INTRODUCTION & GENERAL CONSIDERATIONS
Although the title of this chapter is Dermatologic Emergencies, patients with rashes who make their way to the emergency department although certainly dermatologic, almost never present as emergencies. Few rashes are emergent; however, emergency physicians will never be without a steady stream of rashes in their examination rooms and should have a working knowledge of the most common rashes. It is important to identify if the rash is emergent, indicative of an emergent process, or requiring specific treatment.
As with any complaint that presents to the emergency department, it is important to first assess the patient’s airway, breathing, and circulation (ABC). After initial assessment, a full history and physical will provide the most useful information to make a diagnosis.
A thorough history should be performed including exposure to foods, chemicals, animals, plants, medications, insects, immunizations, toxins, and sick contacts. Attention should be paid to medications, allergies, past medical history (especially history of the same or similar rash in the past), social history, and sexual history. Associated symptoms should be elicited and are necessary in most rashes to make a clinical diagnosis.
Patient should be gowned and examined in a room with adequate lighting. Care should be taken to thoroughly expose all pertinent areas of skin including the scalp, nails, and mucous membranes. Take note of the distribution, pattern, arrangement, morphology, extent, and evolutionary changes of the lesions. For an accurate diagnosis, be careful to discriminate primary lesion from secondary lesions. Finally, document your findings using descriptive terminology. Tables 47–1 and 47–2 list descriptors and morphology of lesions.
Lesion configuration descriptors.
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Table 47–1. Lesion configuration descriptors.
|Descriptor ||Configuration |
|Annular ||Ring-like or pertaining to the outer edge |
|Arcuate ||Curved or pertaining to the curve |
|Circinate ||Circular |
|Confluent ||Blending together |
|Dermatomal ||Belt-like or limited to one side of the body in anatomic dermatome |
|Discoid ||Solid, round, slightly raised, or pertaining to a disk |
|Discrete ||Separate or individual |
|Grouped ||Clustered |
|Guttate ||Scattered |
|Gyrate ||Coiled or winding |
|Herpetiform ||Creeping |
|Iris ||Concentric circles |
|Linear ||In a line |
|Polycyclic ||Overlapping circles or borders of irregular curves |
|Retiform ||Net-like |
|Serpiginous ||Snake-like |
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Table 47–2. Lesion morphology.
|Descriptor ||Morphology ||Lesion Nature ||Height Relative to Adjacent Skin ||Image |
|Excoriation ||Linear marks from scratching ||Secondary ||Flat || |
|Erosion ||Ruptured vesicle or bulla with denuded epidermis ||Secondary ||Depressed || |
|Fissure ||Linear cracks on skin surface ||Secondary ||Flat || |
|Ulcer ||Epidermal or dermal tissue loss ||Secondary ||Depressed...|
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