Its for the Doctors who may be interested in knowing about dermatology and easy approach to make a diagnosis in dermatology. For every doctor who want to be in dermatology in future . its for you!

1. APPROACH TO
DERMATOLOGICAL
DIAGNOSIS
DR. S.A.SHAH
FCPS, D.Dsc (UK),
M.A.A.C.S (USA)

2. Skin Lesions And Diagnosis
 Thorough approach to the evaluation decreases the risk of
making an in correct diagnosis or overlooking another
diagnosis
 Knowledge and appropriate use of dermatological
terminology are fundamental

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 The entire mucocutaneous surface, as well as the hair and nails, should
be examined whenever reasonable.
 Diseases have characteristics morphology and distribution.
 Common pitfalls in dermatologic diagnosis exist and can be avoided.

4. Approach To The Patient
 Introduction
 History
 History of present illness
 Systemic review
 Past medical & surgical history
 Family history
 Social history
 Drug history

5. •Examination
- cutaneous
- General physical
- Loco-regional
- Systemic
 Differential diagnosis
 Provisional diagnosis
 Investigations
 Final diagnosis
 Treatment
 Follow up

6. HISTORY
Dermatology a visual specialty
 But In most cases, a carefully directed history is important
for :
- refining the diagnosis,
-for identifying further investigations
-and to address issues that may be important for optimal
management

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 Perform a brief examination initially before taking history
 it helps to obtain streamlined and more focused history
later

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Demographics
Name , Age, race, sex, occupation, residence , mode
of admission etc

9. Presenting complaint:
 Symptoms.
 Itch is the prime dermatological symptom
 Rash
 History of a growth
 Symptoms usually parallel development of eruption but
discordance can be diagnostically useful

10. History of present illness:
It includes complete detail of presenting
complaint.

11. History of a rash: key
questions
 When did it start?
 Did it itch, burn or hurt?
 Where on the body, did it start?
 How has it spread?
 How have individual lesions changed?
 Provocative factors?
 Previous treatments & response?

12. History of a growth: key questions
 How long has the lesion been present?
 Has it changed, grown, bleed, itched or failed to heal?

13. Systemic review
 Review of systems as indicated by
clinical situation, with particular attention to symptoms indicating a
possible connection between cutaneous signs
and disease of other organ systems.

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 e.g. rheumatic complaints: myalgias, arthralgias, Reynaud's
phenomenon,
sicca symptoms.

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Review of symptoms for growth suspicious for,
or associated with malignancy.
Particular attention to symptoms of metastasis
(weight loss, fever, headache ,abdominal pain,
bone pain etc.)

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 Constitutional symptoms
 “Acute illness” syndrome: headaches, chills,
 fever, weakness
 “Chronic illness” syndrome: fatigue, weakness,
anorexia, weight loss, malaise

17. 3. Past history
 Illnesses
 Operations
 Atopic history
( asthma, hay fever, eczema)

18. 4. Family history
 Family medical history , particularly of skin disorders and of atopy.
 Family history of skin and other cancers.

19. 5. social history
 Social history with particular reference
to occupation, hobbies , sun exposure, tobacco smoking, alcohol use,
recreational drugs , travel, sexual orientation and exposure.

20. 6. Drug history
 History of any drug intake.
 History of drug allergies.

21. LABORATORY STUDIES
Special procedures as determined by individual
clinical situation:
 Dermatoscopy
 Hand lens
 Biopsy for histopathologic & other analysis (electron
microscopy, immunofluorescence, special stains)

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 Gram stain of scales , crust or exudates
 Potassium hydroxide preparation for yeast or fungi
 Tissues to be minced for bacterial and fungal culture
 Cytological preparation (tzanck smear) in vesicular &
bullous eruptions

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 Swab for bacterial, fungal, viral culture
 Wood’s lamp examination of urine
for porphyrins & of hair & skin for fluorescence or for
changes in
pigmentation
 Patch testing for allergic contact dermatitis

24. General laboratory studies
 Hematology
 Chemistry
 Urine analysis
 Serology
 Imaging studies

25. Final diagnosis
 Re-examination over time
 More than one biopsy may be required for definitive diagnosis

26. Examination of the
dermatologic patient
Scope of the complete cutaneous examination:
 it includes examining entire skin
 Identification of potentially harmful lesions
 Identification of benign lesion

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 Finding hidden clues to diagnosis
(e.g. scabies lesions on penis,
psoriatic plaques on buttocks,
Wickham striae of lichen planus
on buccal mucosa.)

28. The pre-requisite of dermatologic diagnosis is recognition of
 the type of skin lesion
 the color
 margins
 Consistency
 shape
 arrangement
 distribution of lesions

29. Recommended tools for skin examination
 A magnifying tool such as loupe, magnifying glass,
dermatoscope.
 A bright focused light
 Glass slides
 Alcohol pads to remove scales or surface oil
 Gauze pads or tissues with water

30.  Gloves
 A Ruler for measuring lesions
 A surgical blades for scraping or incising lesion
 Camera for photographic documentation
 A wood’s lamp for highlighting pigmentary changes

31. Techniques for dermatologic physical
examination

32.  Inspection :
Observe the patient at a distance for any kind of
asymmetry , obesity, pallor, fatigue , jaundice.
Next examine the patient in a systematic way
from head to toe.

33. Palpation:
Palpate the patient for any kind of mass ,
growth,
whether they are soft ,fleshy, firm, tender
fluid-filled.

34. Palpation:
Palpate the lesion for ,
 Texture
 Consistency
 Thickness
 Tenderness
 temperature

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After completing the examination ,
it is important to document the
findings