When it comes to rashes, Emily Rose, MD, FACEP, FAAP, is about as practical as they come. And that’s what she wants attendees to take away from her talk at ACEP18, “The Death Rash: Lethal Rashes You Can’t Miss.”
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“I want people to walk away with the confidence to make the diagnosis,” said Dr. Rose, assistant professor of clinical emergency medicine at Keck School of Medicine at the University of Southern California and USC Medical Center, both in Los Angeles. “The key features depend on whatever rash we’re talking about…you want to make sure you get a good history. You want to make sure you consider context and perform an educated, targeted exam which helps to confirm or exclude the condition.”
Emergency physicians should evaluate the mucosal membranes and examine characteristics of the skin to help land on specific diagnoses, as well as look for telling diagnostic features such as a Nikolsky’s or Asboe-Hansen sign. Overall, Dr. Rose, who has edited a new textbook on rashes entitled Life-Threating Rashes: An Illustrated Practical Guide, urged physicians to “just consider a differential diagnosis of the rash in even seemingly mundane cases.”
“Generate that differential,” she said. “‘What could this be?’ In a diffuse erythematous rash, this could be just a viral issue. Or it could be toxic shock. Just work through the possibilities to pick up the subtle cases.
“My emphasis in the lecture is ‘How can I apply this information clinically?’” Dr. Rose said. “Most clinicians are familiar with the textbook presentation of these rashes. But these conditions often present atypically. …I want providers to walk away with practical, clinically relevant information that can be applied at the bedside to a patient on the next shift.”