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
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