SKIN DISCHARGE

SKIN DISCHARGE: Excerpt from Differential Diagnosis in Primary Care

The differential diagnosis of a weeping skin lesion is covered in the section on rash (see page 446), but certain conditions should be mentioned here. In all nonbloody discharges, infection (usually bacterial) is the most prominent etiology; Staphylococcus and Streptococcus organisms are the most common offenders in the skin. In working up from the smallest organism to the largest, however, one will not forget the weeping blisters of herpes zoster and simplex, smallpox, and chickenpox; the ulcers and bullae of syphilis; the draining sinuses and ulcers of actinomycosis, sporotrichosis, and other cutaneous mycosis; and the weeping ulcers of cutaneous leishmaniasis and amebiasis cutis. There are many more—but decidedly rare—infections in all these categories. By recalling the anatomy of the skin, the infected hair follicles and sebaceous cysts (furunculosis and carbuncles), infected apocrine glands (hidradenitis suppurativa), and inflamed sweat glands (milariasis) come to mind.

Finally, using the mnemonic VITAMIN one will recall the following:

1. V—Vascular conditions of the skin like postphlebitic ulcers that cause a discharge
2. I—Inflammatory conditions of a noninfectious nature like erythema multiforme, pyoderma gangrenosum, and pemphigus that produce weeping. Specific infections are listed above.
3. T—Traumatic conditions such as third-degree burns
4. A—Autoimmune and allergic disorders associated with weeping vesicles and ulcers, such as periarteritis nodosa and contact dermatitis
5. M—Malformations such as bronchial clefts and urachal sinus tracts
6. I—Intoxicating lesions such as a vesicular or bullous drug eruption
7. N—Neoplasms such as basal cell carcinoma and mycosis fungoides that produce weeping ulcers

Approach to the Diagnosis

Smear and culture of the lesion are most important, although a skin biopsy is sometimes necessary. Serologic tests or cultures on special media are necessary to diagnose fungi and parasites.

Other Useful Tests

1. CBC (systemic infection)
2. Sedimentation rate (systemic infection, collagen disease)
3. Tuberculin test
4. VDRL test (primary or secondary syphilis)
5. X-ray of area involved (abscess, osteomyelitis)
6. ANA analysis (collagen disease)
7. Skin test and serology for fungi
8. Biopsy
9. Muscle biopsy (collagen disease, trichinosis)

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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