... 052. ApproachtothePatient
with a Skin Disorder
(Part 1)
Harrison's Internal Medicine > Chapter 52. ApproachtothePatientwith
a Skin Disorder
APPROACH TOTHEPATIENTWITH ... Fig. 52-3) and to
formulate a differential diagnosis (Table 52-4). For instance, the finding of scaling
papules (present in patients with psoriasis or atopic dermatitis) places thepatient
in ... that the erosion is the primary lesion and the redness and scale
are secondary, while the correct interpretation would be that thepatient has a
pruritic eczematous dermatitis with erosions caused...
... polycythemia
vera, and delusions of parasitosis.
Figure 52-3
Erosion: Loss of epidermis without an associated loss of dermis.
Ulcer: Loss of epidermis and at least a portion ofthe underlying ... configuration of skin lesions formed from coalescing rings or
incomplete rings.
Pruritus: A sensation that elicits the desire to scratch. Pruritus is often the
predominant symptom of inflammatory skin ... destruction of hair
follicles.
Table 52-3 Common Dermatologic Terms
A schematic representation of several common primary skin lesions
(see Table 52-1).
Chapter 052. Approachtothe Patient...
... lesions often correlates highly with diagnosis (Fig. 52-6).
For example, a hospitalized patientwith a generalized erythematous exanthem is
more likely to have a drug eruption than is a patientwith ... a patientwith a similar rash limited to
the sun-exposed portions ofthe face. Once the distribution ofthe lesions has been
established, the nature ofthe primary lesion must be determined. ... lesions, the shape of individual lesions, and the arrangement ofthe
lesions.
An ideal skin examination includes evaluation ofthe skin, hair, and nails as
well as the mucous membranes ofthe mouth,...
... characterized by small and
large erythematous papules and plaques with overlying adherent silvery scale.
Figure 52-8
Chapter 052. ApproachtothePatient
with a Skin Disorder
(Part 5)
Figure...
... lesions with a
generalized arrangement are common and suggest a systemic etiology.
Figure 52-9
Erythema multiforme.
This eruption is characterized by multiple erythematous plaques with ... represents a hypersensitivity reaction to drugs
(e.g., sulfonylamides) or infections (e.g., HSV). (Courtesy ofthe Yale Resident's
Slide Collection; with permission.)
Figure 52-10
...
... against the surface ofthe
skin and rotated with downward pressure until it penetrates tothe subcutaneous
tissue. The circular biopsy is then lifted with forceps, and the bottom is cut with
iris ... suspected. The edge of such a lesion is scraped
gently with a no. 15 scalpel blade, and the removed scale is collected on a glass
microscope slide then treated with 1 to 2 drops of a solution of 10–20% ... previous illnesses
6. History of allergies
7. Presence of photosensitivity
8. Review of systems
9. Family history (particularly relevant for patients with melanoma,
atopy, psoriasis, or acne)...
... may also aid in the demonstration of tinea versicolor and
in recognition of ash leaf spots in patients with tuberous sclerosis.
Figure 52-12
Diascopy is designed to assess whether a skin lesion ...
noting the amount of blanching that occurs. Granulomas often have an opaque to
transparent, brown-pink "apple jelly" appearance on diascopy.
Figure 52-11
Chapter 052. Approachtothe ... or crusted
lesion, is unroofed, and the base ofthe lesion is scraped gently with a scalpel
blade. The material is placed on a glass slide, air-dried, and stained with Giemsa
or Wright's...
... >0.
Proof. The proof is similar to that ofthe proofs of Theorems 4.1 and 5.1. □
Corollary 5.2. Let θ ≥ 0 and let p be a real number with 0 <p<1. Let X be a
normed vector space with norm ... Point Theory and Applications 2011, 2011:67
http://www.fixedpointtheoryandapplications.com/content/2011/1/67
Page 12 of 14
for all x ẻ X and t >0.
Proof. The proof is similar tothe proof of Theorem ... (x,0)
|m|−|m|L
.
Proof. The proof is similar tothe proof of Theorem 3.1. □
Corollary 3.2. Let θ ≥ 0 and p be a real number with p >1. Let f : X đ Y be a map-
ping satisfying f(0) = 0 and (6). Then, for...
...
Chapter 019. FeverofUnknownOrigin
(Part 1)
Harrison's Internal Medicine > Chapter 19. FeverofUnknownOrigin
Definition and Classification
Fever ofunknownorigin (FUO) was ... the number of undetected cases of
systemic lupus erythematosus and other autoimmune diseases.
Table 19-1 Classic FUO in Adults
A
uthors
(Year of
Publicati
Y
ears
of
Study
o. of
Cases
... adult patients with FUO encompassing all eight university hospitals in the
Netherlands and using a standardized protocol in which the first author reviewed
every patient. Coincident with the...
...
d
Empirical therapy is a last
resort, given the good prognosis of most patients with FUO persisting without a
diagnosis.
Febrile agglutinins is a vague term that in most laboratories refers to
serologic ... Approachtothepatientwith classic FUO.
a
"Potentially diagnostic
clues," as outlined by de Kleijn and colleagues (1997, Part II), may be key
findings in the history, localizing ... are indicated. In the setting
of recurrent fevers with lymphocytic meningitis (Mollaret's meningitis),
cerebrospinal fluid can be tested for herpesvirus, with use ofthe polymerase chain...