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Figure 52-5 Meningococcemia. An example of fulminant meningococcemia with extensive angular purpuric patches. (Courtesy of Stephen E. Gellis, MD; with permission.) Figure 52-4 Necrotizing vasculitis. Palpable purpuric papules on the lower legs are seen in this patient with cutaneous small vessel vasculitis. (Courtesy of Robert Swerlick, MD; with permission.)[newpage] APPROACH TO THE PATIENT: SKIN DISORDER In examining the skin it is usually advisable to assess the patient before taking an extensive history. This way, the entire cutaneous surface is sure to be evaluated, and objective findings can be integrated with relevant historic data. Four basic features of a skin lesion must be noted and. | Chapter 052. Approach to the Patient with a Skin Disorder Part 4 Figure 52-5 Sourc F tue A3 K p rt L irtunuald H uit SL. Longo C L. J on ion JL. Loicalco Ji Micron s 17th Edition httpi itw. ccessmcdlane.com Copyright ö Th. mc îkîu-hiH compiriiif tnc. All right hii Wd Meningococcemia. An example of fulminant meningococcemia with extensive angular purpuric patches. Courtesy of Stephen E. Gellis MD with permission. Figure 52-4 Necrotizing vasculitis. Palpable purpuric papules on the lower legs are seen in this patient with cutaneous small vessel vasculitis. Courtesy of Robert Swerlick MD with permission. newpage APPROACH TO THE PATIENT SKIN DISORDER In examining the skin it is usually advisable to assess the patient before taking an extensive history. This way the entire cutaneous surface is sure to be evaluated and objective findings can be integrated with relevant historic data. Four basic features of a skin lesion must be noted and considered during a physical examination the distribution of the eruption the types of primary and secondary lesions the shape of individual lesions and the arrangement of the lesions. An ideal skin examination includes evaluation of the skin hair and nails as well as the mucous membranes of the mouth eyes nose nasopharynx and anogenital region. In the initial examination it is important that the patient be disrobed as completely as possible. This will minimize chances of missing important individual skin lesions and make it possible to assess the distribution of the eruption accurately. .
