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HWN Suggests

Don't be Rash about Deadly Rashes

Although you might not always (or rarely?!?) know the exact etiology of the rash, there are some Can't-Miss life threatening rashes that we must be able to recognize in the ED. And rashes account for 5% of all ED visits, so you should be diligent to identify these dangerous diagnoses.

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Articles of Interest

Practical Approach to Lethal Rashes

“Generate that differential,” she said. “‘What could this be?’ In a diffuse erythematous rash, this could be just a viral issue. Or it could be toxic shock. Just work through the possibilities to pick up the subtle cases.

Approach to the Adult Rash

The key for differentiating a diffusely erythematous rash includes the presence or absence of the Nikolsky sign..

Basics of EM – Rash

Truly emergent causes: meningococcemia, TTP, DIC, TSS, SJS, TEN, and necrotizing fasciitis

Describing a Rash

When describing a rash there are many characteristics to make note of, including its primary morphology, secondary morphology, demarcation, colour, configuration, and distribution. The focus or this article will be on primary morphology.

Don't be RASH: Emergency Physician's Approach to the Undifferentiated Lesion

In summary, it is the job of the EM physician to have an organized, systemic approach to the unknown lesion. We must quickly recognize toxic from benign rashes, and initiate appropriate initial resuscitative measures. The modified lynch algorithm is a useful tool and resource to help organize our differential as young EM physicians and initiate appropriate interventions.

Drug Rashes: Not always so simple…

Approximately 90-95% of all drug rashes are “drug-induced exanthems”, also referred to as morbilliform or maculopapular drug eruptions. These rashes are defined by widespread erythematous macules or papules that appear about a week or two after starting the triggering drug, with antibiotics as the most common culprits.

Paucis Verbis: Approach to rashes

We see a variety of rashes in the Emergency Department. The first step is to accurately describe the rash. Is this a macule or nodule? Is this a vesicle or bulla? The next step is to quickly “profile” it to see if it fits any classic pattern by patient age, lesion distribution, or presence of hypotension. And finally, if you are still stumped, use an algorithm based on the rash type.

Rash Week! Briefs: The fever the rashes

Roseola, AKA exanthema subitum, is a common viral illness that peaks between 7 and 13 months. The causative pathogen is HHV-6 (Human Herpes Virus 6). Almost all cases (>90%) occur before the child is two. Following 3 to 5 days of fever you get the characteristic rash.

Rashes in Children

Understand the common treatments for eczema and reasons for treatment failure. Be able to manage children with acute bites and infestations, including recognition of signs and symptoms of life- and limb- threatening complications.

Rashes in Infants and Children - Just the Facts

Rashes in children are typically benign and self-limited with only a handful of serious or potentially life-threatening rashes that require intervention, though they are commonly of great concern to parents and may prompt ED visit.

This Rash Puts You in the ICU

Erythroderma, or “red skin,” is a severe cutaneous condition that presents with diffuse erythema involving greater than 75% of the body’s surface and skin exfoliation.1 It classically spares the periorbital regions and nasolabial folds

What’s that Rash? An approach to dangerous rashes based on morphology

For an organized approach to dangerous rashes, this post will focus on four broad categories based on visual and tactile characteristics: Petechial/Purpuric, Erythematous, Maculopapular, Vesiculobullous.

When a Rash is Deadly

Critical dermatologic processes are divided into two categories: cutaneous manifestation of a critical illness and acute skin failure. The presence of a dermatologic abnormality does not itself represent a life threat. Instead, the skin lesion suggests the presence of an underlying critical process. The prototypical example would be the petechiae and purpura in meningococcemia.

Resources

9 Rashes That Affect the Palms and Soles

HFM to TSS...

Common Rashes Module

Aoife Fox is an emergency medicine trainee with an interest in medical informatics.

JETem

The Modified Lynch Algorithm provides a systematic approach to the diagnosis of rashes by providing a number of questions and branching points to narrow down the differential diagnosis of important and life-threatening rashes for the emergency physician.