Q: What tests should I take if I have skin problems?

People with any skin issue are often advised to “get some tests done.” In this context, “getting tests done” seems almost mystical, as if solving skin problems is impossible without them, and these problems are inevitably rooted in internal organ issues. If you have acne – get a full hormone panel, dark circles under your eyes – check liver function, rosacea – time for a complete blood biochemistry. However, if you look into medical standards for diagnosing skin diseases, you will (surprise!) find very few blood tests. It’s important to note that this doesn’t apply to all diseases, and sometimes tests are necessary – this is determined by the doctor.

Acne

The first line in acne diagnosis standards states that the diagnosis is made based on a medical examination and history taking. The dermatologist identifies the type of lesions, their quantity, and location, asks about your family history and associated conditions, and then selects a treatment. But there are two exceptions:

1. People with signs of hyperandrogenism: Irregular menstrual cycles and increased hair growth in women, acne appearing in children under six, hair loss, and voice changes in prepubescent boys. In such cases, hormone tests and additional endocrine studies may be prescribed.
2. People with severe, “angry” forms of acne (acne fulminans): This is characterized by multiple cysts, abscesses, and sores. A complete biochemical blood test, liver function tests, C-reactive protein and ESR, serum cholesterol, and triglycerides may be ordered, and in some cases, even an X-ray (to exclude systemic diseases).

Rosacea

This diagnosis is also made after a skin examination and history taking. Rosacea is characterized by persistent erythema (redness), papules, pustules, and skin dryness. Ophthalmological symptoms like dryness, burning, and discomfort in the eyes often accompany it. In very rare cases, a skin biopsy may be needed to rule out another diagnosis or confirm granulomatous rosacea. Blood tests are not required for this skin condition.

Melasma (Pigmentation)

Here too, the diagnosis is made by a dermatologist after a simple skin examination. Sometimes, a procedure called dermatoscopy is performed to clarify the depth of the pigment. This is an instrumental research method also used for early diagnosis of malignant moles.

In general, the principle is clear: For the vast majority of skin diseases and conditions, tests are not prescribed unless the doctor has serious reasons to suspect a more severe, systemic disease. The skin is an organ like any other and can “suffer” from its own diseases.