Cath Lab Digest

N urses, nondermatology physicians, and other healthcare professionals frequently encounter patients with skin disease in their daily practice. In fact, of all patient visits to physicians for skin disease, the majority are to nondermatologists.¹ Unfortunately, nondermatology physicians lack the training and acumen compared to dermatologists with respect to the diagnosis and treatment of cutaneous disease^2-6; clearly, a need exists for either improvement in their skills or reliance on specialist consultation. To improve the quality of care rendered by nondermatologists, health professionals must become facile with several simple skills involved in the care of patients with cutaneous disorders, such as obtaining a dermatologic history, performing a dermatologic examination, and understanding and properly utilizing the dermatologic lexicon. This has the potential not only to enhance professional communication, but also to achieve more expeditious resolution of disease if proper diagnoses are made earlier.

Obtaining a Dermatologic History

Many physicians have been taught in medical school that the most valuable information leading to an accurate diagnosis of a malady can be gleaned from taking a careful and thorough history. However, this is not always the case with respect to disease of the skin. In fact, the history obtained from patients with skin disease often can be quite misleading. Because the skin is uniquely situated- ie, much of it is visible to the naked eye- patients are often cognizant of skin lesions and have at least a vague idea of when the disorder began. Therefore, they are often apt to attribute some explanation, often erroneous, as to a cause. For example, ascribing a rash to a new laundry detergent or a recently ingested food is not unusual. Although laundry detergents can cause a contact dermatitis and people can develop urticaria and other lesions from food, this is uncommon. Similarly, patients often present complaining of a lesion that began after a spider or insect bite; in fact, the resultant rash is often from the self-treatment the patient applied. For this reason, clinicians should examine the skin carefully first, formulate a differential diagnosis, and subsequently obtain a focused history that limits the differential diagnosis further.

When obtaining a dermatologic history, certain key elements are often very helpful. Demographic information frequently is of paramount importance because certain illnesses are more prevalent in one gender, certain ethnic groups, or in members of a specific age group. For example, systemic lupus erythematosus is more prevalent in young, African-American females; whereas, skin cancer is more common in elderly Caucasians.

Inquiring about subjective cutaneous symptoms is often useful. Although many lesions are asymptomatic, patients may report pruritis, pain, throbbing, stinging, burning, or anesthesia. The pain of carbuncles, furuncles, and cellulitis may be described as throbbing, while an anesthetic hypopigmented patch is highly suggestive of leprosy.