Difference between revisions of "General approach to rashes"
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''This page is for adult patients; for other age groups see [[pediatric rashes]] and [[neonatal rashes]]'' | ''This page is for adult patients; for other age groups see [[pediatric rashes]] and [[neonatal rashes]]'' | ||
==Background== | ==Background== | ||
+ | [[File:3D medical animation skin layers.jpg|thumb|3D medical illustration showing major layers of skin]] | ||
*A wide range of benign and dangerous pathology can present with a rash | *A wide range of benign and dangerous pathology can present with a rash | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Generalized rash DDX}} | {{Generalized rash DDX}} | ||
{{Bullous rashes DDX}} | {{Bullous rashes DDX}} | ||
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{{Purpura DDX}} | {{Purpura DDX}} | ||
{{Erythematous rash DDX}} | {{Erythematous rash DDX}} | ||
+ | {{DDX dark raised lesions}} | ||
==Evaluation== | ==Evaluation== | ||
+ | [[File:Dermatologic Emergencies.png|1500px|Algorithm for the Evaluation of Dermatologic Emergencies]] | ||
{{General rashes images}} | {{General rashes images}} | ||
+ | {{Erythematous rashes images}} | ||
{{Bullous rashes images}} | {{Bullous rashes images}} | ||
+ | {{Dark raised skin lesions images}} | ||
==Management== | ==Management== | ||
+ | *Based on diagnosis | ||
==Disposition== | ==Disposition== | ||
+ | *Based on diagnosis | ||
==See Also== | ==See Also== | ||
− | *[[Fever and | + | *[[Fever and rash]] |
− | *[[Pediatric | + | *[[Pediatric rashes]] |
*[[Visual diagnosis (main)]] | *[[Visual diagnosis (main)]] | ||
*[[Ulcerative STDs]] | *[[Ulcerative STDs]] | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
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[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Symptoms]] | [[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
Contents
Background
- A wide range of benign and dangerous pathology can present with a rash
Rash Red Flags[1]
- Fever
- Toxic appearance
- Hypotension
- Mucosal lesions
- Severe pain
- Very old or young age
- Immunosuppressed
- New medication
Dermatology Nomenclature
Small lesions (<0.5cm)
Name | Raised/Palpable | Fluid-Filled | Other Description | Diagram |
Macule | No | None | flat, cirumscribed, colored | ![]() |
Papule | Yes | None | Solid | ![]() |
Vesicle | Yes | Clear | ![]() | |
Pustule | Yes | Pus | Leukocytes or keratin | ![]() |
Large lesions (>0.5cm)
Other
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
- Acute generalized exanthematous pustulosis
- Allergic reaction
- Aphthous stomatitis
- Atopic dermatitis
- Chickenpox
- Chikungunya
- Coxsackie
- Dermatitis herpetiformis
- Erysipelas
- Exfoliative erythroderma
- Impetigo
- Measles
- Miliaria (Heat Rash)
- Necrotizing fasciitis
- Pellagra
- Poison Oak, Ivy, Sumac
- Psoriasis
- Pityriasis rosea
- Scabies
- Seborrheic dermatitis
- Serum Sickness
- Smallpox
- Shingles
- Tinea capitus
- Tinea corporis
- Vitiligo
Vesiculobullous rashes
Febrile
- Diffuse distribution
- Varicella
- Smallpox
- Disseminated gonococcal disease
- DIC
- Purpural fulminans
- Localized distribution
Afebrile
- Diffuse distribution
- Bullous pemphigoid
- Drug-Induced bullous disorders
- Pemphigus vulgaris
- Phytophotodermatitis
- Erythema multiforme major
- Bullous impetigo
- Localized distribution
Necrotizing rashes
- Necrotizing soft tissue infections
- Purpura fulminans
- Drug rash
- Levamisole toxicity
- Heparin-induced skin necrosis
- Warfarin-induced skin necrosis
Petechiae/Purpura (by cause)
- Abnormal platelet count and/or coagulation
- Septicemia
- Idiopathic thrombocytopenic purpura (ITP)
- Hemolytic uremic syndrome
- Leukemia
- Coagulopathies (e.g. hemophilia)
- Henoch-Schonlein Purpura (HSP)
- Acute hemorrhagic edema of infancy (AHEI)
- Hypersensitivity vasculitis
- Primary vasculitides
- Wegener's
- Microscopic polyangiitis
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
- Secondary vasculitides
- Trauma
Erythematous rash
- Positive Nikolsky’s sign
- Febrile
- Staphylococcal scalded skin syndrome (children)
- Toxic epidermal necrolysis/SJS (adults)
- Afebrile
- Febrile
- Negative Nikolsky’s sign
Dark raised skin lesions
Evaluation
Rash visual diagnosis
Poison ivy/Oak/Sumac
Poison ivy/Oak/Sumac
Psoriasis before and after treatment.
Erythematous rash
Vesiculobullous rashes visual diagnosis
Bullous impetigo (after the bulla have broken)
Dark raised skin lesions
Management
- Based on diagnosis
Disposition
- Based on diagnosis
See Also
- Fever and rash
- Pediatric rashes
- Visual diagnosis (main)
- Ulcerative STDs
- Dermatologic nomenclature
- Pigmented rashes
- Rashes of pregnancy
External Links
References
- ↑ Nguyen T and Freedman J. Dermatologic Emergencies: Diagnosing and Managing Life-Threatening Rashes. Emergency Medicine Practice. September 2002 volume 4 no 9.