Dermatologic Complaints#

Approach to common skin complaints in primary care. Most dermatologic presentations can be diagnosed clinically with pattern recognition—the key is distinguishing benign from concerning lesions and infectious from inflammatory conditions.

Key Principles#

• Distribution matters: Symmetric vs asymmetric, sun-exposed vs covered areas, dermatomal vs diffuse
• Morphology first: Macule, papule, plaque, vesicle, pustule—accurate description guides diagnosis
• Timeline: Acute (<2 weeks) vs chronic (>6 weeks) changes differential significantly
• Medication review: Drug eruptions are common; always ask about new medications in past 2-6 weeks
• Infection vs inflammation: Cellulitis requires antibiotics; dermatitis requires steroids—getting this wrong causes harm

Topics#

Rashes#

• Rash (Acute) — <2 weeks; viral exanthems, drug eruptions, contact dermatitis
• Rash (Chronic/Recurrent) — >6 weeks; eczema, psoriasis, seborrheic dermatitis
• Cellulitis vs Dermatitis — critical distinction; antibiotics vs steroids
• Urticaria — acute vs chronic; anaphylaxis risk; antihistamine approach

Pruritus and Lesions#

• Pruritus (Without Rash) — systemic causes; xerosis; neuropathic itch
• Skin Lesion Evaluation — benign vs malignant; when to biopsy; melanoma red flags

Wounds and Appendages#

• Wound Concerns — infection assessment; healing problems; when to refer
• Nail Changes — onychomycosis, psoriatic nails, melanonychia
• Hair Loss — scarring vs non-scarring; pattern vs diffuse; workup

When to Refer to Dermatology#

• Uncertain diagnosis after initial evaluation
• Suspected skin malignancy requiring biopsy (or biopsy-proven malignancy)
• Severe or refractory inflammatory conditions (psoriasis, eczema requiring systemic therapy)
• Blistering disorders
• Suspected autoimmune skin disease (dermatomyositis, lupus skin findings)
• Chronic wounds not responding to standard care
• Hair loss with scarring alopecia