Dermatology Quick Reference for Primary Care

Any new rash or skin complaint.

Painful dusky or target-like lesions with erosions of the eyes, mouth, or genitals, fever, and skin sloughing, usually 4 to 28 days after a new drug. Under 10% of body surface is SJS, 10% to 30% is overlap, and over 30% is TEN.

Estimating sunburn and skin cancer risk, or recording skin tone in the chart.

A raised lesion that does not need sampling below the dermis, such as a seborrheic keratosis, actinic keratosis, or a likely superficial basal cell carcinoma. It is not for a lesion that might be melanoma.

Choosing or comparing a topical steroid.

Moderate to severe atopic dermatitis on the face, eyelids, and folds, and as steroid-sparing maintenance. Also used off-label for vitiligo and seborrheic dermatitis.

Inflammatory acne, rosacea, purulent skin infection, and tick-borne rashes. It is strongly recommended by the AAD for acne.

A chronic, relapsing, itchy rash of dry, red or violaceous, scaly patches on the flexures, neck, face, and hands. Adults often have hand and eyelid involvement and thickened skin.

Choosing a starting treatment for any patient with acne.

Sharply bordered red plaques with thick silvery scale on the elbows, knees, scalp, and lower back. Scraping the scale can cause pinpoint bleeding, known as the Auspitz sign, and new plaques can appear at sites of injury.

Honey-colored crusted erosions around the nose and mouth in children, or flaccid blisters in the bullous form. It spreads by touch.

One or more round or oval scaly patches with a raised red edge and central clearing, on the trunk, arms, or legs. It is itchy and spreads outward.

Tingling or burning, then grouped blisters on a red base at the lip border, which crust over in 7 to 10 days. Triggers include sun, fever, and stress.

Intense itch, worse at night, with small red papules and thread-like burrows in the finger webs, wrists, waist, genitals, and under the breasts. Family members itch too. In infants the palms, soles, and scalp are involved.

Itchy raised wheals that come and go in hours, each lasting less than 24 hours, with no bruising or scale. They last under 6 weeks.

Rough, scaly, pink or tan patches that feel like sandpaper on the face, scalp, ears, and backs of hands in sun-damaged skin. Many are felt better than seen.

Waxy, stuck-on tan to brown or black plaques with a rough, cracked surface and sharp edges, on the trunk, face, and scalp. They multiply with age and are not caused by sun.

Receding temples and thinning of the crown, with progressive miniaturization of hairs (shorter, thinner). It begins in the late teens to 40s and has a family history.

A thick, yellow-white or brown, crumbly toenail, with debris under the nail and lifting from the nail bed. It begins at the free edge and spreads backward.

Any rash in the first 2 months of life. Most are benign, but a few are not.

Any pregnant patient with a rash who needs a topical drug.

A shallow, irregular, weeping ulcer on the inner ankle (the gaiter area), surrounded by brown pigment, swelling, and eczema. It is usually painless or mildly aching, and relieved by elevation.

Velvety, thickened, brown to black skin in the neck, armpits, and groin folds. It is closely linked to insulin resistance and obesity.

Any rash with an unclear cause, and every widespread rash.

Morbilliform rash with facial swelling, fever, enlarged nodes, high eosinophils, and organ involvement, usually the liver. It begins 2 to 8 weeks after starting a drug such as allopurinol, an anticonvulsant, a sulfonamide, or vancomycin.

Any inflammatory rash in brown or Black skin.

Inflammatory rashes, blistering disease, hair loss, and lesions that need a full-thickness sample.

Choosing a steroid for a specific part of the body.

Mild to moderate atopic dermatitis in patients 2 years and older, especially on the face and folds.

Inflammatory acne when doxycycline is not tolerated. The AAD gives a conditional recommendation.