skin lesions and diagnosis
TRANSCRIPT
Skin Lesions and Diagnosis
James H Herndon MDClinical Professor, Dermatology
UT Southwestern Medical Center
Skin Lesions and Diagnosis
• Recognition of the significant can be life- and health-saving (melanoma, RMSF, vasculitis)
• Failure to recognize normal/inconsequential can also cause harm (the black seborrheic keratosis, pigmentary purpura of the lower legs, physiologic variations in genital areas)
Skin Lesions and Diagnosis
• Skin acts as window in several ways. Two examples:– Point mutations may cause skin and internal change.
• Birt-Hogg-Dube Syndrome causes cutaneous fibrofolliculomas, renal tumors, and spontaneous pneumothorax by affecting the folliculin gene.
– Hormonal overdose causes skin and internal change.• PCOS causes elevated androgens -> acne, hirsutism and
also hyperinsulinemia -> acanthosis nigricans and diabetes
Skin Lesions and Diagnosis
• How to bring order to confusion:– What component is mainly affected? (dermis,
epidermis, subcutaneous fat, blood vessels)– What is the primary change and what is secondary?– Next assess the lesions by type, shape, arrangement,
and distribution.– Finally, how did the changes evolve over time?
Skin Lesions and Diagnosis• How to bring order from confusion, continued.
– History should contain: exact description of onset, first lesions if any, details of development.
– Prior treatment, of home or physician source, and the diagnosis(es) based on.
– Other drugs, herbal remedies, ethnic medications.– Effect of sunlight, season, contact with immediate
environment (plants, animals, chemicals, metals).– Role of physiologic changes (menses, pregnancy).
Skin Lesions and Diagnosis
• Why do experienced clinicians often view the rash before taking a history?– Visual diagnosis may be sharper without
preconceived ideas. – Some lesions and patterns are so distinctive that
history is needed only as confirmation.– In other cases the rash guides and interacts with the
history, allowing one to diagnose more efficiently.
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis
Skin Lesions and Diagnosis