Rash Flashcards
OSOCRATES
Open- describe the rash for me
Site- where is it
Onset- when/ how did it start (did you knock it)
Colour- what colour is it/ red and inflamed?
Radiation- is it just in that area or has it spread elsewhere
Associated features- itchy/ painful/ discharge/ burning or numbness/ does it disappear when you touch it
Timing- is it always there/ has it changed over time/ had this before
Exacerbation/ relief- what triggers it/ any new detergents or soaps/ anything make it better/ worse in the sun
Severity- how is it affecting day-to-day life
NB- if patient appears covered up/ has a hat on they may be hiding their rash (ask them to show you if they don’t mind etc.)
Systems Review- screening questions so if get a positive response, may require further questions of that system (don’t forget red flags)
Constitutional – FWAR and any nausea?
URTI/LRTI – Any recent infections? Recent cough with phlegm?
UTI – Any problems passing urine?
Meningitis – Any headache? Neck stiff ness? Photophobia?
Autoimmune – Do you suffer from pain in your joints or your back? Painfully cold hands? Dry eyes or mouth? Ulcers? Hair loss?
PMH
Any previous skin conditions/ investigations for a possible skin condition
FH
Ask about rashes, allergies and arthritis (ask about which one eg. psoriatic) eczema
SH
Job- do you come into contact with harmful chemicals/ do you wear gloves/ is it affecting job
Home- is it clean/ does anyone at home have the rash
Smoke alcohol recreational drugs
Purpuric Rash
Small purple raised spots on the skin that don’t blanch when pressed
Meningococcaemia Henoch-Schonlein purpura Vasculitis Leukaemia (and other haematological malignancies) NAI DIC (due to sepsis) ITP
Cellulitis
Well-demarcated erythematous rash, with swelling, warmth and tenderness
Usually localised, often on the legs. Th ere may be tracking, whereby the rash spreads along the routes of the lymphatics
Fever, tachycardia and malaise may be present
MAY CAUSE DELIRIUM IN OLDER ADULT
Patients perspective
How do you feel about it How has it impacted your life Do you have any ideas what may have caused it Concerns Expectations
DH
Any medications or OTC remedies
Any changes to medications in the last few months
Any allergies
Atopic eczema
Red exudative or scaly lesion often with vesicles
Usually on flexor surfaces face and neck favouring skin creases
Often very itchy (escoriation/ lichenification)
FH of atopy eg. Asthma hay fever or drug allergies
Psoriasis
Well demarcated red scaly plaques (chronic plaque psoriasis)- other forms do exist
Usually on extensor surfaces
FH often present
May be itchy and associated arthropathy and nail changes
Contact dermatitis
Similar in presentation to eczema but with an irritant or allergic aetiology
Commonly on hands and may be linked to occupation eg. Cleaner/ hairdresser
Seborrhoeic dermatitis
Scary greasy itchy rash that typically affects scalp and face (nasolabial folds/ eye brows/ eye lids)
Dandruff
In newborns= cradle cap
Viral induced rash
Most common maculo papular rash in children
Usually a preceding history of viral illness/ malaise
Rash balances when pressed and isn’t itchy or sore
Varicella zoster
Diffuse itchy painful vesicular and pustular lesions at different stages on development
Shingles presents in immunocompromised adults in dermatomal distribution
HZ ophthalmicus may occur in trigeminal nerve involvement
