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 |
Lesions/Ulcers/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, acneform skin lesions • bites, human, animal, and other vectors – tick bites, lice infestation (pediculosis) • burns, chemical, thermal, and electrical • dermatitis, allergic, contact, atopic (e.g., eczema), irritant, perioral, stasis, seborrheic; dermatoses and pruritus in pregnancy • fungal infections – candidiasis, tinea capitis, tinea corporis • hair-related conditions – folliculitis, hirsutism/hypertrichosis, hydradenitis suppurativa, alopecia (areata, universalis, traction) • nail plate/ungual conditions, acute and chronic – nail trauma and infections (e.g., paronychia); discoloration; nail fold and bed deformities, primary, or secondary to systemic disease (e.g., koilonychia, onychosis, Beau lines, clubbing, splinter hemorrhages, Muehrcke lines, Terry nails) • newborns, normal dermatologic manifestations (e.g., cradle cap/seborrheic dermatitis, milia, erythema toxicum, vascular birthmarks) • rashes – impetigo, vesicobullous lesions • skin lesions, immunologic (e.g., related to foods, medications, aeroallergens, autoimmune disease immunodeficiency, infection), nonimmunologic (e.g., related to 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 sclerosus et atrophicus; pruritus with or without primary skin lesions (e.g., manifestations of systemic disease); carcinomas, cutaneous – basal cell, squamous cell, melanoma • skin/cutaneous pigmentation lesions and disorders, congenital and acquired – vitiligo; solar lentigo; overexposure to ultraviolet (UV) radiation; phototoxic drug eruptions; nevi; acanthosis nigricans; discoid lupus erythematosus; vascular lesions (e.g., petechiae, purpura) • sweat gland-related conditions – bromhidrosis, hyper/hypohidrosis; miliaria • systemic diseases – disseminated gonorrhea, secondary syphilis; lupus; Kawasaki disease; Raynaud syndrome (e.g., 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, neurologic, infectious (cellulitis and cutaneous abscesses, furuncles, carbuncles), metabolic, drug-related • urticaria, acute and chronic • viral infections – varicella, herpes, enteroviruses, pityriasis rosea
CONSTITUTIONAL SIGNS AND SYMPTOMS
fatigue • fever • generalized weakness • involuntary weight loss • malaise • night sweats • pallor
PHYSICAL EXAM FINDINGS
Auspitz sign • Nikolsky sign • visual inspection (including temperature, color, moisture, tenderness)
LABORATORY TEST FINDINGS AND DIAGNOSTIC IMAGING
microscopic evaluations, fungal cultures, skin biopsies, Wood lamp