Introduction to Differential Diagnosis in Dermatology

There are over 2000 named diseases in dermatology but common things occur commonly. They just sometimes look a bit different! In practice these common conditions can be diagnosed using 4 mnemonics. This approach will not appeal to the purists amongst you but it works. In a busy general practice it gives you a basis on which to approach most of the common rashes you will see. You just ask yourself the following 3 questions. 1. Is the rash skin coloured or red AND scaly or non scaly? 2. Are there pustules or blisters? 3. Is it a funny shape, colour or distribution? The mnemonics are as follows. The red rashes are the commonest in white people. 1 PMs PET for red scaly diseases 2. CU DVA EVEI for red non scaly diseases 3. II for pustular diseases 4. ICI for Blistering diseases.

1. Diagnosing skin diseases is not difficult. You look at a rash and decide if it is red and scaly or red and non scaly. If it is red and scaly you use the mnemonic PMs PET (PET is Psoriasis, Eczema and Tinea. This is the Prime Minister's Pet ( I used to always think of Kevin Rudd with a siamese cat called Petal sitting on his lap!) The first P of PM is for Pityriasis rosea or Pityriasis versicolor and the M is for Mycosis fungoides, a T cell lymphoma of the skin.) View red scaly rashes Now we know that his pet cat is called PETAL. This helps us to remember Psoriasis, Eczema and Tinea but also the less common red scaly diseases of A for Annular erythemas and L for Lupus erythematosus and Lichen Planus. 2. If it is red but not scaly consider Cellulitis, Urticaria, Drug reaction, Viral exanthem or Annular erythema .The mnemonic is C U at the Department of Veterans Affairs Evei (your girlfriend Evei) (CUDVA EVEI) where EVEI stands for Erythema multiforme, Vasculitis and Erythema nodosum and Infiltrates View the red non scaly rashes

3. If there are Pustules then the mnemonic is II (aye aye) Infective( viral, bacterial, fungal) or Inflammatory eg psoriasis or a pustular drug reaction. Common causes include Staph folliculitis , modified fungal infection or if the vesicles are grouped herpes simplex. Pustules on the face are Acne, Rosacea, Staph folliculitis or H Simplex if grouped. View the pustular rashes 4. If there are Blisters The mnemonic is ICI(Imperial Chemical Industries) Inflammatory including Immunological, Contact dermatitis and Infective. Inflammatory causes can include drugs but remember Immunological causes in the elderly particularly bullous pemphigoid. Contact dermatitis usually gives smaller vesicles rather than blisters but individual vesicles can join up into blisters. If blisters are linear and itchy it is probably a Plant contact dermatitis. Infective blisters are usually bullous impetigo due to a staph infection. If in a dermatomal distribution blisters are likely to be Herpes Zoster. View the blistering rashes For other morphologies such as funny shape, colour or distribution, click on the link in Labels opposite to go to the appropriate section for sample images of relevant conditions and a discussion on how to diagnose them. If you need help with skin disease terminology try this tutorial from Logical Images.