Assessing Rash Characteristics Carrie A Thomas Ph D

Objectives n n n Describe features you should assess when investigating a report of

Distribution n Where is the rash located? n n Localized – restricted to one

Progression n Did the rash move over the body during the course of illness?

Color n What color is the rash? n n Rashes can appear red, white,

Texture n Rashes can be flaky, scaly, bumpy or smooth and the texture of

Additional details n Record additional details about the rash n n n Is it

Accompanying signs and symptoms n Ask about additional signs/symptoms (and their timing in relation

Case Study n n Get a report from a school that they have an

Case Study – Line List Rash Description Patient Distribution/ Location Progression Case 1 Rash

Medical Terms n n n n Papule - A small solid rounded bump rising

Summary n n n Distribution / Location Progression Color Texture Additional info about the

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Assessing Rash Characteristics Carrie A. Thomas, Ph. D Epidemiologist (VPD/IBD) Division of Infectious Disease Epidemiology West Virginia Bureau for Public Health www. wvidep. org (304) 558 -5358 Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Objectives n n n Describe features you should assess when investigating a report of a febrile rash illness Review accompanying signs and symptoms associated with febrile rash illnesses Define commonly used medical terms related to febrile rash illnesses Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Distribution n Where is the rash located? n n Localized – restricted to one area of the body Generalized – present on several areas of the body Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Distribution n Where is the rash located? n n Localized – restricted to one area of the body Generalized – present on several areas of the body Localized rash – Lyme Disease Generalized rash – Rubella Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Progression n Did the rash move over the body during the course of illness? Smallpox on first day of skin rash onset Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Color n What color is the rash? n n Rashes can appear red, white, purple or silver Is the color uniform or patchy/blotchy? Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Color n What color is the rash? n n Rashes can appear red, white, purple or silver Is the color uniform or patchy/blotchy? Meningococcemia Measles Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Texture n Rashes can be flaky, scaly, bumpy or smooth and the texture of the bumps may range from fine to course and can be solid or fluid-filled Scarlet fever Chickenpox Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Additional details n Record additional details about the rash n n n Is it itchy? Is it sore? Is it numb or tingly? Is it scabbing or crusty? If there’s fluid involved, what color? Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Accompanying signs and symptoms n Ask about additional signs/symptoms (and their timing in relation to rash onset date) n n n n Fever, highest recorded temperature Cough Conjunctivitis Respiratory symptoms, including runny nose Joint pain Swollen lymph nodes Fatigue Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Case Study n n Get a report from a school that they have an outbreak of a rash illness What’s the first thing you want to know? Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Case Study – Line List Rash Description Patient Distribution/ Location Progression Case 1 Rash on trunk and face Started on face then body Face – bright red; trunk – red Rough Fever, headache Case 2 Face, body Face then body Face – dark red; body red Face – bumpy Runny nose, fever Case 3 Trunk and extremities Just saw it Red, appears Smooth on trunk and like a lace extremities pattern Abdominal pain, fever, headache Case 4 torso Saw it on torso Nausea, vomiting, fever, URTI Color Dark pink Texture Did not touch it S&S Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Case Study n n Get a report from a school that they have an outbreak of a rash illness What’s the first thing you want to know? Fifth Disease aka Parvovirus B 19 Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Medical Terms n n n n Papule - A small solid rounded bump rising from the skin (scarlet fever) Vesicle - a small blister filled with fluid (Hand, Foot & Mouth Disease) Macule - A small localized change in the color of skin that is neither raised (elevated) nor depressed (Rocky Mountain Spotted fever) Pruritic – itchy Erythematous – red Petechiae - Pinpoint flat round red spots under the skin surface caused bleeding into the skin (do not turn pale with pressure) Purpura - A hemorrhagic area in the skin. Early purpura is red and becomes darker, then purple, and brown-yellow as it fades. Does not blanch when touched. Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org

Summary n n n Distribution / Location Progression Color Texture Additional info about the rash presentation n n Itchy, sore, numb, etc. Accompanying signs and symptoms n Fever, cough, respiratory symptoms, etc. Office of Epidemiology and Prevention Services Divisions of Infectious Disease Epidemiology www. wvidep. org