Difference between revisions of "General approach to rashes"

(Background)
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''This page is for adult patients; for other age groups see [[pediatric rashes]] and [[neonatal rashes]]''
 
==Background==
 
==Background==
===Types===
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[[File:3D medical animation skin layers.jpg|thumb|3D medical illustration showing major layers of skin]]
*Plaque/scaley papule
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*A wide range of benign and dangerous pathology can present with a rash
*Eschar
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*Erosion/ulcer
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{{Rash red flags}}
*Purpura/petechia
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{{Primary derm lesions names}}
*Plaque/smooth papule
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*Flat/macular
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==Clinical Features==
*Erythema
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===History===
*Vesicular/pustular
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*Key elements from the history include:
 +
**Distribution and progression of the skin lesions
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**Recent exposures (sick contacts, foreign travel, sexual history and vaccination status)
 +
**Any new medications
 +
 
 +
===Physical Exam===
 +
*Pay specific attention to vital signs
 +
**A rash associated with fever or hypotension should make you worry about potentially deadly diagnoses
 +
*Perform a careful physical exam
 +
**Undressing the patient to fully examine the trunk and the extremities
 +
**Look at palms, soles and mucous membranes
 +
**Touch the skin with a gloved hand to determine if the lesions are flat or raised
 +
**Press on lesions to see whether they blanch
 +
**Rub erythematous skin to see if it sloughs
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{Generalized rash DDX}}
 
{{Generalized rash DDX}}
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{{Bullous rashes DDX}}
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{{Necrotizing Rashes DDX}}
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{{Purpura DDX}}
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{{Erythematous rash DDX}}
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{{DDX dark raised lesions}}
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==Evaluation==
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[[File:Dermatologic Emergencies.png|1500px|Algorithm for the Evaluation of Dermatologic Emergencies]]
 
{{General rashes images}}
 
{{General rashes images}}
 +
{{Erythematous rashes images}}
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{{Bullous rashes images}}
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{{Dark raised skin lesions images}}
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 +
==Management==
 +
*Based on diagnosis
 +
 +
==Disposition==
 +
*Based on diagnosis
  
 
==See Also==
 
==See Also==
*[[Fever and Rash]]
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*[[Fever and rash]]
*[[Pediatric Rashes]]
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*[[Pediatric rashes]]
 
*[[Visual diagnosis (main)]]
 
*[[Visual diagnosis (main)]]
 
*[[Ulcerative STDs]]
 
*[[Ulcerative STDs]]
 +
*[[Dermatologic nomenclature]]
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*[[Pigmented rashes]]
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*[[Rashes of pregnancy]]
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 +
==External Links==
 +
*[http://www.emdocs.net/9009-2/ EMDOCS: What's that rash? An approach to dangerous rashes based on morphology.]
 +
 +
==References==
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<references/>
  
[[Category:Derm]]
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[[Category:Dermatology]]
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[[Category:Symptoms]]

Latest revision as of 23:06, 9 September 2020

This page is for adult patients; for other age groups see pediatric rashes and neonatal rashes

Background

3D medical illustration showing major layers of skin
  • A wide range of benign and dangerous pathology can present with a rash

Rash Red Flags[1]

Dermatology Nomenclature

Small lesions (<0.5cm)

Name Raised/Palpable Fluid-Filled Other Description Diagram
Macule No None flat, cirumscribed, colored Macule.png
Papule Yes None Solid Papule.png
Vesicle Yes Clear Vesicles (2).png
Pustule Yes Pus Leukocytes or keratin Pustules.png

Large lesions (>0.5cm)

Name Raised/Palpable Fluid-Filled Other Description Diagram
Patch No None Large macule (flat, colored) Patch.png
Plaque Yes None Superficially raised, circumscribed solid area Plaque.png
Nodule Yes None Distinct large papule Nodules.png.png
Bulla Yes Clear Large vesicle/blister or exposed epidermal layer Bulla.png
Wheal Yes Edema Firm and edema of dermis

Other

Ulcer, fissue, and erosion
  • Plaque/scaley papule
  • Eschar
  • Fissure/erosion/ulcer
  • Purpura/petechia
  • Plaque/smooth papule

Clinical Features

History

  • Key elements from the history include:
    • Distribution and progression of the skin lesions
    • Recent exposures (sick contacts, foreign travel, sexual history and vaccination status)
    • Any new medications

Physical Exam

  • Pay specific attention to vital signs
    • A rash associated with fever or hypotension should make you worry about potentially deadly diagnoses
  • Perform a careful physical exam
    • Undressing the patient to fully examine the trunk and the extremities
    • Look at palms, soles and mucous membranes
    • Touch the skin with a gloved hand to determine if the lesions are flat or raised
    • Press on lesions to see whether they blanch
    • Rub erythematous skin to see if it sloughs

Differential Diagnosis

Rash

Vesiculobullous rashes

Febrile

Afebrile

Necrotizing rashes

Petechiae/Purpura (by cause)

Erythematous rash

Dark raised skin lesions

Evaluation

Algorithm for the Evaluation of Dermatologic Emergencies

Rash visual diagnosis

Erythematous rash

Vesiculobullous rashes visual diagnosis

Dark raised skin lesions

Management

  • Based on diagnosis

Disposition

  • Based on diagnosis

See Also

External Links

References

  1. Nguyen T and Freedman J. Dermatologic Emergencies: Diagnosing and Managing Life-Threatening Rashes. Emergency Medicine Practice. September 2002 volume 4 no 9.