hi my name is Bernice Quang I'm a
clinical assistant professor of
dermatology at Stanford medicine and
today I'll be talking about the approach
to the patient with multiple skin rashes
remember patients can often have two or
more different rashes each with their
own diagnosis here I'll show you a
patient with three different diagnoses
and show you how I would simplify this
seemingly complex presentation and now
we'll examine our patient with multiple
skin rashes hi ma'am my name is dr. Kwan
very nice to meet you I'm going to take
a look at your skin today so what we see
here are scattered maybe half to three
centimeter plaques because I can feel
substance to these lesions scattered on
the anterior legs bilaterally when we
feel the lesions we notice that they all
have a rim of peripheral scale on the
left leg
we notice that there's a larger
depressed plaque and we know that it's
depressed because we can feel the cut
off but at the edge we can feel the
lesion actually sinking down and it's
filled with little tiny purple to red
blood vessels which we call teal inject
asia's so in summary we see scattered
erythema tis too Brown plaques and also
on the left leg a depressed atrophic red
Brown plaque with teal inject asia's so
in our approach to a patient with
multiple rashes it is important for us
to examine certain body parts that may
give us clues to the diagnosis so one
example is to make sure we look at the
nails and examine the nails of our
patients to look for any hints that
could signify certain diseases for this
patient when we take a look here she has
a few depressions in her nails which are
consistent with pits which can be seen
in psoriasis man is it okay if I take a
look at your elbows
and on the elbows here we note these
erythema dis scaly raised plaques
symmetrically distributed on both elbows
which could be consistent with the
patient's known diagnosis of psoriasis
we also want to examine her scalp
where we see similar scaly well
demarcated erythema display distributed
on her vertex scalp in this patient with
multiple rashes with a known diagnosis
of psoriasis and with some clinical
lesions classic for psoriasis on her
elbows and scalp it can be difficult to
understand whether or not other rashes
are related to that same diagnosis to
recap we see multiple diagnoses and we
need to approach each one independently
as if they are the only rash for our
first diagnosis we see circular lesions
with outer scaly rims this is consistent
with the diagnosis of poorer keratosis
caused by increased keratin deposits in
the skin the diagnosis is likely given
the isolated lesion that is hypo
pigmented with an elevated rim however
it should be noted that there are
various subtypes of poro keratosis for
our second diagnosis we saw a lesion
consistent with necro bios's lipid oka
diabetic horror this is a lesion often
seen in diabetic patients and it's
diagnosis is made by seeing reddish
brown and sometimes yellow plaques with
an HOH center these lesions are usually
seen on the pretibial region for our
third and final diagnosis we have
psoriasis this was based on our patients
scaly rash on extensor surfaces at the
elbows pitting nails and involvement of
the scalp you'll often have patients
with multiple and complex rashes these
rashes don't need to be confusing you
just need to approach each rash one at a
time by describing primary morphology
and supportive attributes thank you for
your time please visit our stand 4:25
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Stanford junior University please visit
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