What’s not to love about skin rashes?

Target lesion

Man with an unfortunate target lesion on his back

Luckily beauty is only skin deep, because this rash was a beauty. Classic red rings, each containing another red circle centrally—named ‘target’ lesions after the chain store logo.

Erythema multiforme!” I announced with an Ancient Greek twang. I guess the original dermatologists were embarrassed to name any rash ‘lots of red shapes’ in English. “It’s a beauty,” I confirmed.

He looked at me dubiously. Perhaps the eye of his beholder didn’t see it. “Anything I need to avoid, doc?”

I studied the hundreds of bullseyes adorning his skin. “Duck shooting season. Next please!”

I love a good rash.

Unlike inflammation on our inside body-parts, every variant has its own 200-year-old name—and decent names, too. Contrast this with hepatitis, where for all we know each virus might cause a distinctive rash on the liver, but because we can’t see it they just get alphabetised.

No, Hep B and C have nothing on slapped cheek disease. What a ripper! Visions of red-faced orphans in Dickensian London lining up in front of the perplexed physician, and Mr Bumble claiming he never touched ‘em.

Consider the portmanteau word frostbite: it is magnificently descriptive. As is geographic tongue, where regions of smooth skin resemble a map. If this worsens, even better— it’s called scrotal tongue. I like to ask med students how they think you catch it.

Yes, rash names simply tell it like it is. Even struggling students can stave off failure for minutes when asked to describe red man disease or hand, foot and mouth. But I find baboon syndrome soon sorts them out. Most are too scared to correctly guess ‘bright red buttocks’ and instead opt for excessive chest hair or something necessitating the de-lousing of one’s sexual partner.

I shouldn’t taunt them so, but I remember suffering through the world’s grumpiest dermatologist quizzing us on acrokeratoelastoidosis back in the day. No surprise when I later learned his profession invented prick tests.

Students struggle with rashes; even as a GP it takes years to imprint the patterns onto your brain. (Did I mention my theory that encephalitis does the same thing, but we just can’t see it?)

Regardless, the ability to name viral rashes is merely showing off, because the treatment for every patient is identical: give them one week to pay their bill.

As a GP, all you have to remember is that if it’s dry, wet it; if it’s wet, dry it; and if you don’t know what it is, try steroid cream.

Finally, if it lasts longer than a week, dermatologists have invented a special word to insert in front of your original guess: idiopathic.

First published in Medical Observer, March 2014

About Dr Justin Coleman

Justin is a GP working in Aboriginal health in Brisbane, Australia. He is also a medical writer, editor and blogger. Further details at http://drjustincoleman.com/
This entry was posted in medical writing and tagged , , , , . Bookmark the permalink.

3 Responses to What’s not to love about skin rashes?

  1. A wonderfully entertaining column, Justin, thank you. I quite agree that spouting fancy names for rashes are a great way to impress patients, med students and registrars alike. Patients are generally keen to leave my room clutching a scrap of paper on which an important-sounding term is written, although I suspect that scrotal tongue and baboon syndrome are exceptions to this rule. Personally, I have a penchant for diagnosing garden-variety benign dermatological conditions which happen to have exotic names, like poikiloderma of Civatte and idiopathic guttate hypomelanosis. My favourite consultation party-trick, however, is to not only diagnose peri-oral phytophotodermatitis, but to successfully determine (with just a few cryptic questions on history taking) that the cause of the rash was from said patient drinking Corona beer (with lime) on a summer holiday.

  2. Rashes are such a fertile breeding ground for wordsmiths, aren’t they, Genevieve?
    Never heard of Civatte (an Italian town or a variety of necktie?) and my foggy memory will require google-enhancement for poikiloderma.
    But I can assure all patients who doubt my medical abilities that I have heard of Corona and lime, and will have no hesitation diagnosing this ailment from this point onwards.

    • The smithiest of the skin-deep wordsmiths have to be the dermatohistopathologists. The sheer number of flowery terms they like to use to describe a 3mm chunk of skin is truly impressive. And what is most remarkable is that the more uncertain they are, the more numerous and spectacular the descriptors. A biopsy result with a paragraph worth of summary usually equals “I have absolutely no idea what this is”.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s