Interpretation of the clinical picture is rendered
difficult, for identical manifestations may result from widely different
causes. Moreover, the same etiologic factor may give rise to a great diversity
of eruptions. However, there is one great advantage in dermatology, namely,
that of dealing with an organ that can be seen and felt. Smears and cultures
may be readily made for bacteria. By excision and microscopic examination of
the lesion, its histopathology can be studied in relation to the clinical
appearance, more directly in the skin than elsewhere. A skin disease in its
various stages of development can be inspected, palpated, and studied without
dependence upon percussion, auscultation, and other indirect diagnostic methods
necessary in other branches of medicine.
Importance of the History
All facts
contributory to a knowledge of the patient's family, his health, occupation,
living conditions, the onset and course of the disease, and its response to
previous treatment are as pertinent in dermatology as in internal medicine.
A complete history is of more value than
simply serving in the diagnosis. Whereas a history may be superfluous for the
diagnosis, or even for the treatment and cure, of easy cases, it is the
backbone of treatment in difficult ones. The chronic dermatoses are the most
distressing to both the patient and the physician, and form the bulk of
dermatologic practice. For the analysis and identification of the cause of the
disease, for cognizance of those remedies which have been beneficial or seemed
harmful,
for intelligent treatment of the chronic case, a good
history is essential, and the degree of improvement that the patient ultimately
shows is usually proportionate to the quality of the protocol.
The
history should be systematically arranged, with abbreviations as numerous as
clarity permits, all pertinent facts being included, important statements
underlined, and irrelevant matters omitted. The wearisome taking of long
histories is a hardship, so dispatch and thoroughness in essential data are
necessary.
Examination
Examination of the patient should be conducted in a well-lighted room. Daylight
is a necessity for successful dermatologic practice, but some eruptions are
more clearly visible in ultraviolet light, as in the case of faint macular
eruptions, which then become prominent. In tinea capitis the use of ultraviolet
light passed through Wood's filter, which is permeable to wavelengths of 3650
A., is of assistance in diagnosis, for the spores become fluorescent in these
rays.
The manner of display of the diseased areas is
important. The entire eruption must be seen in order that such factors as
distribution and configuration can be studied, as they are of valuable
assistance in the recognition of the disease, and for prescription of treatment
for the areas involved. Laboratory tests may be necessary to complete the study
of the case.