by S. Todd Stolp MD
©August 2007
We should all be dermatologists. To examine the skin of a willing family member requires no scalpel, no anesthesiology, no fancy machinery and no health insurance. However, to understand the relevant features of a skin condition and thereby render your examination much more useful, budding dermatologists must understand the “Language of Dermatology.”
The word “blotch” is generally reserved for horticulturists. A patch of skin that is abnormally colored and less than one half inch in diameter is often referred to as a “macule” (mack-yool). This term can be embellished by including a reference to the color of the macule, such as a “red macule,” or a “white macule.” A larger area of coloration can be referred to as a “patch.”
If a particular rash is “bumpy,” the small bumps (usually less than one quarter inch in size) are called “papules” (pap-yools). Larger bumps are called nodules. If the papules are too tiny to be counted, a rash may feel like sandpaper to the examining finger. You can impress your health care provider by referring to a “sandpaper” rash as a “micropapular” (mike-ro-pap-yooler) rash.
A small bump that is filled with fluid is not a “blister,” but instead goes by the much more dignified term “vesicle.” However, if the fluid appears to be (ugh!) greenish, the “vesicle” becomes a “pustule” (pust-yool), and the fluid within it “pus.”
No Language of Dermatology primer would be complete without a mention of the character of a rash. A rash may be found in similar locations on either side of the body (symmetrical rashes), or it may be in only one spot (localized). A rash may be wet (moist) or dry (scaly or flakey). It may be sore to the touch (tender) or itchy (itchy).
Now you are ready to practice your Sherlock Holmes skills on some sample rashes.
Since school is recently back in session, we can expect our kids to show up with a number of interesting dermatologic challenges. A symmetrical itchy rash with many discrete vesicles usually beginning on the upper chest, often accompanied by a slight fever (over 99.5 degrees F) is typical of chickenpox. This illness is becoming much less common due to the chickenpox vaccine.
A much more common itchy, localized, often asymmetrical, vesicle (or “vesicular) rash that is seen in kids which occurs in locations that are not covered by clothing is poison oak. This eruption is not associated with fever and, contrary to popular belief, cannot be spread by touching the rash and then touching other normal skin.
Sometimes a rash may be preceded by other symptoms. In infants, a high fever (103 degrees F or higher) may occur without many other signs of illness. After four days, the fever may suddenly return to normal and patchy macules and papules (“maculopapular rash”) may break out on the chest, face and extremities. This illness is classic for “Roseola.” This illness can be distinguished from the very rare condition of “Measles” because measles almost always results in severe symptoms including red irritated eyes, severe cough and persistent high fever during the rash. Measles is almost never seen in this country because of vaccinations.
Another case might involve a solid bright red macular rash on the cheeks in a young child. This rash may progress over days to weeks to become a “lacey,” spider-web-like rash on the arms and upper trunk without many symptoms and no fever. This illness may be “Fifth Disease” (also known as “Slapped Cheek”). Occasionally, especially in adults, such a condition can lead to joint pain or blood abnormalities, and may even cause significant problems if a woman in early pregnancy were to contract the illness.
Obviously, dermatology is a very complex medical specialty requiring many years of study. However, a basic understanding of skin (our largest organ!) can empower every one of us to improve our own health care, not to mention enjoy social conversations with other dermatologists.