RASH, LOCAL
The differential diagnosis of a local rash is best approached with the
mnemonic VINDICATE.
V—Vascular lesions suggest livedo
reticularis, acrocyanosis, gangrene of Raynaud syndrome, necrotic areas of
periarteritis nodosa, and petechiae from emboli. Varicose and ischemic
ulcers may also be considered here.
I—Inflammatory lesions include boils, caruncles, folliculitis, hydradenitis suppurativa, abscesses, and
erysipelas. Dermatophytosis, chancre, chancroid, and yaws, pinta, and
tularemia are important. Scabies, insect bites, anthrax, tuberculosis, or
actinomycotic sinus fall into this category. The fistulous tracts of
regional ileitis may belong here. Warts and moluscum contagiosa also need
mentioning here.
N—Neoplasms of the skin include fibromas, melanomas, lipomas,
basal cell and squamous cell carcinomas, and metastatic carcinoma. Kaposi
sarcoma and mycosis fungoides must also be considered.
D—Degenerative lesions such as senile keratosis are considered
here. Kraurosis vulvae may be recalled here.
I—Intoxication includes acid or alkaline burns of the skin.
Fixed-drug eruptions should not be forgotten.
C—Congenital lesions include epidermolysis bullosa, eczema,
neurofibromatosis, and lipomas.
A—Allergic and autoimmune diseases suggest pyoderma
gangrenosum (ulcerative colitis), necrotic lesions of periarteritis nodosa,
and subcutaneous fat necrosis of Weber–Christian disease.
T—Trauma suggests burns, contusions, lacerations, and
hemorrhages.
E—Endocrine diseases immediately recall pretibial myxedema,
necrobiosis lipoidica diabeticorum, diabetic ulcers, the flushed face of
Cushing syndrome, and carcinoid.
Approach to the Diagnosis
The approach to the diagnosis is similar to that of the general rash
.
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
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