Examples of these include classic discoid lupus, psoriasis, or a basal cell carcinoma. You only have to see a moose once to know it’s a moose and to easily identify another moose in the future. To the trained eye, some rashes have such distinct presentations that the diagnosis can be made “from the door.” These rashes are kind of like a moose.
#RASH DECISIONS MEANING SKIN#
These are categories of dermatologic disease morphology that suggest specific differential diagnoses.Īt right: An example of a vesiculobullous reaction pattern: erosions, vesicles, and bullae on skin (eg, pemphigus vulgaris). There has been a lack of skin of color representation in disease images for medical education for many years, but there are ongoing efforts by many to improve this.Īfter you’ve identified the primary lesion(s), salient secondary features, and noted lesion arrangement, etc., rashes can usually be categorized into what dermatologists call reaction patterns. It can be more subtle or dusky in dark skin. It’s important to note that erythema and purpura look different on skin of color. This indicates extravasation of red blood cells into the dermis, which can be from many etiologies including vasculitis. In contrast, purpura indicates a rash that does not blanch with pressure and is generally a darker purple color. To a dermatologist, erythematous communicates that the rash blanches with pressure. Micaceous scale of psoriasis, meaning it resembles mica that comes off in thin layersĮrythema has become synonymous with “red,” when in actuality there are various shades of erythema each with their own connotations.Flaky or “bran-like” such as pityriasis rosea.
When scale is seen, the pathology is generally in the epidermis. There are different types of scale, each suggesting different diagnoses. Retained keratin/stratum corneum on the skin. So, let’s start with some definitions you probably were exposed to briefly during your medical training. A rash of scaly papules and plaques has a completely different differential than a rash of vesicles and erosions. If you’ve correctly described a rash then you’ve identified the morphologic features that allow you to build a differential diagnosis.
#RASH DECISIONS MEANING HOW TO#
This reality is why learning how to observe the salient features of a rash and describe them is so critical. While history still matters in dermatology, for most skin disease it is secondary to the physical exam in discerning the diagnosis. In medical school, the history is emphasized as an all-important tool and the first step of any patient encounter. What follows here is meant to provide insight into how dermatologists think and arrive at specific diagnoses. While skin disease is very common, those adept at diagnosing skin disease are not. This dearth of dermatology exposure in general medical education, combined with the relatively small number of dermatologists, leads to an unfortunate reality. Consequently, it is a skill few clinicians outside of dermatology acquire. Despite this, learning to observe and describe a rash gets little emphasis in general medical education. Imagine a medicine resident shrugging and saying, “All EKGs look the same to me.” While this sounds ridiculous, the phrase “all rashes look the same to me” is frequently uttered by non-dermatologist clinicians at all levels of experience.īut to the trained eye, all rashes don’t look the same. This blog post is based on a webinar hosted by David Harker, MD.
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