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| alopecia areata | eyebrows/eyelashes and fingernails |
| chronic paronychia | look for loss of cuticle |
| collagen vascular disease | top 5 review of systems: |
| • | -physical exam – periungual telangiectasias |
| Darier’s | hands (nails and acrokeratosis verruciformis of Hopf) |
| LS&A | petechiae (in genital lesions) |
follicular plugs resembling comedones (in early lesions)
| LP | buccal mucosa (Wickham's striae) |
| lupus | periungual, ears (DLE) |
ROS: arthritis, photosensitivity, Raynaud’s, sicca sx’s, oral and genital ulcers, and pleuropericardial sx’s
| lepromatous leprosy | peripheral sensation |
| malignancy | lymph nodes, weight loss? epistaxis or easy bruising? (bleeding diathesis) |
| pretibial myxedema | lid lag |
neck for fullness
| secondary syphilis | nodes (inguinal, epitrochlear), mucous membranes (mucous patches, split papules) |
| scleroderma | telangiectasia's |
| tuberculoid leprosy | lesional sensation |
| vitamin deficiency | tongue, gums (scurvy) |
Good Habits:
| • | always globally assess patient’s general appearance, for example... |
| • | cushingoid --> acanthosis nigrans? |
| • | temporal wasting --> thrush, clubbing? |
| • | yellow --> ascites, spiders, palmar erythema, gynecomastia? |
| • | always consider drug (i.e. always check meds) |
| • | always consider the common and boring in your ddx |
| • | always think “what is the distribution”? morphology? arrangement? (and when face is involved, always consider photodistribution) |
| • | when discussing treatment, always include avoiding triggers (e.g. LE, rosacea, urticaria) |
| • | don't forget about ice and UVB for chronic pruritis for anything that itches |
| • | when considering drug reaction (exanthem, urticaria etc…) always elicit contrast dye and blood product history |
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