STUDY - Technical - New Dacian's Medicine
Papular
rash (Classical / Allopathic Medicine)
A
papular rash consists of small, raised, circumscribed -
and possibly discolored (red to purple) - lesions known as
papules. It may erupt anywhere on the body in various
configurations, and it may be acute or chronic. Papular
rashes characterize many cutaneous disorders; they may
also result from allergy or from an infectious,
neoplastic, or systemic disorder. (To compare papules with
other skin lesions, see Recognizing common skin lesions.)
HISTORY:
Ask the patient when he first noticed the rash.
Ask the patient if anything makes the rash better or worse.
Ask the patient if he has noticed changes in the rash. Is it itchy or burning, painful or tender?
Ask the patient about associated signs and symptoms, such as fever, headache, shortness of breath, and GI distress.
Review the patient's medical history for allergies, previous rashes or skin disorders, infections, childhood diseases, and cancer.
Ask the patient about his sexual history. Has he ever had a sexually transmitted disease?
Ask the patient if he has recently been bitten by an insect or rodent or exposed to anyone with an infectious disease.
Ask the patient about travel and food histories, pets, and environmental exposures.
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 when he first noticed the rash.
Ask the patient if anything makes the rash better or worse.
Ask the patient if he has noticed changes in the rash. Is it itchy or burning, painful or tender?
Ask the patient about associated signs and symptoms, such as fever, headache, shortness of breath, and GI distress.
Review the patient's medical history for allergies, previous rashes or skin disorders, infections, childhood diseases, and cancer.
Ask the patient about his sexual history. Has he ever had a sexually transmitted disease?
Ask the patient if he has recently been bitten by an insect or rodent or exposed to anyone with an infectious disease.
Ask the patient about travel and food histories, pets, and environmental exposures.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Recognizing
common skin lesions
Macule
- A
small (usually less than 1 cm in diameter), flat
blemish or discoloration that can be brown, tan,
red, or white and has the same texture as the
surrounding skin
Vesicle
- A
small (less than 0.5 cm in diameter), thin-walled,
raised blister containing clear, serous, purulent,
or bloody fluid
Wheal
- A
slightly raised, firm lesion of variable size and
shape that's surrounded by edema (skin may be red
or pale)
Papule
- A
small, solid, raised lesion less than 1 cm in diameter
with red to purple skin discoloration
Bulla
- A
raised, thin-walled blister that's greater than
0.5 cm in diameter and contains clear or serous
fluid
Pustule
- A
circumscribed, pus- or lymph-filled, an elevated
lesion that varies in diameter and may be firm or
soft and white or yellow
Nodule
- A
small, firm, circumscribed, elevated lesion
approximately 1 to 2 cm in diameter with possible
skin discoloration
Tumor
- A
solid, raised mass that's usually larger than 2 cm
in diameter with possible skin discoloration
PHYSICAL ASSESSMENT:
Examine the rash. Note its color, configuration, and location.
SPECIAL
CONSIDERATIONS:
Transient maculopapular rashes, usually on the trunk, may accompany reactions to many drugs. Apply cool compresses or an antipruritic lotion to the rash for the patient's comfort.
Transient maculopapular rashes, usually on the trunk, may accompany reactions to many drugs. Apply cool compresses or an antipruritic lotion to the rash for the patient's comfort.
PEDIATRIC
POINTERS:
Common causes of papular rashes in children are infectious diseases, such as molluscum contagiosum and scarlet fever; scabies; insect bites; allergies and drug reactions; and miliaria, which occurs in three forms depending on the depth of sweat gland involvement.
Common causes of papular rashes in children are infectious diseases, such as molluscum contagiosum and scarlet fever; scabies; insect bites; allergies and drug reactions; and miliaria, which occurs in three forms depending on the depth of sweat gland involvement.
AGING
ISSUES:
In bedridden elderly patients, the first sign of pressure ulcers is usually an erythematous area, sometimes with firm papules. If not properly managed, these lesions progress to deep ulcers and can lead to death.
In bedridden elderly patients, the first sign of pressure ulcers is usually an erythematous area, sometimes with firm papules. If not properly managed, these lesions progress to deep ulcers and can lead to death.
PATIENT
COUNSELING:
Advise the patient to keep his skin clean and dry; to wear loose-fitting, nonirritating clothing; and to avoid scratching the rash.
Advise the patient to keep his skin clean and dry; to wear loose-fitting, nonirritating clothing; and to avoid scratching the rash.
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.