Dermatology

Dangerous Common Insect Bites Hair & Scalp Part 1 and Part 2 Face Neck

Body Body Folds Itching Painful Extremities (Arms)
Legs Feet Hands



WARNING: this Website is not finished yet. It may have small errors.

First step is take the vital signs to determine if the person has any immediately life threatening medical problems such as Niseria Meningococcemia or Necrotizing Fasciitis

Second step is to inform the patient that you are do not have sophisticated equipment, therefore, you may not be able to give a definite diagnosis. Though many diagnosis are made from clinical appearance there is always the possibility that that a clinical diagnosis will be incorrect.

Third step is to rule out the most dangerous possible problems first. In this Case some of the most dangerous skin conditions are shown in picturesin "Dangerous" Section

Dangerous

Fourth Step is to considerate all of the possible diagnosis for you patient's presentation. These are too numerous to list but the list can be reduced by investigating this web site specific body location such as the neck or hand.

Fifth Step is to do the Appropriate and Necessary History

Ask about time of onset?
The location?
The character?

Ask if there has been travel during the past month?
Forested Areas(Rocky Mountain Spotted Fever, Lyme, Poison Ivy etc)?
The Beach(sand flies)?
Hotels(bed bugs)?
Internation such as Africa (Ebola risk)?
Ask about medication and herbal allergies:
Ask, "Have you any different medications, herbs, or foods during the last month?" idiopathic thrombycytopenia


Sixth Step is to do the Appropriate and Physical Exam:

Examine the extent of involvement: the less the better

For smaller area involvement look for Cancer:  Melanoma (growing irregular shape), basal cell and squamous cell.

For all areas feel for crepitus, which might indicate gas gangrene, or necrotizing fasciitis.

Check for blanchability. (Blanchable is desired)

Rule out all dangerous skin rashes by comparing the patient's rash with the dangerous rashes on this website Dangerous

Look for pus? Consider MRSA (some sources recommend treating for MRSA anytime there is pus ).

Itch or no itch? Having an itch is usually a good sign, and NOT having an itch usually a bad sign

Seventh: Is to any necessary labs; if the necessary labs are not available then this patient will most likely need to be referred to a higher level of care where they will be available.

Eighth: Consider the need for to consult and MD regarding: diagnosis, treatment, or referral

Ninth: make diagonosis based on available information: send home with apppropirate meds, refer out to appropriate location if needed

Tenth: Make a plan to call the patient back: high risk call back later in the day or tomorrow: Medium risk: 2-3 days, Low risk: after 2 day or no call at all 23 Potentially life-threatening disorders: that have skin rashes as the primary symptoms are:

Eleventh: Possible Treatments: Ketoconozole, Bactroban, Triamcinolone, Doxycycline

Education: When a rash does not blanch it is usually more dangerous. Meningococcemia does not blanch.
Other causes of non-blanchable lesions are: polymorphic petechia (<5 mm) and purpura (> 5 mm), Vasculitis (palpable petechia or purpura),  idiopathic thrombycytopenia, Rocky Mountain Spotted Fever, Henoch-Schenlein Purpura, viral Exanthenm.

(Henoch Schonlein purpura and viral exanthem are NOT blanchable but are not life threatening, Thus, when a rash is blanchable it is less likely to be life threatening--but not being blanchanble does not mean the opposite, it does NOT mean that it will always be life threatening.

Good signs are a single color with a symtetrical border, blachable, and no crepitus due gas forming bacteria (necrotizing bacteria, or gas grangene) Staphylococcal scaled skin syndrome



Dangerous Skin Conditions

More in Pediatrics than Adults
Kawasaki: May have conjunctivitis, and swollen hands and feet and strawberry tongue:
Kawasaki Diesease Kawasaki Disease: Dangerous because it can lead to a varity of permanent heart changes aneurysm of coronary artery. Causes Vasculitis which causes strawberry tongue (mucusitis), pink palms, and pink swollen feet. Patient also has a high fever x 5 days.
Measle: May also have Conjunctivitis, Fever, and rash Measles  
Chicken Pox (varicell) Chicken Pox  
MRSA MRSA  
May Be either Pediatric or Adult
Cellulitis (painful) Peri anal cellulits Peri anal cellulitis severe cellulitis periorbital  
More Cellulitis (painful) Cellulitis (painful)

cellultiis of the leg cellutlits nose cellultits of ear

cellulitis periorbital

cellultitis orbital mild orbital cellulits moderate cellulitis severe orbital

 
Pemphigus Vulgaris Pemphigus 1  
Stevens-Johnson syndrome (SJS) * also called Erythema Multiforme MAJOR

* will usually also have purulent comjunctibitis

* usually also involves mucous membranes
Steven  Johnson Syndrome  
Toxic Epidermal Necrolysis (TEN)
*usually involves mucous membrane
* Positve Nikolsky-slight rubbing skin causes a new blister in a few minutes
Ten Disease  
Toxic Shock Syndrome (TSS)Erythroderma or Toxic Shock Syndrome - pt. is very sick, pt is in shock, BP is low. TX: IV Clindamycin or Vancomycin

toxic shock syndrome

toxic shock syndrome

 
Scalded Skin Syndrome (SSS) scalded skin syndrome  
Melanoma: greater than 6 mm, irregular borders, and irregular colors Melanoma  
Squamous cell carcinoma squamous cell carcinoma  
Basal Cell Carcinoma Basal Cell CA  
Nisera Menningiditis

(Will Not Blanch)
niseria mennigiditis  
Necratizing Fasciitis (Is there Crepitus)
(Pain beyond the erythema)
(Pain is greater than cellulitis )
necrotizing Fasciitis  
Idiopathic Thrombocytopenia (will not blanch) For some unknown reason the platelets have decreased and patient can bleed easily (Epistaxis common)  
Lyme Disease Exposure to a tick for greater than 24 hours.. The rash is described as erythema Chronicum Migrans (bullseye). This rash may occur up to a week late or never (20%).  Lyme assay is a method of testing for suspected Lyme disease.  Early symptoms of Lyme disease are similar to influenza symptoms and include facial palsy.  A wide variety other neurological symptoms may occur later in lyme disease.  
Rocky Mountain Spotted Fever  
Herpes Zoster Opthalmicus Herpes Opthalmicus  
Poisonous Snake Bites They will leave two fang marks. Rarely fatal with _. If they Dont inject venom with their bite, there is no burning and no edema 3/8" or 1 cm away from bite.  If there is envenomtion, reduce circulation, splint limb, keep limb low. Relax and keep pulse rate low.  Go to ER for antivenom. Rattle Snake Bite  
Infected Insect Bites: Common treatment:
antibiotic PO (keflex 500 mg tid or qid
doxycycline 100 mg bid x 10
Bactrim DS bid x 10 days)
Infected Insect Bite  
Arizona Bark Scorpion Stings (rarely fatal, Usually causes pain at site and possibly convulsion of extermities)only 1 of 80 scorpion type in US has a lethal capability. The lethal scorpion is 2-3 inches long and is brown and yellow. TX-antivenom, this scorpion can be found in CA, larger scopion have less toxic venom. Bite feels like a bee sting.Usually will have a single stinger mark. Scorpion Sting    
Brown Recluse (not in southern CA) At worst, will cause hemolysis and thrombocytopenia. Usually will have 2 fang marks. Soemtimes can be treated with Dapsone. Brown Recluse Bite    
Black Widow Rare in CA, TX-valium, there is antivenom, mortality is as high as 5% - to as low as .2%, bite feels like a bee sting (usually to fang marks

 

Black Widow Bite    

 

 


Common Non-lethal bites
flea bite: No-infection: Small children hydrocortisone 2.5% bid - qid, teenagers and adults Momentasome q day, triamcinolone 1% tid Flea Bite
mosquito bite Mosquito Bite
chiggar bite Ciggar Bite
sandfly bite Sanfdly Bite
tarrantula bite NO picture could be found. Supposed to look like a bee sting.
bedbugs Bedbugs

 

 


Most Common Skin Problems
contact dermatitis contact dermatitis watch
drug eruption drug eruption 2
pityriasis rosea pityriasis rosea 2
psoriasis Psoriasis Guttate Psoriasis
scabies Scabies Locations Scabies
Erythema Multiforme (MINOR) is NOT that common-but must be considered and compared secondary syphilus and drug eruption. The difference is that Erythema multiforme usually is painful. erythema multiforme
syphilis (secondary): non-painful Syphilis
tinea corporis Tinea Coporis 1 Tinea Corporis 2
tinea vesicolor Tinea Versicolor 1
Eczema (also called Atpic Dermatitis)

eczema 1 eczema periorbital

eczema antecubital

Grover's Disease (rare itchy erythematous papular vesicles mostly on the abdomen brought on by heat and sweat. TX traimcinolone, (acutane?, cool) Grover's Disease
LESS COMMON
DERMATITIS HERPETIFORMIIS dermatitis herpetiformis
PARAPSORIASIS ParaPsoriasis
PITYRIASIS RUBRA PILARIS Pityriasis Rubra Pilaris
Herpes zoster Herpes zoster 1
MYCOSIS FUNGOIDES Mycosis
Folliculits  

Hair and Scalp Part 1

Lice Nits Hair Lice
MRSA MRSA
Fungus (Kerion) kerioin 2
Stress Alopecia Appears as other alpocias
Toxic Alopecia Appears as other alpocias
Hair Shaft Weakness Appears as other alpocias
Trichollomania Tricholomania
Alopecia Areata
Secondary Syphillis
Androgenic Alopecia
Traction Alopecia
Pityriasis Rocea pityriasis rosea 3 last chance

 

Hair and Scalp Part 2
PediculosisCapitus (Hair Lice) Pediculosis Capitus
Scalp Dysesthesia  
Wart wart_scalp
Nevi (Mole) Nevi
Cysts cyst on scalp
Organoid Nevi organoid nevi
Malignancies (basal cell, squamous cell, melanoma) basal cell carcinoma
Lichen Simplex (nape of neck only) lichen planus
Acne Keloid acne keloid
Psoriasis
Secondary Syphilis
Seborrheic Dermatitis
Bacteria Infection
MRSA
Folliculitis
Fungal Infection
Lichen Simplex Chronicus
Lupus Erythematous lupus erythematous 10
Herald Patch
   
Pitiriasis Rocea pityriais rosea 2
folliculitis

 

folliculits back
Hidradenitis Suppurativa hidrendenitis Suppurativo

Face
Tinea Faciei

tinea_Faciei_1

tinea faciei periorbital tinea_faciei_1

Acne Vulagaris (vs Acne Rocecea; this is supposed to acne vulgaris). Acne rocecea has more facial flushing. acne vulgaris 1
Eczema (Atopic Dermatitis) Eczema 2
Cellulitis

cellulitis mild orbitalcellulitis nose cellulitis_of_ear

 

Melanoma melanoma.jpg
Basal Cell Carcinoma basal cell CA 1
Squamous Cell Carcinoma suamous cell CA 1
Actinic Keratosis actinic keratosis
Tuberous Sclerosis tuberous sclerosis
Perioral Dermatitis: TX topical steroids perioral dermatitis 1
Acne Rosecea acne rosecea 1
Folliculitis folliculitis
Herpes Simplex herpes simplex labilis
Chelitis (fungal or bacterial) chelitis 3
Angular Chelitis angular chelitis 1
Erythema Multiforme (on lips): May be due to a drug reaction eerythema multiforme lips
Seborrheic Dermatitis seborrheic dermatitis 10
Erysipelas erysipelas 1
Lupus Erythematous 10 lupus erythematous
Pseudofolliculitis Barbae pseudofolliculitis barbae
Tinea Barbae tinea barbae 1
Herpes Zoster (one side only) It is possible to have numbness, tingling, and itching WITHOUT or BEFORE vesicle appear herpes zoter 6
Impetigo impetigo contagiosus 2 impetigo congatiosus 3
Contact Dermatitis contact dermatitis oak
Celllulits of Nose cellulitis nose
Cellulitis of Ear cellulits of ear
Hutchinson's Sign hutchinson nose
Ramsey Hunt ramsey hunt
Folliculitis folliculitis face

Neck
Folliculitis folliculits neck
Herpes Zoster herpes zoster neck
Acanthos Nigracans Acanthos Nigracanas
   
   
   


Body or Trunk
Contact Dermatitis (more likely to be where there was contact with a new substance, poison ivy (unprotected areas); Cloths detergent rash would be expected to be all where cloths touch skin Contact Dermatitis
Drug Reaction: more likely to bilateral and symetrical drug reaction
Pityriasis rosea: more likely on back, but can be on scalp, face, chest, and back (may find a larger initial skin patch - HEARLD PATCH) Pityriasis Rocecea
Psoriasis: usually scaling flakes over erythematous base Psoriais
Scabies: usually it does not have the classic track. More likely it will appear as small papules, which have often been scratched. Usually, intensely itchy at night. scabies 1.png scabies track
Syphilis (secondary): Likely to be on palms and feet same as erythema multiforme. Not likely to be painful, however, erythema multiforme is often painful   Syphilis secondary Body syphilis 2nd hands and feet
Tinea corporis tinea corporis tinea corporis2
Tinea Versicolor tinea vesicolor 1
Grover's Disease: start as papules and fragile vesicles Grover's Disease
Refer to above section on bites
Dermatitis Herpetitiform dermatitis herpetiform
Parapsoriasis Parapsoriasis
Pityriasis Rubra Pilaris Pityriasis Rubra Pilaris
Mycosis Fungoides Mycosis fungoides

Omphalitis:

infection of umbilical stump with surrounding cellulitis, that can lead to sepsis. Send to ER, requires admission

omphalitis 2
cellulitis of perianal perianal cellulitis
cellulitis of perineum cellulitis perineum
MRSA MRSA may appear as scalded skin syndrome
MRSA MRSA Hair Follicules
erythrasma: Needs to be treated with antibiotic. Glows under a black light. erythrasma groin
herpes zoster herpes zoster 4
Folliculits folliculits back


Body Folds

Atopic Dermatitis atopic dermatiis
Contact Dermatitis contact dermatitis axilla
Miliaria Miliaria neck
Psoriasis psoriasis_neck
Seborrheic Dermatitis seborrheic Dermatitis
Erythrasma [bacterial Infection] erythramsa axilla
Folliculis (especially if recently Shaved) folliculitis axilla
erythrasma axilla [bacterial Infection] erythrasma axilla
herpes zpster herpes zoster arm
Folliculitis folliculits axilla
Hydradenitis Suppurativo hydrendenitis Suppurativo
Pilonidal Cyst Pilinodal Cyst

Arms: and Body Extremities

Atpic Dermatitis eczema antecubital
Contact Dermatitis contact dermatitis watch
Nummular Eczema numular eczema
Psoriasis
Scabies scabies 5 arm
Syphilis suphilis body
tinea infection tinea versicolor 3
Keratosis Pilaris keratosis piloris 1
  Uncommon
Dermatitis Herpetiformis dermatitis herpetiformis
Lichen Planus lichen planus leg
Sarcoid sarcoid on leg
Xanthoma xanthoma leg
Leprosy leprosy
Herpes Zoster: legs, arms herpes zoster leg
  Also See insect bites
Follculitis folliculitis arm

Hands

class="classname"> HANDS AND FEET
Wart wart
Pyogenic Granuloma pyogenic granuloma 1
Eczema eczema hand
Nevus (Mole) nevi
Blue Nevus blue nevus
Myxoid Cyst myxoid cyst
Glomus Tumor glomus tumor
Lentigo (Frecklke) lentigos
Wart (Flat) Verruga wart hand flat
Granuloma Annulare granuloma annulare hand
Lichen Planus lichen planus hand
Sarcoid sarcoid face
Xanthoma xanthoma hand
Seborrheic Keratosis seborrheic keratosis hand
Actinic Keratosis actinic keratosis
Keratoacanthoma keratoacanthoma
Basal Cell Carcinoma basal cell carcinoma hand
Squamous Cell Carcinoma squamous cell carcinoma
Melanoma melanoma hand
Psoriasis psoriasis hand
Contact Dermatitis contact dermatitis hand
Secondary Syphillis syphilis hands and feet
Scabies scabies hand
BLISTERS ON HAND blister hand
Callous On Hand callous hand
Gonococcemia gonococcemia hand
Dyshidrotic Eczema [vessicular eczema] dyshidrotic eczema 1
Fungal Infection fungus hand
Psoriasis psoriasis hand
Hand-Foot-And- Mouth Disease hand foot mouth adult
Herpetic Whitlow herpetic whitlow
Erythema Multiforme (minor) erythema multiforme
Vasculitis vasculitis hand
Rocky Mountain Spotted Fever rocky mountain hand
Secondary Syphilis syphilis secondary
Postinflammatory Desqumation post imflammatory dequamation hand
Acute Paronychia paronychia acute toe
Chronic Paronychia paronychia acute toe
Anthrax anthrax
Dishidrotic Eczema dyshidrotic eczema
Fungal Infection fungus on hand
Psoriasis psoriasis hand
Contact Dermatitis contact dermatitis hand
Onychomycosis onychomycosis
Folliculitis  

  Legs

Erythema Multiforme Minor (after illness or due to drug reaction such as Antibiotic) erythema multiforme
Henoch-Schonlein Purpura (This is non-blanchable rash. It will also often accompany a joint pain and abdominal pain. TX:refer to PCP because a repeated UA is needed because there is possible risk of permanent kidney disease) Henoch_Schonlein Purpura Henoch_Schonlein
Veruca Vulgaris wart
Verruca Plana veruca plana leg
Granuloma Annulare granular leg 1
Diabetic Dermopathy diabetic dermopathy
Necrobiosis Lipoidica necrobiosis lipoidica
Sarcoid sarcoid leg
Stasis Dermatitis stasis dermatitis
Capilaritis capilaritis
Melanoma melanoma 1
Basal Cell Carcinoma basal cell carcinoma leg
Squamous Cell Carcinoma squamous cell CA 2
ITCHY
LICHEN SIMPLEX CHONICUS lichen simplex chronicus
TINEA CORPORIS tinea corporis 3
CONTACT DERMATITIS contact dfermatitis leg
Herpes Zoster herpes zoster leg
  Also See Insect Bites
GRANULOMA ANNULARE granuloma annulare 1
LICHEN PLANUS lichen planus leg
Painful
Erythema Nodosum erythema nodusum legs
Vasculis vasculitis allergic
Erythema Induration erythema induration
Panniculitis paniculitis
Superficial Thrombophlebitis superficial thrombophlebitis
Cellulitis cellulitis leg
Stasis Dermatitis stasis dermatititis stasis dermatitis 1
Herpes Zoster Leg herpes zoster leg
Folliculitis follioculitis leg







Feet


Dorsum of Feet
Contact Dermatitis Contact dermatititis feet
Insect Bites bite sand flea
  Toe Webs
TINEA PEDIS tinea pedis 2
DYSHIDROTIC ECZEMA dyshydrotic eczema feet
ERYTHRASMA [bacterial infection] erythrasma foot
CANDIDA INFECTION candida feet
  Soles of Feet
Tinea Pedis tinea pedis soles
Dyshydrotic Eczema dyshydrotic exzema sole
Juvenile Plantar Dermatosis juvenile plantar dermatosis
Psoriasis psoriasis feet
Secondary Syphilis secondary syphilis hand and feet
Reiter's Syndrome [also may be lesions on penis, and conjunctivitis] Reiter Syndrome
PSORIASIS psoriasi on feet
SECONDARY SYPHILIS secondary syphilis soles
VIRAL EXANTHEMS viral exanthm feet
ROCKY MOUNTAIN SPOTTED FEVER rocky mountains spotted fever
ERYTHEMA MULTIFORME erythema multiforme legs
SECONDARY SYPHILIS syphilis feet
SCABIES scabies foot
DRUG REACTION drug reaction feet
Folliculitis