Neurology and the skin

As knowledge of pathophysiology grows, so does the refinement of diagnoses. Sometimes increased knowledge permits consolidation and unification. Unfortunately, at our present level of understanding, it usually demands proliferation of diagnostic categories. As tedious as this diagnostic splintering may seem, such is the price currently exacted of both the investigator and the clinician who seek to optimise management. Increased diagnostic refinement often requires inquiry into matters outside the bounds of one's specialty. Most often we turn to the radiologist or to the laboratory to narrow the differential diagnosis generated from the history and neurological examination. As we have shown, a useful intermediate step is extension of the physical examination to organs such as the skin, which are not the traditional preserve of the neurologist. That any text could confer the sophistication required for expert dermatological diagnosis is an unrealistic expectation. However, we hope that this review will encourage careful examination of the skin, hair, and nails by the neurological practitioner, with consideration of referral to a dermatologist when greater expertise is required.