Skin Lesions and Diagnosis

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Skin Lesions and Diagnosis

• James H Herndon MD
• Clinical Professor, Dermatology
• UT Southwestern Medical Center

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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)

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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 -gt acne, hirsutism
  and also hyperinsulinemia -gt acanthosis nigricans
  and diabetes

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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?

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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).

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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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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis
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Skin Lesions and Diagnosis