GP Student Handbook Rashes Flashcards
Define a rash
A widespread skin eruption – it can include individual ‘lesions’
Important features of a rash
S L E E C
Colour - most rashes of white skin are pink/ red but can appear different in racially-pigmented skin
Surface features – normal, dry/moist, smooth/scaling.
Edge/border – level of definition
Evidence of ‘excoriation’ (trauma caused by scratching).
Lichenification – thickening of the skin, caused by rubbing/scratching.
Define lesion
Lesion = discrete area/s of altered skin, which can be single/multiple or a component of a rash.
5 different types of lesion
Papule Macule Plaque Blisters (bulla, vesicle, pustule) Weal
Define papule and examples of when found
small (<1 cm) ELEVATED solid palpable lesion
E.g.
many rashes including drug rashes, viral rashes, rosacea
Define macule and examples of when found
small (<1.5cm) NON-PALPABLE area of colour change
E.g.
many rashes including drug rashes, viral rashes
Define blister and examples of when found
Bulla: fluid-filled blister >0.5cm
Vesicle: fluid-filled blister <0.5cm
Pustule: pus-filled vesicle
E.g. burns/trauma herpes (simplex and varicella) acute eczema impetigo
Define wheal and examples of when found
localised oedema
E.g. Urticaria (Hives)
Define plaque and examples of when found
flat palpable lesion
e.g. psoriasis
What questions should be asked during a rash enquiry?
• Duration and temporal pattern.
When did the rash start? Is it consistent or variable? Has it evolved? Urticaria typically disappears from one site and reappears at another.
• Distribution.
Which areas of the body are affected? Don’t forget to ask about scalp, nails, mouth and genitalia. Psoriasis can affect scalp and nails.
• Is the rash itchy and/or painful?
Shingles is often painful.
• Are there systemic symptoms?
Viral rashes may be associated with fever.
• Previous similar episodes?
Eczema and urticaria commonly recur.
• Drug history.
Has the patient taken new medications? Drug rashes are common.
• Exposure.
Has there been recent exposure to chemicals, plants or ultraviolet light?
• Is there a similar rash in close contacts?
Scabies is contagious.
• Family history.
Atopic eczema and psoriasis are hereditary.
- Patients’ ideas of causation - may or may not be accurate: rashes are often wrongly attributed to washing powder.
- Patient’s concerns (i) cosmetic appearance, (ii) fear of contagion (iii) implication of poor hygiene.
What are the different forms of topical treatment used for rash treatment?
Topical preparations come in different forms – e.g.
cream (white, water-based)
ointment (greasy, oil-based)
lotion (liquid), and powder.
Dry skin conditions such as eczema respond better to ointments and emollients.
Scalp conditions might be treated with a lotion.
Actions of emollients in dry skin conditions
Reduce itch
Reduce need for potent topical treatments
Anti inflammatory action
What does atopic mean?
Atopy refers to the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma and atopic dermatitis (eczema). Atopy is typically associated with heightened immune responses to common allergens, especially inhaled allergens and food allergens.
Typical presentation of atopic eczema/dermatitis in GP?
Atopic eczema/dermatitis is a chronic inflammatory condition which usually presents in childhood and can persist into adulthood.
It is associated with other atopic conditions (asthma and allergic rhinitis).
In children, it usually affects the knee and elbow flexures while in adults the distribution is more variable.
Acute eczema is typically red, scaling, excoriated, and there may be ‘weeping’ (exudate). Secondary bacterial infection is common. In chronic eczema, skin may be lichenified.
Typical psoriasis presentation in GP?
Chronic condition which presents in early adulthood
Commonest type= Chronic plaque psoriasis, affecting..
- Extensor aspects of elbows and knees
- Scalp involvement
- Pitting of the nails
Typical acne presentation in GP?
Inflammatory conditions, presenting during puberty
Presents at: Forehead, nose and chin. Blackheads and white heads are pathognomonic
Typical urticaria presentation in GP?
Presents as: Acute rash in children, or uncommonly chronically in adults
Characterised by raised, red lesions (wheals) which are transient (i.e. individually the wheals come/go)
Typical rosacea presentation in GP?
Typically middle-aged women
Location: Face (*cheeks)
Characteristics: Flushing, background redness, telangectasia and papules
Typical pityriasis rosea presentation in GP?
Presentation: Generalised, slightly itchy rash of oval plaques at trunk. Starts with single “herald patch”
Typical yeast infection presentation in GP?
Common at all ages.
In babies, yeast (candida) infections can cause nappy rash.
In adults, ‘intertrigo’, is a common red, inflamed rash which occurs in moist areas (axillae and groins) and between skin folds (sub-mammary or between rolls of fat).
Persistent fungal or yeast infections should raise the suspicion of type 2 diabetes.
Typical fungal infections seen in GP?
Fungal infections (tinea) can affect the:
groins: tinea cruris
feet: tinea pedis (athlete’s foot)
nails: tinea unguium
body generally: tinea corporis (ringworm).
Persistent fungal or yeast infections should raise the suspicion of type 2 diabetes.
Typical scabies presentation in GP?
Causative agent: Sarcoptes scabeii mite (which burrows into skin). Skin-skin transmission
Presentation Rash on trunk and limbs
Results: Intense itching, worse at night
Typical shingles presentation in GP?
Shingles can affect anyone who has had chickenpox but mainly older adults. It is a very characteristic rash caused by reactivation of the Varicella zoster virus. Pain and itching is followed, after a few days, by lesions (papules, vesicles, pustules) in the distribution of a single dermatome.
Typical drug rashes presentation in GP?
Drug rashes are very common - they can result from prescribed as well as over-the-counter and alternative medications, and they can take many forms. GPs should be careful when prescribing, be alert to the possibility of drug rashes, and be prepared to stop medications on a trial basis.
