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eyeglasses when outdoors and taping or patching the eye during sleep.
- Instill artificial tears several times throughout the day and viscous artificial tears (if available) at bedtime will
help keep the eye surface lubricated and free of debris. - Prednisone 60mg/day po with taper over 10 – 14 days for severe cases. Most young adults will make a
full recovery with no treatments. - For herpes zoster, give Acyclovir 800 mg po five times a day x 5 days.
Patient Education: Expect full recovery in several weeks. Protect the eye until able to close it fully.
No Improvement/Deterioration: Weakness may worsen during the first few days but then stabilize.
Return Evaluation: Evaluate patient once a week or until recovery is imminent.
Evacuation/Consultation Criteria: Refer to ophthalmology if signs of exposure keratitis develop. Refer to
neurology for gradual worsening (over several days to weeks), failure to improve by three months and/or
involvement of other parts of the nervous system.
Chapter 6: Skin
Introduction to Dermatology
MAJ Daniel Schissel, MC, USAClassical Elements of the Clinical Approach to Dermatologic Disease Diagnosis and DispositionSubjective:
Gather information just as in the approach to other organ systems, including skin symptoms like pain,
pruritis and paresthesia, and constitutional symptoms like fever.
Objective: Diagnose skin eruptions visually based on primary and secondary type, shape, arrangement,
and distribution of skin lesions. Always include a thorough evaluation of all the mucous membranes, hair
and nails.
I. Type of Skin Lesion (see Color Plates Picture 20)
a. Primary Lesions
i. Macule: A circumscribed area of change in normal skin color that is flat and less than 1 cm
in diameter. Example: freckles.
ii. Patch: A circumscribed area of change in normal skin color that is flat and > 1 cm in diameter.
Examples: café-au-lait spots, port-wine stains.
iii. Papule: A solid lesion, usually dome-shaped, <1 cm in diameter and elevated above the skin.
Examples: verrucae, molluscum contagiosum.
iv. Nodule: A solid lesion, usually dome-shaped, > 1 cm in diameter and elevated above the skin.
Examples: neurofibromas, xanthomas, and various benign and malignant growths.
v. Plaque: An elevation above the skin surface occupying a relatively large surface area in
comparison with its height. Frequently formed by a confluence of papules. Examples: lichen
simplex chronicus and psoriasis.
vi. Vesicle: A circumscribed, thin walled, elevated lesion < 1 cm in diameter and containing fluid.
Examples: herpes, dyshydrotic eczema, varicella, and contact dermatitis
vii. Bullae: A circumscribed, thin walled, elevated lesion > 1 cm in diameter and containing fluid.
Examples: burns, frostbite, pemphigus.
viii. Comedone: Retained secretions of horny material within the pilosebaceous follicle. Examples:
open (blackheads) and closed (whiteheads), the precursors of the papules, pustules, cysts and
nodules of acne.
ix. Pustule: A circumscribed elevation containing pus. Examples: sterile lesions as in pustular
psoriasis or bacterial as in acne and impetigo.
x. Cyst: A circumscribed, thick walled, slightly elevated lesion extending into the deep dermis and