General approach to rashes

Revision as of 12:46, 28 July 2016 by Rossdonaldson1 (talk | contribs) (=History)

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

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 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)

Evaluation

Rash visual diagnosis

Vesiculobullous rashes visual diagnosis

Management

Disposition

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.