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Evaluation of the Dermatologic Patient

By

Julia Benedetti

, MD, Harvard Medical School

Last full review/revision Feb 2019| Content last modified Feb 2019
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Dermatologic history

Important information to obtain from history includes

A negative history is as important as a positive history. The history of the particular skin lesions is also important, including time and site of initial appearance, spread, change in appearance, and triggering factors.

Dermatologic examination

Visual inspection is the central evaluation tool; many skin disorders are diagnosed by the characteristic appearance or morphology of the lesions (see also Description of Skin Lesions Description of Skin Lesions An extensive language has been developed to standardize the description of skin lesions, including Lesion type (sometimes called primary morphology) Lesion configuration (sometimes called secondary... read more Description of Skin Lesions ). A full skin examination, including examination of the scalp, nails, and mucous membranes, is done to screen for skin cancers and to detect clues to the diagnosis of a widespread eruption. Magnification with a hand lens can help reveal morphologic detail. A hand-held dermatoscope with built-in lighting is particularly useful in evaluating pigmented lesions. Further information can be gathered by using diascopy or a Wood light Wood light Diagnostic tests are indicated when the cause of a skin lesion or disease is not obvious from history and physical examination alone. These include Patch testing Biopsy Scrapings Examination... read more Wood light .

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A 65-year-old man comes to the office because he has had an itchy rash for the past 6 weeks that is purple in color on the flexor aspect of each wrist. On physical examination, the lesions are flat and smooth. Biopsy is performed, and lichen planus is confirmed. Which of the following laboratory studies should be done? 
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