Let's move on to nummular eczema.
And this one I include just because it can
look like a few different types of rash,
but it is its own form of illness.
And what you look for is
these two or even larger,
up to 10 cm erythematous plaques,
they have a sharp border
and they have some scale.
So, taken out of context,
they might look like a tinea,
like a fungal infection,
but they –
with that sharp border and with a scale.
However, they are a lot more
widespread than most fungal infections.
They also have a certain distribution,
dorsal hands and feet,
extensor surfaces of the limbs.
And treatment, like a lot of forms of eczema,
is moisturizers and topical corticosteroids.
Because this one is more widespread,
it can be difficult to use topical corticosteroids,
and so, therefore,
you may need to think about sending these
cases on to dermatology for further management.
Pityriasis rosea can seem very scary.
I think patients who get it are very, very concerned
because it is such a broad generalized rash,
but it actually is benign.
So, here, you're looking for,
again, fairly big lesions,
these salmon-colored patches,
they usually have a
distinct border as well.
Things to look for are herald patch.
And you can see one in the picture on the left.
It's just a larger lesion.
It’s the herald patch.
So, it heralds the rashes to come.
So, therefore, it appears first.
It's usually a little bit bigger.
And even when I see patients
two or three days later,
it still stands out.
It’s like there's the patch
that started it all.
A lot of times,
because this rash is
common on the trunk,
if you look at the patient from
the front or from the back,
you’ll actually see kind of a
Christmas tree pattern to the rash
and that it kind of looks like it's a little bit more in the middle
and then kind of more diffused on the sides.
And I think that usually it's a pretty benign rash.
Sometimes it does follow viral illness.
There's not much to do because the
pruritus associated with is pretty mild.
You can give some antihistamines
or something along those lines if
it's really bothering patients a lot
because this one is so widespread.
Creams don't work very well.
But usually, it’s just a question
of reassuring the patient.
All right. Now, something that's, obviously, more
prolonged and more serious is psoriasis.
And psoriasis affects about 2% of US adults.
Most have the plaque form.
You’re going to look at
the extensor surfaces.
The classics are knees and elbows.
This is not your knee.
I know this.
In terms of management,
just to really briefly summarize psoriasis management
because it has changed a lot.
This is to me not the majority of patients I see,
but when the skin
involvement is pretty minimal,
less than 5%,
just treat topically and treat intermittently.
And patients with more severe psoriasis,
where even though it’s only a small area
and corticosteroids aren’t effective,
I do refer on to dermatology.
You can consider the calcineurin inhibitors
again for more continuous treatment,
which avoids the side effects
of the topical corticosteroids.
In my mind and in my practice, though, most patients
have a more extensive involvement of their skin
or they have evidence of arthritis.
This is a skin disorder with a large component
of promoting other types of symptoms as well,
the main one being arthritis.
And now, the current management is to really think
about using early disease modification in these patients
to avoid particularly chronic joint disease
as well as improve
quality of life with skin lesions.
So, with that, I think we've
covered our rashes
and we are going to be moving on.
Thank you for your attention.