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10. Patient Presentations Related to the Integumentary System

Patient presentations span all relevant age categories, special populations, and varied clinical settings.

10.1 Hair and Scalp Disorders
10.2 Cyanosis/Pallor/Pigmentation Disturbances and Disorders of Coloration
10.3 Nail Disorders
10.4 Skin Lesions/Ulcers and Masses
10.5 Pruritus
10.6 Rashes, Exanthems, and Acne
10.7 Burns
10.8 Wounds
10.9 Urticaria and Angioedema
10.10 Dermatologic Presentations of Systemic Disease
10.11 Sweating Disorders
10.12 Bites/Stings/Infestations
10.13 Physical Exam Findings Related to the Integumentary System
10.14 Laboratory Test Findings and Diagnostic Imaging Related to the Integumentary System


The Guide to clinical presentations in this category may include, but is not limited to, the following ways in which patients present for osteopathic medical care:

acne and related conditions – rosacea, acne vulgaris, acneiform skin lesions • bites, human, animal, and other vectors – tick bites, lice infestation (pediculosis) • burns, chemical, thermal, and electrical • dermatitis, allergic, contact, atopic (eg, eczema), irritant, perioral, stasis, seborrheic (eg, cradle cap), dermatoses and pruritus in pregnancy • fungal infections – tinea capitis, tinea corporisexanthems, viral – varicella, herpes, enteroviruses, pityriasis rosea • hair-related conditions – folliculitis • hirsutism/hypertrichosis, hydradenitis suppurativa, alopecia (areata, universalis, traction) • infections – candidiasis • nail plate/ungual conditions, acute and chronic – nail trauma and infections (eg, paronychia); discoloration; nail fold and bed deformities, primary, or secondary to systemic disease, koilonychia, onychosis, Beau lines, clubbing, splinter hemorrhages, Muehrcke lines, Terry nails • newborns, normal dermatologic manifestations (eg, cradle cap [seborrheic dermatitis], milia, erythema toxicum, vascular birthmarks) • rashes – impetigo, vesicobullous lesions • skin lesions, immunologic (eg, foods, medications, aeroallergens, autoimmune disease immunodeficiency, infection) and nonimmunologic (eg, physical stimuli) • skin/cutaneous lesions and dermatologic disorders, congenital and acquired – keratosis; wheals; vesicles; bullae; pemphigus (vulgaris, bullous); verrucae (warts); macules; papules; psoriasis; papulosquamous lesions; pustules; plaques; lichen planus and lichen sclerosis et atrophicus; pruritus with or without primary skin lesions (eg, manifestations of systemic diseases); carcinomas, cutaneous – basal cell, squamous cell, melanoma; • skin/cutaneous pigmentation lesions and disorders, congenital and acquired- vitiligo/vitiligines; solar lentigo/lentigines; overexposure to ultraviolet (UV) radiation; phototoxic drug eruptions; nevi; acanthosis nigricans; discoid lupus erythematosus; vascular lesions (eg, petechiae, purpura) • sweat-gland-related conditions – bromhidrosis, hyper/hypohidrosis; miliaria • systemic diseases and the skin – disseminated gonorrhea, secondary syphilis; lupus; Kawasaki disease; Raynaud syndrome (eg, primary, secondary); Stevens-Johnson syndrome; cutaneous manifestations of internal malignancies • trauma, skin – abrasions, lacerations, contusions, stab wounds, surgical wounds, high-pressure injection injuries • ulcers, skin – traumatic; neurological; infectious, including cellulitis and cutaneous abscesses, furuncles, and carbuncles; metabolic; drug-related) • urticaria, acute and chronic

fatigue • fever • generalized weakness • involuntary weight loss • malaise • night sweats • pallor

Auspitz sign • Nikolsky sign • visual inspection (including temperature, color, moisture, tenderness)

microscopic evaluations, Wood lamp, fungal cultures, skin biopsy results