Rashes and Overall Derm Strategy

[SubmersibleSandwich]

Just was curious if anyone had a go to approach when it comes to dealing with derm and specifically rashes. There are so many mimics, and it also depends what stage the rash may present as. And then you have your atypical presentations and different skin tones to consider as well. Finishing my final rotation in peds and it has me feeling overwhelmed. My preceptor diagnosed a kid with pityriasis and it looked nothing like pityriasis and even left her unsure. Just looking to develop some kind of strategy as I proceed into my career. Thanks.

 

[SedRate]

How comprehensive was your derm lecture? I felt like mine was pretty good and helped me understand the nuances. A thorough history and ROS also help (and that goes for most of medicine). 

Honestly, in practice, medicine is incredibly variable and oftentimes doesn't follow the books. Not sure if that helps you feel better, but just know that not everything will look or present exactly how you learn it. A good history and physical are paramount and your diagnostics should be supportive/confirmatory. If you don't already have a solid differential after your history and physical, step back and gather more info.

2 hours ago, Dirtyeggroll said:

My preceptor diagnosed a kid with pityriasis and it looked nothing like pityriasis and even left her unsure.

Can you explain why/how it looked nothing like it? 

[SubmersibleSandwich]

15 hours ago, SedRate said:

Can you explain why/how it looked nothing like it? 

Well, it looked more like miliaria, with lesions around 1-2mm, started in the axilla before spreading down the trunk and thigh strictly on the left side without any classic "X-mas tree distribution" and no obvious herald patch. 

My preceptor told me that many times, especially with the viral exanthems, that sometimes it's a shot in the dark and as long as they don't have any systemic sx or aren't toxic appearing then 100% identification doesn't always matter. Especially when considering that supportive treatment is the mainstay for many of the rashes.

[SedRate]

26 minutes ago, Dirtyeggroll said:

Well, it looked more like miliaria, with lesions around 1-2mm, started in the axilla before spreading down the trunk and thigh strictly on the left side without any classic "X-mas tree distribution" and no obvious herald patch. 

Interesting, yeah, that does sound a bit different. Hopefully some of the folks on here with more experience in FM and UC can weigh in. 

26 minutes ago, Dirtyeggroll said:

My preceptor told me that many times, especially with the viral exanthems, that sometimes it's a shot in the dark and as long as they don't have any systemic sx or aren't toxic appearing then 100% identification doesn't always matter. Especially when considering that supportive treatment is the mainstay for many of the rashes.

Yep, they have a point. Oftentimes we want a definitive diagnosis and/or etiology, and sometimes that just doesn't happen. This goes for a lot of other areas of medicine. 

[CAAdmission]

On 5/15/2023 at 10:28 AM, Dirtyeggroll said:

as long as they don't have any systemic sx or aren't toxic appearing then 100% identification doesn't always matter

There's wisdom there. You can probably say this for most patient presentations, derm or otherwise. 

 

“The art of medicine consists of amusing the patient while nature cures the disease.”

― Voltaire

 

[SedRate]

6 hours ago, CAAdmission said:

“The art of medicine consists of amusing the patient while nature cures the disease.”

― Voltaire

Amusing the pt is the hardest part, haha. 

[ohiovolffemtp]

Best reference:

https://www.amazon.com/Skin-Disease-Diagnosis-Thomas-Habif/dp/0323442226/ref=sr_1_5?crid=245R35ZM3C7P0&keywords=habif&qid=1684728671&sprefix=habif%2Caps%2C162&sr=8-5