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GENERAL PRINCIPLES

DIAGNOSIS OF SKIN DISORDERS

Examination of the skin requires that the entire surface of the body be palpated and inspected in good light. The onset and duration of each symptom should be recorded, together with a description of the primary lesion and any secondary changes, using the terminology in Table 15–1. In practice, characteristics of skin lesions are described in an order opposite to that shown in Table 15–1. Begin with distribution, then configuration, color, secondary changes, and primary changes. For example, guttate psoriasis could be described as “generalized, discrete, red, or scaly papules.” Of note, cutaneous lesions may present differently in patients with varying skin tones, and historically, mainstream dermatology literature and training have not focused on skin of color. The reader is encouraged to explore dermatologic manifestations in a variety of skin colors. An excellent reference is given by Taylor and Kelly, 2016. Several online and social media platforms, including the Instagram account “Brown Skin Matters” offer follower-submitted photographs and other helpful resources.

Table 15–1.Examination of the skin.

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