Pariser R J, Pariser D M
J Am Acad Dermatol. 1987 Aug;17(2 Pt 1):239-45. doi: 10.1016/s0190-9622(87)70198-4.
This study analyzes the errors made by primary care physicians in handling skin disorders in patients seen prospectively over a 20-month period in a dermatologic practice. There were 319 errors in 260 patients. Eighty-eight percent of the errors were in diagnosis. There was a striking tendency to overdiagnose infectious dermatoses such as bacterial pyodermas, superficial mycoses, scabies, and herpes simplex and to underdiagnose inflammatory dermatoses such as contact dermatitis, nummular dermatitis, pityriasis rosea, and psoriasis. In 218 cases (68%) the error probably could have been prevented if the following diagnostic criteria were considered mandatory: positive culture or potassium hydroxide preparation for dermatophytosis or candidiasis, positive Tzanck smear or viral culture for herpes simplex, zoster, or varicella, and demonstration of ectoparasite for scabies. These findings have implications for the medical education of primary care physicians and for the practitioner who handles cutaneous disorders.
本研究分析了在皮肤科诊所对前瞻性观察20个月的患者进行皮肤疾病诊治时，初级保健医生所犯的错误。260名患者中出现了319处错误。88%的错误在于诊断。存在一种明显的倾向，即对细菌性脓疱病、浅表真菌病、疥疮和单纯疱疹等感染性皮肤病过度诊断，而对接触性皮炎、钱币状皮炎、玫瑰糠疹和银屑病等炎症性皮肤病诊断不足。在218例（68%）病例中，如果将以下诊断标准视为强制性标准，错误可能本可避免：皮肤癣菌病或念珠菌病的培养阳性或氢氧化钾制剂阳性、单纯疱疹、带状疱疹或水痘的Tzanck涂片阳性或病毒培养阳性，以及疥疮的外寄生虫证明。这些发现对初级保健医生的医学教育以及处理皮肤疾病的从业者具有启示意义。
