Rashes

A raised, reddish, patchy with irregular bordered margins, silvery-whitish scale, over the elbow measuring around 10 cm x 8 cm.







It is important to describe what ever you see in totality. This is just a rough guide - nature of the rash (raised or flat), colour, shape, margins, any characteristic signs/nature of rash that will give away the diagnosis of a particular rash, (for e.g. silvery scale in psoriasis)and site of the rash seen. These are not placed in order and should only be used as a guide. I personally prefer to tell the location of a rash first. (E.g. I see a rash over Mrs. X's elbow. It is a raised, reddish...etc)

While describing a rash seen is VERY important to come to a diagnosis, NEVER forget that the patient's age, gender and presentation of illness are also an EXTREMELY important aid in coming to a diagnosis.
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There is a rash seen on the left, anterior to medial, middle half shin of Mr. X. It is measuring around 8 cm x 7 cm, erythematous, tender (I'm sure it is!), swollen (compare both sides of his leg) with shinny skin (these are the give away, after this...its quite pointless to go on..), with poorly defined margins with some satellite lesions (red round patches seen around the main big patch).

It also gives a BIG plus point if you can add a point or two from your history taking (e.g. the site of the current rash is over a previous wound while Mr. X was gardening, cuts, blisters, burns, insect bites, surgical wounds.) This helps seals the diagnosis of cellulitis.
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This is rash seen all over the back of Mr. Z. It is flat, erythematous (maculopapular rash), typically described as isles of white in a sea of red, that is blanchable (disappears upon pressure). Putting this together with his symptoms of fever, body aches and retro-orbital pain, with the leucopenia and thrombocytopenia, a diagnosis is easily established. Though not shown here, the rash in dengue is usually centipetal. This means that the rash starts on the limbs before "moving" or spreading to the trunk (differentials would be coxsacki virus, secondary syphilis, rRocky mountain spotted fever, smallpox). Centrifugal means the rash starts on the trunk (differentials would be chickenpox, rubella, measles (rubeola), & typhus.

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I'm sorry I can't put up more pictures as there are just too many to mention here. However, I hope that you get the idea of it. :)