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Probability diagnosis

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Herpes simplex

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Herpes zoster

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Varicella (chicken pox)

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Hand, foot and mouth disease

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Dermatitis: contact, atopic

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Insect and arachnoid bites

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Molluscum contagiosum

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Burns

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Serious disorders not to be missed

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Vascular:

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  • Allergic vasculitis

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Infection:

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  • Bullous impetigo (scalded skin syndrome)

  • Scabies

  • Anthrax

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Cancer:

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  • Associated e.g. lymphoma, leukaemia

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Other:

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  • Erythema multiforme

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Pitfalls (often missed)

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Pompholyx

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Pemphigus/pemphigoid

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Dermatitis herpetiformis

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Fixed drug eruption e.g. sulphonamides

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Trauma e.g. skin friction, thermal, acid, caustic

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Rarities:

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  • Porphyria cutanea tarda

  • Epidermolysis bullosa acquisita

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Masquerades checklist

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Drugs e.g. penicillamine, barbiturates

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Key history

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Ask about recent and general health esp. any infections and associated symptoms of infectious diseases. Check for any recent travel history or history of skin trauma, bites or stings, as well as drug intake esp. antibiotics. Is there a family history of bullous disorders?

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Key examination

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General examination of skin and mucus membranes including mouth looking for hand, foot and mouth infection and pompholyx.

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Key investigations

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Unlikely to be helpful.

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Consider:

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  • FBE

  • wound swabs (if evidence infection)

  • viral studies and patch testing

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