Basic Skills

INTRODUCTION

Few disciplines evoke more mystery and confusion among health care professionals than the examinations and diagnosis of skin disorders. Frequently, fellow physicians whose diagnostic abilities in other areas are sharp and accurate express a sense of absolute helplessness when faced with a common exanthem.

With the current evolutionary changes in the health care system, primary care practitioners are being called on to improve their skills in all areas of medicine including der-matologic diagnosis. Diseases of the skin are a surprisingly large part of primary care practice. The aim of this book is to improve dermatologic skills by presenting a concise, logical, stepwise approach to skin examination. Mastery of these principles will improve your diagnostic accuracy and minimize use of expensive laboratory testing. This is truly "cost-effective" medicine.

Part I is designed to provide the basic skills upon which subsequent disease-specific chapters are based. A thorough knowledge and understanding of these principles is essential.

As in other medical disciplines, accurate diagnosis of skin disorders requires a history and physical examination. After many years of practice, dermatologists become skilled at cutting through the chaff while obtaining a specific history of the immediate problem. This specific history does not replace a general medical history and may, in fact, reveal areas where the general medical history should be amplified. This book will address salient areas of the specific history.

Physical examination of skin lesions is primarily visual and to a lesser extent tactile. Accurate diagnosis is sometimes dependent on subtle changes in color and surface character. Recognizing these changes is a skill acquired over many years. Mastery of the basic information in this book will allow primary care practitioners to improve their skills in diagnosing common skin diseases. Once these principles have been incorporated into your armamentarium, you can go on to acquire a sense of more subtle aspects of dermatologic diagnosis.

Each word in the description of a skin lesion is a meaningful clue. When faced with a difficult diagnostic challenge, these are the basics that a dermatologist will return to in order to obtain a correct answer.

Ask yourself, for instance, "Is the color red, red-yellow, dusky, or bright red? Are these papules dome-shaped, flat-topped, or polygonal?" In this way you will truly begin to see the physical changes which are present—changes that allow dermatologists to distinguish one condition from another.

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