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Rash

  • Common ddx

    • contact dermatitis, atopic dermatitis/eczema, acne, shingles, allergies, cellulitis, psoriasis, sunburn, mosquito/insect bites, erythema nodosum
  • Common febrile ddx

    • viral exanthem, varicella
  • Serious febrile ddx

    • meningitis, RMSF, TSS, SSS, Kawasaki, scarlet fever, measles, erysipelas, DIC
  • Serious ddx

    • any rash with fever, mucosal involvement (SJS, TEN, Kawasaki, pemphigus), endocarditis, anaphylaxis, skin cancer, necrotizing fasciitis
  • Common Labs

    • Wood's lamp if fungus
    • microscopy if scabies
    • CBC, Chem
    • LP if suspect meningitis
    • STD panel if suspect STD
    • anti-strep titer if suspect rheumatic fever
    • ANA, ESR if suspect autoimmune
    • GI workup if Crohns or UC
    • consider skin biopsy
  • Common Tx

    • steroid cream for eczema, contact dermatitis
    • steroids for severe allergies
    • antifungal for candidiasis
    • ceftriaxone if suspect meningitis
    • doxycycline if suspect RMSF
  • STD ddx

    • syphilis, gonorrhea
  • Pediatric ddx

    • viral exanthem, roseola, parvovirus, molluscum, ringworm, Kawasaki, scarlet fever, SSS, hand-foot-mouth disease
  • Derm ddx

    • pityriasis rosea, molloscum contagiosum, eczema, psoriasis
  • Allergies ddx

    • food allergies, drug allergy, environmental allergies, pressure urticaria, mastocytosis, erythema multiforme
  • Blisters ddx

    • contact dermatitis, varicella, burns, shingles, herpes, pemphigus, pemphigoid
  • Ring rash ddx

    • ringworm, Lyme, erythema multiforme, SJS, porokeratosis
  • Palmar rash ddx

    • syphilis, Kawasaki, endocarditis, scabies, hand-foot-mouth disease
  • Petechia or pupura ddx

    • meningitis, ITP, TTP/HUS, HSP, vasculitis, endocarditis, DIC
  • Pruritus ddx

    • contact dermatitis, atopic dermatitis, scabies, urticaria, allergic response, parasites, candidiasis
  • Flushing ddx

    • carcinoid, EtOH, menopause
  • Other ddx

    • Lyme disease, smallpox, celiac disease, IBD, parasites, occult malignancy, GVHD
  • HPI

    • onset
    • triggering event
    • location, distribution, progression
    • size, shape, elevation, texture
    • quality: pain, itch, blistering, herald patch
    • alleviates
    • aggravates
  • ROS

    • fever, weight loss
    • headache
    • photophobia
    • oral ulcers, stiff neck
    • chest pain, dyspnea
    • nausea, vomiting, diarrhea, abdominal pain
    • painless chancre, genital discharge, dysuria
    • paresthesia, muscle weakness
  • PMH

    • recent infection
    • recent mono treated with amoxicillin
    • lupus
    • celiac, IBD
    • recent strep throat
    • vaccine hx
  • SH

    • tick, insect, mosquito bite, hiking, exposure to ivy
    • foreign travel
    • recent sun exposure
    • sick contacts
  • Meds

    • tetracycline
    • new meds, antibiotics
  • Allergies

    • food, drugs, ivy, chemicals
  • Px

    • vitals: fever, BP
    • rash location, distribution (central vs peripheral)
    • palmar rash, interdigital burrows, splinter hemorrhage, elbow crease
    • rash types: urticaria, blistering, erythema nodosum, ring-like
    • blanching vs nonblanching, wet vs dry, palpable vs nonpalpable
    • Nikolski sign
    • ENT: mucosal involvement
    • cardio: murmurs
    • pulm
    • abd
    • neuro: strength, reflex, sensation, finger-to-nose, RAM, gait
    • genitalia exam if suspect STD
  • Rash description

    • how to describe the rash: size, color, temperature, pain, blanching, rough vs smooth, dry vs oozing
    • flat: macule, erythema
    • raised: papule, maculopapular, nodule, dome, plaque, urticaria, palpable
    • pus: pustule
    • blisters: vesicle, bulla
    • blood red: petechia, purpura
    • nasty looking: erosion, ulcer, fissure, excoriation
    • location: central, peripheral, extensor surface, flexor surface

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    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.