Dermatology
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;
•
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.
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