Cutaneous Signs and Diagnosis




The astute clinician uses the appearance of the eruption and its accompanying symptoms to arrive at an accurate diagnosis. A symptom, such as itch or pain, is something that the patient reports. In contrast, a sign is elicited by the physician during examination. Pain is a symptom; tenderness to palpation is a sign.


This chapter will focus on the morphologic patterns skin lesions may have primarily or acquire over the course of time. The latter are called secondary characteristics and are not as helpful diagnostically as those present at the onset of the condition. Examples of each primary and secondary lesion are included, as well as other findings that are utilized to narrow the differential diagnosis such as the configuration, grouping, and color.


Finally, examples throughout will emphasize that the astute clinician should utilize all observable findings, inducing those of the hair, nails, and mucous membranes.


Fig. 2.1


Nevus of ota (macule).

Courtesy Steven Binnick, MD.



Fig. 2.2


Axillary freckling neurofibromatosis (macules).



Fig. 2.3


Voriconazole-induced lentigines (macules).

Courtesy Jennifer Huang, MD.



Fig. 2.4


Vitiligo (patch).



Fig. 2.5


Nevus depigmentosus (patch).

Courtesy Scott Norton, MD.



Fig. 2.6


Drug eruption (macules, some small papules present surmounting the erythema).



Fig. 2.7


Drug eruption (morbilliform appearance).



Fig. 2.8


Sarcoidosis (papules).



Fig. 2.9


Eruptive xanthomas (papules). Yellow color is uncommon in the skin and helps to narrow the differential diagnosis.



Fig. 2.10


Darier disease (papules).



Fig. 2.11


Verruca vulgaris (scaly papule).



Fig. 2.12


Hypertrophic lupus erythematosus (scaly papules and plaques).

Courtesy Steven Binnick, MD.



Fig. 2.13


Oral hairy leukoplakia (plaques).



Fig. 2.14


Psoriasis (plaques).

Courtesy Steven Binnick, MD.



Fig. 2.15


Xanthomas in homozygous familial hypercholesterolemia (plaques of yellow color).



Fig. 2.16


Dermatofibroma sarcoma protuberans (nodule).



Fig. 2.17


Acute myelogenous leukemia (nodules).



Fig. 2.18


Erythema nodosum (subcutaneous nodules).



Fig. 2.19


Pyogenic granuloma (tumor).

Courtesy Curt Samlaska, MD.



Fig. 2.20


Melanoma (tumor).

Courtesy Chris Miller, MD.



Fig. 2.21


Basal cell carcinoma (tumor).



Fig. 2.22


Neurofibromatosis (macular hyperpigmentation, papules, tumors).



Fig. 2.23


Keloids (plaques and tumor).



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Sep 3, 2019 | Posted by in Dermatology | Comments Off on Cutaneous Signs and Diagnosis

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