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Skin lesions and diagnosis

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Skin lesions and diagnosis

  1. 1. Skin Lesions and Diagnosis James H Herndon MD Clinical Professor, Dermatology UT Southwestern Medical Center
  2. 2. 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)
  3. 3. 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
  4. 4. 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?
  5. 5. 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).
  6. 6. 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.
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