TAILIEUCHUNG - Chapter 052. Approach to the Patient with a Skin Disorder (Part 7)

Allergic contact dermatitis (ACD). A. An example of ACD in its acute phase, with sharply demarcated, weeping, eczematous plaques in a perioral distribution. B. ACD in its chronic phase demonstrating an erythematous, lichenified, weeping plaque on skin chronically exposed to nickel in a metal snap. (B, Courtesy of Robert Swerlick, MD; with permission.) As in other branches of medicine, a complete history should be obtained to emphasize the following features: 1. Evolution of lesions a. Site of onset b. Manner in which the eruption progressed or spread c. Duration d. Periods of resolution or improvement in chronic eruptions 2. Symptoms associated with the eruption a. Itching, burning,. | Chapter 052. Approach to the Patient with a Skin Disorder Part 7 Allergic contact dermatitis ACD . A. An example of ACD in its acute phase with sharply demarcated weeping eczematous plaques in a perioral distribution. B. ACD in its chronic phase demonstrating an erythematous lichenified weeping plaque on skin chronically exposed to nickel in a metal snap. B Courtesy of Robert Swerlick MD with permission. As in other branches of medicine a complete history should be obtained to emphasize the following features 1. Evolution of lesions a. Site of onset b. Manner in which the eruption progressed or spread c. Duration d. Periods of resolution or improvement in chronic eruptions 2. Symptoms associated with the eruption a. Itching burning pain numbness b. What if anything has relieved symptoms c. Time of day when symptoms are most severe 3. Current or recent medications prescribed as well as over-the-counter 4. Associated systemic symptoms . malaise fever arthralgias 5. Ongoing or previous illnesses 6. History of allergies 7. Presence of photosensitivity 8. Review of systems 9. Family history particularly relevant for patients with melanoma atopy psoriasis or acne 10. Social sexual or travel history as relevant to the patient DIAGNOSTIC TECHNIQUES Many skin diseases can be diagnosed on gross clinical appearance but sometimes relatively simple diagnostic procedures can yield valuable information. In most instances they can be performed at the bedside with a minimum of equipment. Skin Biopsy A skin biopsy is a straightforward minor surgical procedure however it is important to biopsy a lesion that is most likely to yield diagnostic findings. This decision may require expertise in skin diseases and knowledge of superficial anatomic structures in selected areas of the body. In this procedure a small area .