THE PATIENT WITH A SKIN PROBLEM

A patient who presents with a skin problem often complains of
"itchy rash all over the body". Indeed many patients are referred
to the skin clinic with "itchy rash all over the body" as a diagnosis.
After taking a history and performing a proper skin examination
you may find he or she is suffering from anything as varied as
eczema, urticaria, a drug reaction, a skin infection, scabies or
any other skin disease. A proper skin examination should be performed
in good light, preferably daylight. Ideally the whole skin
should be examined. The aspect, extent and localisation of all
the lesions is essential for making a diagnosis and will influence
your management.
Some terms used to describe skin lesions are: Macule: Circumscribed
colour change without change in the level of the skin. Papule: Small
superficial circumscribed elevation. Plaque: Superficial circumscribed
elevation larger than a papule. Lichenification: Thickening of the skin
with exaggeration of the normal skin lines and deepening of the natural
creases, caused by scratching and rubbing. Nodule: Circumscribed, solid
proliferation, clearly apart from surrounding tissue and often occurring in
the dermis or subcutis. Pustule: Blister filled with pus. Wheal (hive):
Temporary elevation of the skin caused by oedema in the upper dermis
causing severe itchiness. Atrophy: thinning, wasting away of the skin.