Skin lesions patient history

Diagnosis. Dermatologists obtain the patient s medical history and assess his or her status. They examine the affected skin and adjacent areas to determine the nature and extent of the lesions. A frequently used method is dermoscopy (or epiluminescent microscopy), which employs a quality magnifying lens and a powerful lighting system to allow a close examination of the skin s structure. It is useful in evaluating pigmented skin lesions and can facUitate the dk nosis of melanoma. 

Cutaneous reactions may also be provoked by infliximab. Three patients with rheumatoid arthritis, none of whom had a personal or family history of psoriasis, developed what was described as psoriasiform skin lesions 6-9 months after the initiation of infliximab therapy. Two of the... 

The authors recommended that when a patient presents with chronic skin lesions, a vague medical history, negative findings during previous examinations, labile affect, and delusional behavior, a drug screen should be obtained to check for cocaine use. 

Several observations suggest that IgE plays an important role in AD (29,30) the majority of the patients with AD have a family history of atopy, more than 80% of them have increased serum IgE (Table 2), and it has been demonstrated that allergens can exacerbate the skin lesions. Approximately 85% of AD patients have positive immediate skin tests or RAST for specific IgE to a variety of food... 

Taking the history of the patient and noting the clinical symptoms and localization of the lesions are critical. Allergen identification for a patient with a possible contact allergy to cosmetics is performed by means of patch testing with the standard series, specific cosmetic-test series, the product itself, and all of its ingredients. We can only find the allergens we look for. For skin tests with cosmetic products... 

A 70-year-old white man, with no significant preceding medical history, developed an acute painful rash, a fever (38.4° C), and severe arthralgia 5 days after starting to take diazepam 10 mg bd for lumbar muscular contracture due to hard physical exercise. He had taken no other medications. There were well-defined purple-red skin plaques, surmounted by vesicular and hemorrhagic blisters. He had a leukocytosis. Sweet s syndrome was confirmed by punch biopsy of a lesion. Diazepam was withdrawn, and prednisolone 30 mg/day was given for 2 weeks and then tapered. The patient improved quickly and the eruption cleared in 10 days. 

Before a treat-or-refer recommendation can be made, the pharmacist or other health professional must make a reasoned assessment of the problem and make a presumptive diagnosis (or at least rule out some of the many skin disorders). Several factors affect this decision, including patient age and hormonal status, patient complaint and history, and lesion assessment. 

AK usually presents as a small (2 to 6 mm), erythematous papule that feels flat, rough, or scaly when palpated (Fig. 94-12, Plate 12). It tends to be found in chronically sun-exposed areas, such as the top of the hands, head, neck, and forearms. Typically, patients with AKs are elderly and have fair skin, light-colored eyes, freckles, and a history of significant sun exposure and tend to sunburn easily. Because AKs are likely caused by ultraviolet radiation, sun-preventive measures, particularly in childhood, are of utmost importance. Most commonly, AKs are treated with liquid nitrogen, which will remove the lesion. Another frequently used therapy is topical 5-fluorouracil. Patients who are prescribed topical 5-fluorouracil should be properly counseled, as significant erythema, erosion, crusting, and even ulceration normally occur during treatment. 

Severity, lesion types, scarring, and skin discoloration, as well as previous treatment history, helps to determine a treatment approach to acne vulgaris (see Table 95-1). Most treatments reduce or prevent new eruptions and may take up to 8 weeks to produce visible results. During the first few weeks of therapy, acne may appear to worsen as existing acne lesions may resolve more rapidly. Patients must understand the need to continue therapy for optimal outcome. 

Pustular and acneiform ICD are results of exposure to certain irritants, such as croton oil, mineral oils, tars, greases and naphthalenes. This syndrome must always be considered in conditions in which acneiform lesions develop outside the typical acne age. Those most affected are atopies and patients with seborrhoea, macroporous skin conditions or prior acne vulgaris. The pustules are sterile and transient however, subcorneal pustular eruption may also be a manifestation of allergy to trichlorethylene, which has to be considered as a differential diagnosis in patients with appropriate history (Goh 1995). 

A 73-year-old man presented with a dark coloured patchy macular pigmentation on the nasal columella. The patient had no personal or family history of skin cancer and was himself not aware of the lesion. His medical history consisted of asthma, peripheral vascular disease, hypertension and nocturnal leg cramps and had been on simvastatin, bendroflumethiazide, quinine, salbutamol and aspirin for several years. Histology of biopsy tissue showed evidence of sun-damaged skin with increased basal melanin pigmentation and pigment incontinence in the superficial dermis. There was no evidence of increased melanocyte numbers, dysplasia... 

I understand that there is a risk (although small) of developing a temporary or permanent pigment (color) change in the skin. There is a small incidence of the reactivation of cold sores (herpes infection) in patients with a prior history of herpes. There is also a rare incidence of a flare of acne-like lesions resulting from the peel. There is a rare incidence of scarring. 

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