Paucis Verbis: Approach to rashes

Paucis Verbis: Approach to rashes



Doc, what’s this itchy rash?

Answer: Contact dermatitis from poison ivy

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” the rash to see if it fits any classic pattern by patient age, rash distribution, or presence of hypotension. And finally, if you are still stumped, use an algorithm based on the rash type.

These figures are from March 2010’s Emergency Medicine Magazine (it’s free!). It’s not meant to be a comprehensive article on rashes but it sure does take the guesswork out of 90% of the rashes you see.

PV Card: Approach to Rashes

Go to the ALiEM Cards site for more resources.

Thanks to Dr. Hemal Kanzaria for including this idea as a PV card.

Michelle Lin, MD
ALiEM Editor-in-Chief
Academy Endowed Chair of EM Education
Professor of Clinical Emergency Medicine
University of California, San Francisco
Michelle Lin, MD
Michelle Lin, MD

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  • Awesome. One of your best works yet.

    What about superficial (i.e. sun) burn as afebrile erythematous rash?

  • Hi Kit:
    Thanks! I too love this card, especially since I really dislike undifferentiated rash cases. Can’t really take credit for the PV card though. Thank the author Dr. Muprhy-Lavoie who wrote this up in EM Magazine. The algorithm isn’t meant to be all-inclusive, but yes sunburn would be in the erythematous rash/afebrile branch of the algorithm.