The hazards of neglecting the skin
Editor – Elder et al1 have addressed the important but overlooked subject of the physical examination. However, as a dermatologist I was disappointed to discover that of 58 different components of the physical examination that they considered, ranging from ophthalmoscopy to digital rectal examination, examination of the largest and most accessible organ of the body, the skin, had been entirely overlooked, other than ‘skin turgor’.
Cutaneous manifestations of systemic disease are numerous and common; the fingernails alone may reveal splinter haemorrhages (endocarditis), periungual fibromas (tuberose sclerosis), nail fold telangiectasia (dermatomyositis), clubbing, koilonychia (iron deficiency), and yellow nails (benign pleural effusion) to give but a few examples.
Every dermatologist has the experience of being called to the medical or surgical wards to find important physical signs in the skin that had been overlooked and which lead the correct diagnosis of a puzzling clinical presentation.
A brief but systematic examination of the skin from the top of the head (syphilitic alopecia) to the tip of the toe (subungual malignant melanoma) is, in these cost-conscious days, inexpensive but often highly rewarding. It should not be neglected.
- © Royal College of Physicians 2018. All rights reserved.
Reference
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- Elder AT
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