Is there a simple set of rules for the identification and treatment of conditions characterized by general skin rash?—GREG STAFFORD, PA-C, Chillicothe, Mo.
The phrase “general skin rash” can best be evaluated by separately considering each of its components. “General” typically implies the widespread, diffuse distribution of the lesions. “Skin” usually refers to the cutaneous surface but may also include mucosal membranes, hair, and nails. And while “rash” has been reported to describe the occurrence of drug-induced reactions, it is a nonspecific term that requires further characterization. Is the rash skin-colored, red, hyperpigmented, or hypopigmented? Is the rash flat or raised? And, if the rash is raised, are the lesions flat-topped plaques or dome-shaped papules or nodules? Is the rash asymptomatic or pruritic or tender? Without additional information, it is difficult (if not impossible) to determine the correct diagnosis of a “rash.” Therefore, there is not a simple set of rules for the identification and treatment of conditions characterized by “general skin rash.”—Philip R. Cohen, MD (143-6)