By Mary Jo Goolsby, Laurie Grubbs
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Additional resources for Advanced Assessment-Interpreting Findings and Formulating Different Diagnosis
The lesion is usually isolated, although multiple sites are possible. The lesion emerges as a ﬁrm, tender, reddened nodule, usually along the anterior aspect of the leg, although other sites can be involved. Over a period of up to 2 weeks, the lesion fades in color and the degree of ﬁrmness decreases. Diagnostic Studies. The ESR is often elevated. Chest x-ray may reveal ﬁndings consistent with sarcoidosis or another chronic condition (performed only after pregnancy is excluded). PSORIASIS (PLATE 22) Psoriasis is a chronic condition that affects the skin and is associated with arthritis.
Diagnostic Studies. If performed, speciﬁc histopathologic features identiﬁed. SECONDARY SYPHILIS Secondary syphilis is commonly referred to as the “great imitator” because the associated skin lesions can have a variety of presentations and appearances. The condition is caused by infection with Treponema pallidum. The onset of the rash associated with secondary syphilis occurs weeks to months following the primary lesion. Signs and Symptoms. The patient may provide the history of a more generalized rash developing two or more weeks following the primary lesion.
Diagnostic studies are typically not warranted or ordered. Deﬁnitive diagnosis can be made by viral culture of the lesion and Tzanck smear. VARICELLA (PLATE 29) The varicella-zoster virus causes chickenpox, which is considered a common childhood disease. Owing to the recent introduction of chickenpox vaccine, the incidence of chickenpox/varicella is decreasing. Signs and Symptoms. The onset of the condition often is evident only when the characteristic skin lesions appear, although some patients describe a brief prodromal period of malaise and fever.