Value of Whole Skin Examination in Older Children Presenting With Skin Conditions

Medical teaching has always emphasized the importance of a good history and a complete medical examination. Missing some areas of examination can lead to errors in diagnosis and management and to adverse outcomes. At the same time, factors including time pressures, medicolegal concerns, and the desire to avoid embarrassment for patients have led to many practitioners routinely bypassing genital and/or breast examination.

This study is a prospective audit of examination findings in patients attending their first appointment at a consultant pediatric dermatology clinic.

Data were collected on 221 adolescents, and 46 (20%) of them had unexpected findings on skin during genital and/or breast examination. These findings were not mentioned in history and were sufficient to change the management plan in some way. In 24 cases (10%), the change in plan involved a changed prescription and/or identification of a new problem requiring ongoing management. These findings included eczema, psoriasis, new moles, molluscum, vitiligo, severe phimosis, hidradenitis, and acanthosis nigricans.

During history taking, anogenital pathology is often not revealed by the adolescent or the family. Inspection of the anogenital area may be of value in optimizing the medical management plan for an adolescent. Reasons for examination should be explained and the exam performed respectfully with discretion.