itchy rash d. erichsen md. case 2 siblings, 16 and 13 y. o present with rash trunk > extremities,...

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