Items in AFP with MESH term: Dermatology
ABSTRACT: Physicians often have difficulty diagnosing a generalized rash because many different conditions produce similar rashes, and a single condition can result in different rashes with varied appearances. A rapid and accurate diagnosis is critically important to make treatment decisions, especially when mortality or significant morbidity can occur without prompt intervention. When a specific diagnosis is not immediately apparent, it is important to generate an inclusive differential diagnosis to guide diagnostic strategy and initial treatment. In part I of this two-part article, tables listing common, uncommon, and rare causes of generalized rash are presented to help generate an inclusive differential diagnosis. The tables describe the key clinical features and recommended tests to help accurately diagnose generalized rashes. If the diagnosis remains unclear, the primary care physician must decide whether to observe and treat empirically, perform further diagnostic testing, or refer the patient to a dermatologist. This decision depends on the likelihood of a serious disorder and the patient's response to treatment.
ABSTRACT: Although it is important to begin the evaluation of generalized rash with an inclusive differential diagnosis, the possibilities must be narrowed down by taking a focused history and looking for key clinical features of the rash. Part I of this two-part article lists the common, uncommon, and rare causes of generalized rashes. In part II, the clinical features that help distinguish these rashes are described. These features include key elements of the history (e.g., travel, environmental exposures, personal or family history of atopy); characteristics of individual lesions, such as color, size, shape, and scale; areas of involvement and sparing, with particular attention to palms, soles, face, nails, sun-exposed areas, and extensor and flexor surfaces of extremities; pruritic or painful lesions; systemic symptoms, especially fever; and dermatologic signs, such as blanching, and the Koebner phenomenon.
Conditions of the Skin - Core Educational Guidelines
Shave and Punch Biopsy for Skin Lesions - Article
ABSTRACT: Shave and punch biopsies are essential procedures for physicians who manage skin conditions. These office-based procedures can diagnose questionable dermatologic lesions, including possible malignancies. Approaches include the superficial shave biopsy, saucerization excision, punch biopsy, and elliptical excision. A superficial shave biopsy can be used for raised lesions. A saucerization biopsy may be performed for flat or pigmented lesions. Punch biopsies yield full-thickness samples and can be used for lesions that require dermal or subcutaneous tissue for diagnosis. Indications for biopsy of suspected melanoma remain controversial. Sufficient tissue may be obtained with the quicker, less costly saucerization biopsy or the more time-consuming, invasive elliptical excisional biopsy.