methodological/systematic approach to derm diagnosis
history, distribution (where on body is it located? localized? widespread? systemic?); examine and describe lesions (arrangement and shape of lesions; primary lesions; secondary lesions)
When possible, classify the lesion ino a diagnostic group:
1. eczematous disorders (erythematous patches) 2. maculopapular disorders & pigmented lesions 3. vesicular and bullous diseases 4. psoriasis and popularsquamous disorders 5. hair and nail disorders 6. vascular disorders
History: what do you ask?
onset & duration (acute or chronic?); location (distribution); rate of change/progression (better or worse) (manipulation); aggravating/alleviating factors (seasonal flare ups? relationship to specific exposures? What has patient dones to try to treat it?); exposure/occupation/allergies; past/family/social history; ROS (itch, fever, pain?); meds/allergies to meds?
pattern of recognition: distribution
localized, regional, generalized/systemic
pattern of recognition: distribution_localized
extensor/flexor surfaces, dermatomal, sun exposed areas, intertiginal areas, contact vs. non-contact areas, palms/soles
pattern of recognition: distribution_regional
trunk, extremities, etc...
pattern of recognition: distribution_generalized/systemic
dermatologic conditions affecting a high % of skin area; skin findings indicating systemic health problems
patient skin types
Type I = always burn... to Type IV = dark pigment, rarely burn
Skin, Hair, and Nails Methods of general inspection
EXPOSE your patient and have another health care provider in the room for sensitive exams- as specific lesions are notes, they are evaluated (context of history, skin type, and described using specific terminology for arrangement, primary, and secondary lesions)
T/F: the same lesion can appear differently on different patients and at different points in the disease process?