Diagnosis of skin disorders
The key to successful treatment is an accurate diagnosis. You can look up treatments, but you cannot look up diagnoses. Without a proper diagnosis, you will be asking ‘What’s a good treatment for scaling feet?’ instead of ‘What’s good for tinea pedis?’ Would you ever ask yourself ‘What’s a good treatment for chest pain? Luckily, dermatology differs from other specialties as its diseases can easily be seen. Keen eyes and a magnifying glass are all that are needed for a complete examination of the skin. Sometimes it is best to examine the patient briefly before obtaining a full history: a quick look will often prompt the right questions. However, a careful history is important in every case, as is the intelligent use of the laboratory.
The key points to be covered in the history are listed in Table 3.1 and should include descriptions of the events surrounding the onset of the skin lesions, of the progression of individual lesions, and of the disease in general, including any responses to treatment. Many patients try a few salves before seeing a physician. Some try all the medications in their medicine cabinets, many of which can aggravate the problem. A careful inquiry into drugs taken for other conditions is often useful. Ask also about previous skin disorders, occupation, hobbies and disorders in the family.