Confirming diagnosis The obvious skin lesion confirms folliculitis, furunculosis, or carbunculosis. Wound culture shows S. aureus; sensitivity will help guide antibiotic therapy.
In carbunculosis, patient history reveals preexistent furunculosis. A complete blood count may reveal an elevated white blood cell count (leukocytosis).
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Pustular rash:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Have the patient describe the appearance, location, and onset of the first pustular lesion. Did another type of skin lesion precede the pustule? Find out how the lesions spread. Ask what medications the patient takes and if he has applied any topical medication to his rash. If so, what type and when did he last apply it? Find out if he has a family history of a skin disorder.
Examine the entire skin surface, noting if it’s dry, oily, moist, or greasy. Record the exact location and distribution of the skin lesions and their color, shape, and size.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Vesicles/Bullae/Pustules:
Differential Overview
(Field Guide to Bedside Diagnosis)
Vesicles
❑ Herpes simplex
❑ Contact dermatitis
❑ Varicella/zoster
❑ Dyshidrotic eczema
❑ Scabies
❑ Erythema multiforme
❑ Coxsackievirus
❑ Dermatitis herpetiformis
Bullae
❑ Friction blister
❑ Bullous impetigo
❑ Diabetic bullae
❑ Fixed drug eruption
❑ Frostbite
❑ Porphyria cutanea tarda
❑ Staphylococcal scalded skin syndrome
❑ Toxic epidermal necrolysis
❑ Coma bullae
❑ Pseudoporphyria
❑ Pemphigus vulgaris
❑ Bullous pemphigoid
❑ Variegate porphyria
Pustules
❑ Acne vulgaris
❑ Rosacea
❑ Folliculitis
❑ Furuncle
❑ Candida
❑ Gonococcemia
❑ Pustular psoriasis
❑ Hiradenitis suppurativa
❑ Ecthyma gangrenosum
Diagnostic Approach
Vesicles are less than 5 mm in diameter, and bullae are larger. If bullae, petechiae, purpura, or necrosis are present, look for an “allergen” such as HSV, strep, deep fungal infection, collagen disease (especially lupus), or occult neoplasm.
Erythema multiforme can be differentiated from a drug reaction by a dusky violet color and petechiae at the center of the lesion. A target or iris lesion is also characteristic of erythema multiforme.
Staphylococcal scalded skin syndrome can be differentiated from toxic epidermal necrolysis by superficial blisters and absence of oral lesions.
Multidermatomal or disseminated zoster in a young adult should suggest HIV infection.
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Source: Field Guide to Bedside Diagnosis, 2007
Folliculitis, furuncles, and carbuncles:
Diagnosis
(Handbook of Diseases)
The obvious skin lesion confirms folliculitis, furuncles, or carbuncles. Wound culture usually shows S. aureus. In carbuncles, patient history reveals preexistent furuncles. A complete blood count may show an elevated white blood cell count (leukocytosis).
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Pustular rash:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Have the patient describe the appearance, location, and onset of the first pustular lesion. Did another type of skin lesion precede the pustule? Find out how the lesions spread. Ask what medications the patient takes and if he has applied any topical medication to his rash. If so, what type and when did he last apply it? Find out if he has a family history of a skin disorder.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Pustular rash:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Have the patient describe the appearance, location, and onset of the first pustular lesion. Did another type of skin lesion precede the pustule? Find out how the lesions spread. Ask what medications the patient takes and if he has applied topical medication to his rash. If so, what type and when did he last apply it? Find out if he has a family history of a skin disorder.
Examine the entire skin surface, noting if it's dry, oily, moist, or greasy. Record the exact location and distribution of the skin lesions and their color, shape, and size.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
RASH, LOCAL:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The approach to the diagnosis is similar to that of the general rash
.
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Source: Differential Diagnosis in Primary Care, 2007
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