Assessment of a rash
• 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?
• 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;
• Describe distribution of p lesion, e.g. diffusely scattered, linear.
• Look for and describe:
• s changes, e.g. excoriation (scratch marks);
• 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.