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Wolff, Klaus (2009-02-19). Fitzpatrick's Color Atlas and 
Synopsis of Clinical Dermatology : Sixth Edition 
(Fitzpatrick's Color Atlas & Synopsis of Clinical 
Dermatology) (Kindle Locations 651-680). McGraw-Hill. 
Kindle Edition. 
APPROACH TO DERMATOLOGIC DIAGNOSIS 
There are two distinct clinical situations regarding the 
nature of skin changes: 
I. Incidental findings 
o “Bumps and blemishes” 
 many asymptomatic lesions 
that are medically 
inconsequential may be 
present in well and ill 
persons and are not the 
reason for the visit to the 
physician 
 every general physician 
should be able to recognize 
these lesions to 
differentiate them from 
asymptomatic but 
important, e.g., malignant, 
lesions. 
o Important skin lesions not noted by 
the patient but that must not be 
overlooked by the physician 
 e.g., atypical nevi, 
melanoma, basal cell 
carcinoma, squamous cell 
carcinoma, café-au-lait 
macules in von 
Recklinghausen disease, 
xanthomas. 
II. Chief complaint of the patient 
o “Minor” problems: 
 e.g., localized itchy rash, 
“rash,” rash in groin, 
nodules such as common 
moles, seborrheic 
keratoses. 
o “4-S”: serious skin signs in sick 
patients 
SSSS: SERIOUS SKIN SIGNS IN SICK PATIENTS 
Generalized red rash with fever 
Viral exanthems 
Rickettsial exanthems 
Drug eruptions 
Bacterial infections with toxin production. 
Generalized red rash with blisters and prominent 
mouth lesions 
Erythema multiforme (major) 
Toxic epidermal necrolysis 
Pemphigus vulgaris 
Bullous pemphigoid 
Drug eruptions 
Generalized red rash with pustules 
Pustular psoriasis (von Zumbusch) 
Drug eruptions 
Generalized rash with vesicles 
Disseminated herpes simplex 
Generalized herpes zoster 
Varicella 
Drug eruptions 
Generalized red rash with scaling over whole body 
Exfoliative erythroderma 
Generalized wheals and soft tissue swelling 
Urticaria and angioedema 
Generalized purpura 
Thrombocytopenia 
Purpura fulminans 
Drug eruptions 
Generalized purpura that can be palpated 
Vasculitis 
Bacterial endocarditis 
Multiple skin infarcts 
Meningococcemia 
Gonococcemia 
Disseminated intravascular coagulopathy 
Localized skin infarcts 
Calciphylaxis 
Atherosclerosis obliterans 
Atheroembolization 
Warfarin necrosis 
Antiphospholipid antibody syndrome 
Facial inflammatory edema with fever 
Erysipelas 
Lupus erythematosus

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Serious skin signs in sick patients fitzpatrick

  • 1. Wolff, Klaus (2009-02-19). Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology : Sixth Edition (Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology) (Kindle Locations 651-680). McGraw-Hill. Kindle Edition. APPROACH TO DERMATOLOGIC DIAGNOSIS There are two distinct clinical situations regarding the nature of skin changes: I. Incidental findings o “Bumps and blemishes”  many asymptomatic lesions that are medically inconsequential may be present in well and ill persons and are not the reason for the visit to the physician  every general physician should be able to recognize these lesions to differentiate them from asymptomatic but important, e.g., malignant, lesions. o Important skin lesions not noted by the patient but that must not be overlooked by the physician  e.g., atypical nevi, melanoma, basal cell carcinoma, squamous cell carcinoma, café-au-lait macules in von Recklinghausen disease, xanthomas. II. Chief complaint of the patient o “Minor” problems:  e.g., localized itchy rash, “rash,” rash in groin, nodules such as common moles, seborrheic keratoses. o “4-S”: serious skin signs in sick patients SSSS: SERIOUS SKIN SIGNS IN SICK PATIENTS Generalized red rash with fever Viral exanthems Rickettsial exanthems Drug eruptions Bacterial infections with toxin production. Generalized red rash with blisters and prominent mouth lesions Erythema multiforme (major) Toxic epidermal necrolysis Pemphigus vulgaris Bullous pemphigoid Drug eruptions Generalized red rash with pustules Pustular psoriasis (von Zumbusch) Drug eruptions Generalized rash with vesicles Disseminated herpes simplex Generalized herpes zoster Varicella Drug eruptions Generalized red rash with scaling over whole body Exfoliative erythroderma Generalized wheals and soft tissue swelling Urticaria and angioedema Generalized purpura Thrombocytopenia Purpura fulminans Drug eruptions Generalized purpura that can be palpated Vasculitis Bacterial endocarditis Multiple skin infarcts Meningococcemia Gonococcemia Disseminated intravascular coagulopathy Localized skin infarcts Calciphylaxis Atherosclerosis obliterans Atheroembolization Warfarin necrosis Antiphospholipid antibody syndrome Facial inflammatory edema with fever Erysipelas Lupus erythematosus