Palpation of the skin--an important issue

A common concept is that dermatologists look at a rash, lesion, or even a photograph, and make an instant diagnosis. This can be true, but a clinical history, other sensory modalities, examination of other sites and supporting tests (biopsy, patch tests, etc.) may all be required to make a diagnosis and management plan. An experienced dermatologist typically touches lesions and rashes to accumulate extra information, a striking difference from new students, who rarely do so unless specifically instructed. This article concentrates on palpation, and specifically on quality of scaling, as an additional component of the examination of skin.