EXAMINATION OF THE SKIN

The examination of the skin is a critical component of the comprehensive medical approach to the patient. By learning how to examine the skin and approach the diagnosis of skin diseases, the physician can focus on the lesions that warrant therapy or provide important information about the systemic health of the patient. Other lesions may be of cosmetic concern to the patient even though they have little or no medical significance.

As the organ system that is an interface with the environment, the skin has an extensive array of mechanical, biochemical, immunologic, and neurologic properties that both inform and protect each individual. The skin also has a vast ability to alter its cellular and acellular components in response to internal or external insults, a process that leads to changes that are subsequently defined as disorders or diseases. The physical examination of the skin can provide information about both cutaneous and systemic diseases, and the examination can sometimes diagnose serious medical conditions at an otherwise asymptomatic stage.

Skin disorders can usually be visualized directly by both the patient and the physician. For example, the patient not only feels the itch and discomfort of an allergic contact dermatitis reaction to poison ivy but also sees the vesicular and crusted skin lesions. The appearance of new lesions or a sudden change in existing lesions can elicit emotional reactions in patients or their family members. The physician must learn to see the same eruptions using a careful and systematic approach that leads to a specific and treatable diagnosis.