Itchy Rash D. Erichsen MD
Jan 13, 2016
Itchy RashD. Erichsen MD
Case• 2 siblings, 16 and 13
y. o present with rash• Trunk > extremities,
face spared• Itch started
immediately after swimming
• Rash after 1 day• ROS negative
Case
• Pmhx: none• Meds: benadryl prn. only• No previous episodes• No other sick contacts
Case presentation
• Nomenclature• Differential• Case discussion
Nomenclature
• Lesion– A lesion is any single area of altered skin.
It may be solitary or multiple.
• Rash– A rash is a widespread eruption of lesions.
• The rules– A description and picture of an example of
a dermatological term will be provided– You have one guess– Each participant has 2 lifelines
• You may ask anyone in the room once excluding myself and the chief resident
• You may ask for a clue once
Descriptive term?
• Round (coin-shaped) lesions. Also known as discoid.
Nummular lesion
• Round (coin-shaped) lesions. Also known as discoid.
Descriptive term?
• A straight shape to a lesion often occurs for some external reason such as scratching. Also striate.
Linear lesion
• A straight shape to a lesion often occurs for some external reason such as scratching. Also striate.
Descriptive term?
• Concentric rings like a dartboard. Also known as iris lesion.
Target lesion
• Concentric rings like a dartboard. Also known as iris lesion.
Descriptive term?
• Lesions grouped in a circle.
Annular lesion
• Lesions grouped in a circle.
Dermatological term?
• An area of color change less than 1.5 cm diameter.
• The surface is smooth.
Macule
• A macule is an area of color change less than 1.5 cm diameter.
• The surface is smooth.
Dermatological term?
• A large area of color change, with smooth surface.
Patch
• A patch is a large area of color change, with smooth surface.
Dermatological term?
• Small palpable lesions. Less than 0.5 cm diameter, although some authors allow up to 1.5 cm. Raised above the skin surface, and may be solitary or multiple.
Papule
• Small palpable lesions. Less than 0.5 cm diameter, although some authors allow up to 1.5 cm. Raised above the skin surface, and may be solitary or multiple.
Dermatological term?
• An enlargement of a papule in three dimensions (height, width, length). It is a solid lesion.
Nodule
• An enlargement of a papule in three dimensions (height, width, length). It is a solid lesion.
Dermatological term?
• A purulent vesicle. It is filled with neutrophils, and may be white, or yellow. Not all are infected.
Pustule
• A purulent vesicle. It is filled with neutrophils, and may be white, or yellow. Not all are infected.
Dermatological term?
• A large fluid-filled blister. It may be a single compartment or multiloculated.
Bulla(e)
• A large fluid-filled blister. It may be a single compartment or multiloculated.
Dermatological term?
• A localised collection of pus.
Abscess
• A localised collection of pus.
Dermatological term?
• An oedematous papule or plaque caused by swelling in the dermis. Often indicates urticaria.
Weal
• An oedematous papule or plaque caused by swelling in the dermis. Often indicates urticaria.
Dermatological term?
• Change in skin caused by chronic rubbing, which results in palpably thickened skin with increased skin markings.
Lichenification
• Change in skin caused by chronic rubbing, which results in palpably thickened skin with increased skin markings.
Dermatological term?
• Occurs when plasma exudes through an eroded epidermis. It is rough on the surface and is yellow or brown in colour.
Crust
• Occurs when plasma exudes through an eroded epidermis. It is rough on the surface and is yellow or brown in colour.
Dermatological term?
• A scratch mark. It may be linear or a picked scratch (prurigo). May occur in the absence of a primary dermatosis.
Excoriation
• A scratch mark. It may be linear or a picked scratch (prurigo). May occur in the absence of a primary dermatosis.
Differential
• Skeeter syndrome• Insect bites• Scabies
Skeeter Syndrome
• IgE mediated allergic skin reaction to mosquito saliva.
• Young children, immuno-compromised and visitors at increased risk.
• Difficult to distinguish from cellulitis.– Develops within hours
• Benign– Topical hydrocortisone– Bacitracin– Benadryl
Insect bites
• Can cause similar local reactions• Diagnosis of exclusion• Treatment similar to Skeeter Syndrome
Scabies