  would  hemorrhagic  papules,  which  may  indicate  vasculitis  or  sepsis  (Figs.  52-4  and  52-5,  respectively).  It  is  also  important  to  differentiate  primary  from  secondary  skin  lesions.  If  the  examiner  focuses  on  linear  erosions  overlying  an  area  of  erythema  and  scaling,  he  or  she  may  incorrectly  assume  that  the  erosion  is  the  primary  lesion  and  that  the  redness  and  scale  are  secondary,  whereas  the  correct  interpretation  would  be  that  the  patient  has  a  pruritic  eczematous  dermatitis  with  erosions  caused  by  scratching.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1155944040
ER  -