CFPC Key Features
In dealing with a persistent skin problem that is not responding to treatment as expected:
Reconsider the diagnosis (e.g., “eczema” may really be a fungal infection).
Investigate or modify treatment (e.g., for acne).
In a patient presenting with a skin lesion, distinguish benign from serious pathology (e.g., melanoma, pemphigus, cutaneous T-cell lymphoma) by physical examination and appropriate investigations (e.g., biopsy or excision).
In a patient presenting with a cutaneous manifestation of a systemic disease or condition (e.g., Wegener’s granulomatosis, lupus, a drug reaction), consider the diagnosis of systemic disease and confirm it through history, physical examination, and appropriate investigations.
When prompted by a patient with a concern about a localized skin lesion or when screening for mucocutaneous lesions, inspect all areas of the skin (e.g., nails, scalp, oral cavity, perineum, soles of the feet, back of the neck).
Diagnose and promptly treat suspected life-threatening dermatologic emergencies (e.g., Stevens-Johnson syndrome, invasive cellulitis, chemical or non-chemical burns).
In high-risk patients (diabetics, bed or chair bound, peripheral vascular disease):
Examine the skin even when no specific skin complaint is present.
Treat apparently minor skin lesions aggressively.
In a patient with a new rash:
Take a focused history and do an appropriate skin examination
If the diagnosis remains unclear obtain a more detailed history and examination, including the entire mucocutaneous system and other body systems as indicated
When assessing a patient with a rash look for and recognize common patterns to aid diagnosis.
Use appropriate terminology with respect to lesion type, shape, arrangement, and distribution to facilitate communication and documentation
In an unwell patient presenting with a rash:
Identify potential life-threatening systemic conditions (e.g., meningococcal septicemia, necrotizing fasciitis, toxic shock, Stevens-Johnson syndrome)
Initiate treatment and/or urgent/emergent referral
In a patient with a persisting undiagnosed rash:
In all patients with a persistent or recurrent rash explore the functional and emotional aspects of that disorder, recognizing that what looks like a minor condition may have a profound impact.
In a patient with a persistent or recurrent rash explore issues of:
Exposure to skin irritants or allergens
Adherence to the treatment plan
Use of confounding medications and treatments (e.g., topical anesthetics, topical steroids, home remedies)
In a patient with an infectious rash:
Manage contagion risk
Ensure that public health bodies are informed when indicated
General Skin Care
Rule-out life-threatening conditions
Fluid Resuscitation for burns >15% BSA in children and >20% BSA in adults
Modified Brooke/Parkland Formula 2-4mL x %BSA x kg Ringer's Lactate, 1/2 in first 8 hours, 1/2 in next 16 hours
Apply antibiotic ointment to non-adherent dressing (Adaptic) then apply to wound
Ensure tetanus vaccine status up-to-date
Follow-up at <72h, to re-assess burn to better characterize partial vs. full thickness
Rule-out serious pathology
Rule-out systemic disease
Scabies (Sarcoptes scabiei)
Last edited 2020-12-11
B. Paul, K. Chan