STUDY - Technical - New Dacian's Medicine
butterfly
rash (Classical / Allopathic Medicine)
The presence of a
butterfly rash is commonly a sign of systemic lupus
erythematosus (SLE); however, it can also signal a
dermatologic disorder. Typically, a butterfly rash appears in
a malar distribution across the nose and cheeks. (See
Recognizing butterfly rash.)
Similar rashes may
appear on the neck, scalp, and other areas. Butterfly rash is
sometimes mistaken for sunburn because it can be provoked or
aggravated by ultraviolet rays, but it has more substance, is
more sharply demarcated, and has a thicker feel than
surrounding skin.
HISTORY:
Ask the patient when he first noticed the butterfly rash and if he has noticed a rash elsewhere on his body.
Ask the patient if he has recently been exposed to the sun.
Ask the patient about recent weight or hair loss.
Ask the patient if there's a family history of lupus.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient if he has experienced malaise, fatigue, weakness, nausea, or vomiting.
Ask the patient when he first noticed the butterfly rash and if he has noticed a rash elsewhere on his body.
Ask the patient if he has recently been exposed to the sun.
Ask the patient about recent weight or hair loss.
Ask the patient if there's a family history of lupus.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient if he has experienced malaise, fatigue, weakness, nausea, or vomiting.
PHYSICAL
ASSESSMENT:
Inspect the skin for the extent of the rash. Note other areas of skin disruption.
Observe the patient for periorbital edema, dyspnea, and weakness.
Inspect the scalp for scaling and alopecia.
Palpate the joints, noting pain, stiffness, or deformity.
Palpate the lymph nodes for tenderness and enlargement.
Inspect the scalp and hair for scaling and alopecia.
Inspect the rash, noting macules, papules, pustules, and scaling. Is the rash edematous? Are areas of hypopigmentation or hyperpigmentation present?
Look for blisters or ulcers in the mouth, and note inflamed lesions.
Check for rashes elsewhere on the body.
Inspect the skin for the extent of the rash. Note other areas of skin disruption.
Observe the patient for periorbital edema, dyspnea, and weakness.
Inspect the scalp for scaling and alopecia.
Palpate the joints, noting pain, stiffness, or deformity.
Palpate the lymph nodes for tenderness and enlargement.
Inspect the scalp and hair for scaling and alopecia.
Inspect the rash, noting macules, papules, pustules, and scaling. Is the rash edematous? Are areas of hypopigmentation or hyperpigmentation present?
Look for blisters or ulcers in the mouth, and note inflamed lesions.
Check for rashes elsewhere on the body.
Recognizing
butterfly rash
In classic butterfly rash, lesions appear on the cheeks and the bridge of the nose, creating a characteristic butterfly pattern. The rash may vary in severity from malar erythema to discoid lesions (plaques).
SPECIAL CONSIDERATIONS:
Be aware that hydralazine and procainamide can cause an SLE-like syndrome.
In classic butterfly rash, lesions appear on the cheeks and the bridge of the nose, creating a characteristic butterfly pattern. The rash may vary in severity from malar erythema to discoid lesions (plaques).
SPECIAL CONSIDERATIONS:
Be aware that hydralazine and procainamide can cause an SLE-like syndrome.
PEDIATRIC POINTER:
Rare in pediatric patients, a butterfly rash may occur as part of an infectious disease such as erythema infectiosum, or “slapped cheek syndrome.”
Rare in pediatric patients, a butterfly rash may occur as part of an infectious disease such as erythema infectiosum, or “slapped cheek syndrome.”
PATIENT
COUNSELING:
Instruct the patient to avoid exposure to the sun or, if he's going to be in the sun, to use sunscreen. Suggest the use of hypoallergenic makeup to help conceal facial lesions.
Instruct the patient to avoid exposure to the sun or, if he's going to be in the sun, to use sunscreen. Suggest the use of hypoallergenic makeup to help conceal facial lesions.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)