I’ve Got You Under My Skin: The Impairment Physical Exam

29 November 2011 / Impairment Physical Exam / Comments Off on I’ve Got You Under My Skin: The Impairment Physical Exam

In honor of my wife, who is a California QME Occupational dermatologist, a few comments on skin impairment rating exams are indicated here. The skin exam an important and frequent focus of impairment rating in a general impairment practice. The area examined needs to be clearly communicated to the reader as to the extent and scope performed.

I especially favor descriptions such as face, upper trunk, waist up, or total body skin screening. Included in the description should be the type of skin (Type 1 (light)-4 (dark)), the amount of photo damage, the hair and eye color, surgical repair scars, actinic damage, and basic descriptors of lesions such as “pigmented”, “raised”, “ulcerated”, “blistered”, “scale”, “erythema” or “vascular mat or telangectasia” are just a few of my favorites.

Plaques or papules can be used to describe raised lesions. The measurement of the lesion or field can be recorded by cm, mm, or percent of body surface area (%BSA). A simple rule of thumb I like is 1% BSA is roughly equal to the size of a hand. When appropriate, include the quality of the hair and nails, moisture patterns, and hair distribution loss which are important findings in many systemic disease processes such as psoriasis, iron deficiency, or autoimmune reactions.

Remember, a careful skin and nail examination is also critical in the evaluation of chronic regional pain syndrome (See page 496, Table 16-16, Chapter 16, The Upper Extremities, AMA Guides 5th Edition, AMA Press, 2004 for diagnostic criteria).

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