(1)
Hôpital Universitaire de Strasbourg, Strasbourg, France
Abstract
Diagnosis of cutaneous lesions requires both history taking and physical examination. History taking must specify the circumstances of the onset and the course of the disease, as well as treatments applied and their effects. The starting date of the disorder and its initial location must be specified, as well as the ways in which the lesions spread and eventually change. The main cutaneous functional symptoms are pain and pruritus. The context in which lesions have appeared is often essential: associated extracutaneous signs, medications, comorbidities, immunodeficiencies, etc. Thus full history taking is often crucial, gathering all past history. Finally, given the large number of skin diseases related to the environment, targeted history taking should be carried out regarding lifestyle, professional and domestic backgrounds, and products that may have been applied and manipulated, in order not to miss, for example, the diagnosis of a contact dermatitis. Dermatological physical examination requires training. It is necessary to know how to recognize the primary lesions of the skin, their arrangement and/or configuration, and their distribution.
Diagnosis of cutaneous lesions requires both history taking and physical examination. History taking must specify the circumstances of the onset and the course of the disease, as well as treatments applied and their effects. The starting date of the disorder and its initial location must be specified, as well as the ways in which the lesions spread and eventually change. The main cutaneous functional symptoms are pain and pruritus. The context in which lesions have appeared is often essential: associated extracutaneous signs, medications, comorbidities, immunodeficiencies, etc. Thus full history taking is often crucial, gathering all past history. Finally, given the large number of skin diseases related to the environment, targeted history taking should be carried out regarding lifestyle, professional and domestic backgrounds, and products that may have been applied and manipulated, in order not to miss, for example, the diagnosis of a contact dermatitis. Dermatological physical examination requires training. It is necessary to know how to recognize the primary lesions of the skin, their arrangement and/or configuration, and their distribution.
Primary lesions are the skin’s response to aggressions and diseases. The term elementary lesions, which clearly reflects the fact that those lesions are the basic response patterns of the skin, is used in the French dermatologic literature. Every skin disorder can be described by means of its constitutive primary lesions. Therefore, a limited set of lesions describes all skin disorders. These lesions can thus be compared to the letters of the alphabet. Their combination produces syndromes.
The arrangement is the positioning of the various lesions relatively to each other. For example, they can form a line (“linear arrangement”) (Fig. 1.1). In herpes, the different vesicles tend to group in clusters (Fig. 1.2).
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