Red, Scaly Rashes: Clinical Pearls


Matthew Zirwas, MD

What should we do with patients who present with red, scaly rashes? Dr Zirwas provides some of his clinical pearls from Maui Derm NP+PA Summer 2015…

  • Look behind the earlobes, under the jaw, and at the upper eyelids to distinguish between airborne contact dermatitis and photodermatitis;
  • Look for islands of sparing and ask if it started on the scalp when you’re considering pityriasis rubra pilaris;
  • With a widespread facial dermatitis, look for sharply demarcated red, scaly patches to diagnose seborrheic dermatitis, even if it isn’t in the normal distribution of seborrhea;
  • In cases of rosacea that don’t respond to treatment the way you expect, look for tiny, pinpoint pustules as a clue that demodex is the driving factor;
  • Dermatitis under a ring is essentially always irritant dermatitis from irritants trapped in the band. Fill in concavities on the inside of the band and only wear one ring per finger;
  • When the fingertips are the main place that is affected with a hand eczema, suspect friction with paper and keyboards as the most likely cause;
  • A rash under a bra-strap is most likely caused by symptomatic dermographism. Push-up bras with thin straps are most likely to cause problems.