Paediatrics: Dermatology Assessment of a rash

Dermatology

Assessment of a rash

History

•   When did the rash start?

•   Where did the rash start?

•   Any exacerbating or relieving factors?

•   Is it itchy?

•   Any contacts with patients with the same rash?

•   General drug history?

•   Recent medications or skin treatments?

•   Past medical history?

•   Family history?

·  Any recent foreign travel?

Examination

•   Undress child and inspect all the skin.

•   Describe p lesion morphology:

•   macule—flat circumscribed lesion <1cm diameter;

•   papule—raised palpable circumscribed lesion <1cm diameter;

•   nodule—palpable mass >1cm diameter;

•   plaque-like—large disc-shaped lesion;

•   vesicle—blister containing clear fluid <0.5cm diameter;

•   bulla—blister containing clear fluid >0.5cm diameter;

•   pustule—visible blister containing pus;

•   erythematous—blanching and red;

•   purpura—red-purple non-blanching discoloration of the skin due to extravasation of red cells;

•   petechia—purpuric lesions <2mm diameter;

•   telangiectasia—permanently dilated visible small blood vessels that blanch on pressure;

•   wheal—raised, itchy, white papule surrounded by red flare;

•   scaly.

•   Describe distribution of p lesion, e.g. diffusely scattered, linear.

•   Look for and describe:

•   s changes, e.g. excoriation (scratch marks);

•   pigmentation;

•   scarring;

•   atrophy (thinning of the skin);

•   lichenification (skin thickening);

•   sclerosis (induration of skin, often due to increased collagen production);

•   erosion (partial thickness loss of epidermis);

•   ulceration (full thickness loss of epidermis and possibly dermis); crusting (due to dried exudates).

•   Palpate: may be impalpable, hard, firm, soft, tender, hot. If lesion is red, test if it blanches on pressure.

General examination: taking care to examine nails, scalp, and mouth.