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Sin Rashes – Describing Skin Lesions & A Pot Pourri

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Presentation on theme: "Sin Rashes – Describing Skin Lesions & A Pot Pourri"— Presentation transcript:

1 Sin Rashes – Describing Skin Lesions & A Pot Pourri
Daniel L. Stulberg, MD Professor Dept of Family and Community Medicine NMAFP 2015

2 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

3 Description - Key Points
Color Raised/Palpable vs. Non-Palpable Distribution Primary characteristics Secondary characteristics 5mm – The usual cut off point Magnification if needed

4 Color - Erythematous

5 Color - Hypopigmented

6 Color - Hyperpigmented

7 Color - Ecchymotic

8 Blanching

9 Non Blanching Petechial < 5 mm Purpuric > 5 mm

10 Non-Palpable Macule < 5mm Patch >5 mm

11 Palpable Papular < 5mm Plaque >5 mm

12 Fluid Filled – Vesicles <5 mm

13 Fluid Filled – Bulla >5 mm

14 Large Ruptured Bulla

15 Fluid Filled – Pustules <5 mm

16 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

17 Atrophy What level? Epidermis Dermis Hypodermis = Subcutaneous

18 Atrophy – Epidermal and Dermal

19 Atrophy - Subcutaneous

20 Surface Characteristics
Scale Verrucous Excoriated Crust Hairy

21 Secondary Characteristics
What other features are present? What has happened to the lesions over time? Crusts / exudates Scale Excoriation – clue to itching Lichenification

22 Scale Fine Scale Waxy Scale

23 Crusts Honey colored – Impetiginized Can be bloody

24 Vesicle – Ruptured

25 Excoriated

26 Lichenified

27 Special Shapes

28 Shape Nummular - Coin shaped Linear Serpiginous - Snakelike
Annular – Bordered by a raised ring Reticular – Net like Umbilicated

29 Nummular

30 Linear

31 Serpiginous - Snakelike
Cutaneous larva migrans Courtesy Richard Usatine, MD

32 Annular

33 Reticular – Net like

34 Umbilicated

35 Margins Sharply demarcated Diffuse margin Coalescing

36 Sharply Demarcated

37 Diffuse Margins

38 Coalescing

39 Distribution Limited / Localized Diffuse Flexural Extensor Palmar
Axillary Truncal Acral Unilateral, Bilateral / Symmetric Crural / Intertriginous Dermatomal Photodistributed Clothing related

40 Limited / Localized

41 Diffuse

42 Flexor

43 Extensor

44 Palmar

45 Axillary

46 Truncal

47 Acral – Peripheral Parts

48 Unilateral Bilateral / Symmetric

49 Crural

50 Dermatomal

51 Photodistributed

52 Clothing Related

53 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

54 Diffuse erythematous scaly papular / guttate rash
Guttate psoriasis

55 Audience Turn! How would you describe this?

56 Localized geometric patch of hypopigmentation with sharp /discrete border

57 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

58 Rashes Usually occur in patterns Location important Description
Associated sx Old dog

59 4 yr Old With Rash Face then chest and arms
Nasal congestion and low fever Slight itch

60 Diagnosis?

61 Young Woman with Rash

62 Diagnosis?

63 Another Happy Child

64 Young Man with Localized Lesion

65 Boy with Localized Rash

66 Young Woman with Facial Rash

67 23 yr Old Woman Who Went Camping

68 Sick Teenager

69 Complications

70 Middle-Aged Woman with Red Spots

71 Mildly ill Infant with Rash

72 Geriatric Patient with Rash

73 Every Day in NM

74 Another Sick Patient Fevers/Chills Malaise
I feel like I was hit by a truck”

75 Febrile Child

76 Time Check/Questions Please contact us if you would like to teach our medical students in your practice!

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