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Published byDestin Maury Modified over 9 years ago
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Sin Rashes – Describing Skin Lesions & A Pot Pourri
Daniel L. Stulberg, MD Professor Dept of Family and Community Medicine NMAFP 2015
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Learning Objectives The learner will know how to accurately describe common rashes The learner will recognize patterns in rashes and the associated diseases The learner will know several risk factors and causes for common rashes
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Description - Key Points
Color Raised/Palpable vs. Non-Palpable Distribution Primary characteristics Secondary characteristics 5mm – The usual cut off point Magnification if needed
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Color - Erythematous
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Color - Hypopigmented
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Color - Hyperpigmented
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Color - Ecchymotic
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Blanching
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Non Blanching Petechial < 5 mm Purpuric > 5 mm
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Non-Palpable Macule < 5mm Patch >5 mm
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Palpable Papular < 5mm Plaque >5 mm
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Fluid Filled – Vesicles <5 mm
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Fluid Filled – Bulla >5 mm
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Large Ruptured Bulla
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Fluid Filled – Pustules <5 mm
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EBM Bullous and Non-Bullous Impetigo are currently predominantly caused by Staph Dynamed – AAFP reviewed Web Resource - Systematic review of the medical literature Accessed 3/5/2008
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Atrophy What level? Epidermis Dermis Hypodermis = Subcutaneous
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Atrophy – Epidermal and Dermal
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Atrophy - Subcutaneous
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Surface Characteristics
Scale Verrucous Excoriated Crust Hairy
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Secondary Characteristics
What other features are present? What has happened to the lesions over time? Crusts / exudates Scale Excoriation – clue to itching Lichenification
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Scale Fine Scale Waxy Scale
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Crusts Honey colored – Impetiginized Can be bloody
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Vesicle – Ruptured
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Excoriated
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Lichenified
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Special Shapes
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Shape Nummular - Coin shaped Linear Serpiginous - Snakelike
Annular – Bordered by a raised ring Reticular – Net like Umbilicated
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Nummular
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Linear
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Serpiginous - Snakelike
Cutaneous larva migrans Courtesy Richard Usatine, MD
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Annular
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Reticular – Net like
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Umbilicated
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Margins Sharply demarcated Diffuse margin Coalescing
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Sharply Demarcated
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Diffuse Margins
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Coalescing
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Distribution Limited / Localized Diffuse Flexural Extensor Palmar
Axillary Truncal Acral Unilateral, Bilateral / Symmetric Crural / Intertriginous Dermatomal Photodistributed Clothing related
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Limited / Localized
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Diffuse
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Flexor
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Extensor
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Palmar
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Axillary
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Truncal
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Acral – Peripheral Parts
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Unilateral Bilateral / Symmetric
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Crural
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Dermatomal
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Photodistributed
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Clothing Related
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Now…Close your eyes Let’s see what your mind can picture as I describe this next photo. Diffuse erythematous papular (<5mm) guttate (drop-like in Latin) rash with silvery scale History, had recent pharyngitis not necessarily strep
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Diffuse erythematous scaly papular / guttate rash
Guttate psoriasis
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Audience Turn! How would you describe this?
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Localized geometric patch of hypopigmentation with sharp /discrete border
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Resources Clinical Dermatology Fifth Edition Habif, Thomas. Mosby, List of disorders based on body location List of disorders based on clinical appearance Differential Diagnosis in Dermatology Ashton, Richard. Radcliffe Medical Press Flow sheets to aid in diagnosis based on body location, appearance and symptoms
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Rashes Usually occur in patterns Location important Description
Associated sx Old dog
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4 yr Old With Rash Face then chest and arms
Nasal congestion and low fever Slight itch
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Diagnosis?
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Young Woman with Rash
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Diagnosis?
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Another Happy Child
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Young Man with Localized Lesion
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Boy with Localized Rash
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Young Woman with Facial Rash
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23 yr Old Woman Who Went Camping
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Sick Teenager
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Complications
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Middle-Aged Woman with Red Spots
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Mildly ill Infant with Rash
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Geriatric Patient with Rash
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Every Day in NM
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Another Sick Patient Fevers/Chills Malaise
I feel like I was hit by a truck”
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Febrile Child
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Time Check/Questions Please contact us if you would like to teach our medical students in your practice!
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