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HOW TO USE THIS BOOK
Students in the classroom
Students should learn the primary and secondary lesions and look at every page in the Regional Differential Diagnosis Atlas at the end of Chapter 1. Select a few familiar diseases from each list and read about them. Obtain an overview of the text. Turn the pages, look at the pictures, and read the captions.
Students in the clinic
You see skin abnormalities every day in the clinic. Try to identify these diseases, or ask for assistance. Study all diseases, especially tumors, with a magnifying glass or an ocular lens. Read about what you see and you will rapidly gain a broad fund of knowledge.
Study Chapters 20 (Benign Skin Tumors), 21 (Premalignant and Malignant Nonmelanoma Skin Tumors), and 22 (Nevi and Malignant Melanoma). Skin growths are common, and it is important to recognize their features.
House officers are responsible for patient management. Read Chapter 2 carefully, and study all aspects of the use of topical steroids. These agents are used to treat a variety of skin conditions. It is tempting to use these agents as a therapeutic trial and ask for a consultation only if therapy fails. Topical steroids mask some diseases, make some diseases worse, and create other diseases. Do not develop bad habits; if you do not know what a disease is, do not treat it.
The diagnosis of skin disease is deceptively easy. Do not make hasty diagnoses. Take a history, study primary lesions and the distribution, and be deliberate and methodical. Ask for help. With time and experience you will feel comfortable managing many common skin diseases.
The non-dermatologist provider
Most skin diseases are treated by non-dermatologist providers. This includes primary care physicians, nurse practitioners and physician assistants. Clinicians involved in direct patient care should read the above guidelines for using this book. Look at the Regional Differential Diagnosis Atlas in Chapter 1 as a general guide. Learn a few topical steroids in each potency group. There are a great number of agents in the Dermatologic Formulary. Many in each table contain similar ingredients and have the same therapeutic effect. Develop an armamentarium of agents and gain experience in their use.
Inflammatory conditions are often confusing, and sometimes biopsies are of limited value in their diagnosis. Eczema is common, read Chapters 2 and 3. Acne is seen everyday, read Chapter 7. Managing acne effectively will provide a great service to many young patients who are very uncomfortable with their appearance. The clinical diagnosis of pigmented lesions is complicated. Look at Chapters 20, 21, and 23. Don’t be afraid to ask for help. A dermatologist can often make a diagnosis without the need for a biopsy.
