Rash Flashcards
1
Q
Differentials of Rash
A
- Herpes zoster*
- Urticaria*
- ITP*
- Allergic - contact or atopic dermatitis
- Varicella
- Measles
- Rubella
- Impetigo
- Cancer - Leukemia, lymphoma
- Scabies
- Psoriasis
- HSP
- Meningococcemia
- HIV
- EBV
2
Q
Rash - Key points in history
A
- Should be adapted to patient’s age as viral exanthema common in children.
- Site and mode of onset of rash, mode of progression and past history (e.g. eczema).
- Constitutional disturbance (e.g. pyrexia, pruritus).
- Drug history and exposure to irritants.
- Diet including unaccustomed food.
- Herald patch (pityriasis rosea).
- Contact with infectious diseases including child carecentres and school.
- Overseas travel.
- Bleeding or bruising tendency.
3
Q
Rash - Key points in PE
A
Skin of whole body
•Nature and distribution of the rash including lesion characteristics
•Nails and soles of feet
•Scalp, mucous membranes and oropharynx
•Conjunctivae and the lymphopoietic system (?lymphadenopathy, ?splenomegaly)
4
Q
Rash - Key investigations
A
Many diagnoses are clinical. Consider: •FBE/ESR/CRP •EBV test •HIV test •serology for rubella, parvovirus, syphilis and other suspected infections •viral and bacterial cultures.
5
Q
Rash - Diagnostic tip
A
Be vigilant for the deadly meningococcal septicaemia, which may present as an erythematous rash initially prior to the development of purpura. •Prescribed drugs are a common cause of rash, especially toxic erythema. Examples are 1. antibiotics, especially penicillin, 2. thiazides, 3. anti-epileptics, 4. allopurinol, 5. NSAIDs and other 6. anti-arthritic agents