

#161 A Rash Approach to Rashes with Helena Pasieka MD
Jul 15, 2019
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Inside Job vs Outside Job Rashes
- Dermatology can be approached by assessing if the rash is an "inside job" (systemic and symmetric) or an "outside job" (introduced externally and asymmetric).
- This framework helps distinguish drug eruptions from contact dermatitis or infections based on rash symmetry and distribution.
Full Skin and Mucosa Exam Is Crucial
- Always do a full skin exam including mucosal areas to assess severity of rashes, especially drug reactions.
- Check oral, nasal, ocular, genital, and perianal mucosa to detect serious dermatologic emergencies.
Differentiate Hives from Morbilliform
- Use a surgical marker to draw on a rash suspected to be urticarial and check if it changes shape or location in 24 hours.
- Perform a dermatographism test with a cotton swab to differentiate hives from a morbilliform drug eruption; treat accordingly with antihistamines or steroids.