Internists Have Key Skills Useful in Diagnosing Dermatologic Conditions, Convention Told

    According to a presentation at Internal Medicine 2011, the annual meeting of the American College of Physicians in San Diego, internists should consult dermatologists about any skin eruption in patients. That said, internists have key skills that are useful in diagnosing patients with skin problems.

   Mark Davis, MD, chair of the division of dermatology at the Mayo Clinic in Rochester, Minnesota, spoke at a session on dermatology in the acute care setting.

   The underlying cause of a skin condition often can be found by means of careful history-taking. He described the case of an infant who was born with atopic dermatitis, was losing her hair,  and had dermatitis on her extremities. The patient had gotten radioallergosorbent testing, which indicated widespread food allergies. Her mother subsequently took her off all foods except rice milk—a piece of historical information that led to a diagnosis of kwashiorkor, a condition most often found in developing countries.

   Dr. Davis also described a young girl who presented with erosions on her nose and lips, as well as high liver function. She survived post-admission cardiac arrest. “Her history revealed she had anorexia nervosa and bulimia,” Dr. Davis told the attendees. “Her skin condition was a manifestation of nutritional deficiency from her poor diet.”

   A third case was of a young boy with a blood pressure of 80/50 and lesions all over his body that had the appearance of Rocky Mountain spotted fever. On history, it was found that a single ibuprofen had led to a diagnosis was toxic epidermal necrolysis. Therapy was supportive care in the ICU until the drug’s effects wore off.

   “This raises the question: Can you reverse a reactive process in a case like this with corticosteroids or IVIG [intravenous immunoglobulin]? There is little data either way,” Dr. Davis said. “The number one thing to do, of course, is remove the cause—get the patient off the drug.”

   The importance of history-taking is also seen with generalized erythroderma, which presents with severe itching and/or painful skin, scaling, high cardiac output, and electrolyte imbalance. The most common etiologies are psoriasis, atopic dermatitis, and drug reactions, Dr. Davis noted.