S2D: The Symptom to Diagnosis Podcast Rash
Sep 15, 2021
Sarah Stein, pediatric dermatologist and associate professor at the University of Chicago, breaks down how to approach rashes like a pro. Short, practical rules: identify the primary lesion, note secondary changes, recognize reaction patterns, and consider distribution and history. Case-based talk covers tense blisters, bullous pemphigoid workup, classic rash fingerprints, and common diagnostic pitfalls.
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Inspect Shape Configuration And Distribution
- Look closely at shape, configuration, and distribution to add specificity to your differential.
- Annular lesions suggest rim activity while discoid lesions mean uniform central and rim changes, which point to different causes.
Always Consider Patient History And Exposures
- Always integrate the patient's broader history and exposures when evaluating a rash.
- Ask about medications, travel, systemic symptoms, and other diseases because these often change urgency and likely etiologies.
Biopsy Two Sites For Blistering Diseases
- For suspected autoimmune blistering disease, biopsy early and take two samples: one for routine histology and one for direct immunofluorescence.
- The histology locates the blister plane; immunofluorescence confirms antibody binding pattern (linear vs granular).
