Test 2

🦠 NAG (KKM) 🎁 Dose Calculator

Dermatology Toolbox

Fast skin triage, rash pathway, and infection support for GP and locum clinic settings.

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Red Flag Skin Triage

Click to view emergency skin features.

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Consider urgent referral or senior discussion if any red flag is present.
  • Systemically unwell, fever, rigors, lethargy, hypotension, confusion, or sepsis concern
  • Severe pain out of proportion to skin findings
  • Rapidly spreading redness, warmth, swelling, or cellulitis with fever or toxicity
  • Skin peeling, dusky rash, target lesions, or widespread blistering
  • Mouth, eye, genital, or other mucosal involvement
  • Eye pain, red eye, visual symptoms, or rash near the eye
  • Facial or periorbital swelling
  • Non-blanching rash, purpura, or petechiae, especially with fever
  • Eczema patient with painful punched-out vesicles or rapidly worsening rash
  • High-risk patient with worsening skin infection: diabetes, immunocompromised, pregnant, infant, or frail elderly
This list supports triage only. Clinical judgement, vital signs, examination findings, and local referral pathways still apply.
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Common Rash Pathway

Choose the closest rash pattern after checking red flags.

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Itchy Dry / Recurrent Rash

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Likely Consider
  • Eczema / dermatitis
  • Contact dermatitis
  • Psoriasis if thick plaques and scale
Quick Check
  • Flexural or extensor distribution
  • Trigger exposure or new product
  • Infection signs
  • Sleep disturbance or recurrent flares
Clinic Direction
  • Use Eczema & Steroid Guide later
  • Use FTU calculator for topical amount
  • Give moisturiser and steroid counselling
⭕

Annular Scaly Rash

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Likely Consider
  • Tinea corporis / ringworm
  • Eczema
  • Psoriasis
Quick Check
  • Central clearing
  • Active scaly edge
  • Steroid-worsened rash
  • Feet, nail, or groin involvement
Clinic Direction
  • Think fungal if typical annular scaly edge
  • Avoid steroid monotherapy if tinea likely
  • Review or refer if widespread, recurrent, uncertain, or scalp involvement
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Honey-Crusted / Pustular Lesions

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Likely Consider
  • Impetigo
  • Ecthyma
  • Infected eczema
Quick Check
  • Localised or widespread
  • Fever or cellulitis
  • Underlying eczema
  • Household or school spread
Clinic Direction
  • Use Skin Infection Helper below
  • Check extent and systemic symptoms
  • Counsel hygiene and transmission prevention
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Red, Hot, Swollen Painful Skin

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Likely Consider
  • Cellulitis
  • Abscess / furuncle
  • Infected wound
  • Infected eczema
Quick Check
  • Fever or toxicity
  • Rapid progression
  • Severe pain
  • Facial or periorbital area
  • Diabetes or immunocompromised
Clinic Direction
  • Re-check red flags first
  • Use Skin Infection Helper below
  • Use NAG guidance for antibiotic decisions
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Painful Unilateral Vesicular Rash

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Likely Consider
  • Herpes zoster / shingles
  • HSV if localised recurrent vesicles
Quick Check
  • Onset less than 72 hours
  • Face or eye involvement
  • Immunocompromised
  • Disseminated lesions
  • Severe pain
Clinic Direction
  • Eye involvement is a red flag
  • Uncomplicated trunk shingles may be outpatient
  • Use infection helper below for zoster/HSV notes
🌊

Wheals / Sudden Itchy Raised Rash

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Likely Consider
  • Acute urticaria
  • Allergic trigger
  • Viral-associated urticaria
Quick Check
  • Lip or tongue swelling
  • Wheeze or shortness of breath
  • Syncope or hypotension
  • New drug, food, NSAID, or infection
  • Duration less or more than 6 weeks
Clinic Direction
  • Airway/systemic symptoms are emergency features
  • Simple urticaria can use antihistamine pathway later
  • Consider chronic urticaria pathway if recurrent or persistent
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Intense Itch, Worse at Night / Household Itch

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Likely Consider
  • Scabies
  • Insect bites
  • Eczema flare if chronic and recurrent
Quick Check
  • Household members itchy
  • Finger webs, wrists, genital area
  • Burrows or excoriations
  • Hostel, dormitory, nursing home exposure
Clinic Direction
  • Use scabies section in infection helper below
  • Treat close contacts if scabies likely
  • Explain itch may persist after treatment
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Groin / Flexural / Intertrigo Rash

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Likely Consider
  • Tinea cruris
  • Candidal intertrigo
  • Eczema
  • Inverse psoriasis
Quick Check
  • Satellite lesions
  • Annular border
  • Moist skin folds
  • Diabetes or obesity
  • Previous steroid use
Clinic Direction
  • Keep area dry
  • Consider fungal section below
  • Avoid prolonged potent steroid in flexures or genital area
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Numb Hypopigmented Patch

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Likely Consider
  • Leprosy
  • Tinea versicolor
  • Vitiligo
  • Post-inflammatory hypopigmentation
Quick Check
  • Loss of sensation
  • Thickened nerves
  • Weakness or deformity
  • Contact history
  • Fine superficial scaling
Clinic Direction
  • Sensory loss or nerve signs should be referred
  • If superficial scaling, consider fungal pathway
  • Document sensation and nerve findings clearly
🔴

Acneiform Rash

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Likely Consider
  • Acne vulgaris
  • Steroid acne
  • Rosacea
  • Folliculitis
Quick Check
  • Comedones
  • Inflammatory papules or pustules
  • Nodules, cysts, or scarring
  • Pregnancy
  • Steroid use or facial flushing
Clinic Direction
  • Acne ladder can be added later
  • Refer if nodulocystic, scarring, severe distress, or treatment failure
  • Consider folliculitis if monomorphic itchy pustules
🦠

Skin Infection Helper

Choose the closest infection pattern after checking red flags.

Use NAG (KKM) for antimicrobial choice and dosing. This helper focuses on pattern recognition, checks, and escalation triggers.
🍯

Impetigo / Ecthyma / Infected Eczema

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Likely Pattern
  • Honey-coloured crusts
  • Pustules or wet erosions
  • Infected eczema flare
  • Deeper crusted ulcer may suggest ecthyma
Quick Check
  • Localised or widespread
  • Fever or cellulitis
  • Underlying eczema or scratching
  • School, nursery, or household spread
Clinic Direction
  • Check red flags first
  • Use NAG for antimicrobial choice if treatment needed
  • Counsel hygiene, avoid sharing towels, cover lesions if possible
  • Review if spreading, fever, or not improving
Escalate if: fever, spreading cellulitis, extensive disease, infant, immunocompromised, ecthyma, recurrent infection, or poor response to initial treatment.
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Cellulitis / Erysipelas

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Likely Pattern
  • Red, hot, swollen, tender skin
  • Painful affected area
  • May have fever or chills
  • Often limb involvement
Quick Check
  • Vital signs and general appearance
  • Rapid spread or severe pain
  • Entry point: wound, ulcer, eczema, tinea pedis
  • Diabetes, CKD, immunocompromised, pregnancy
  • Facial or periorbital area
Clinic Direction
  • Re-check red flags before outpatient treatment
  • Mark margin if managing outpatient
  • Use NAG for antibiotic decision
  • Safety-net for fever, rapid spread, severe pain, blistering, toxicity
Escalate if: toxic or unwell, rapidly spreading, severe pain, blistering, facial/periorbital involvement, high-risk patient, failed outpatient treatment, or concern for deep infection.
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Abscess / Furuncle / Carbuncle

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Likely Pattern
  • Fluctuant tender swelling
  • Pus point or draining pus
  • Boil, furuncle, or carbuncle
  • Recurrent lesions may suggest colonisation or diabetes risk
Quick Check
  • Size, location, and fluctuation
  • Fever or surrounding cellulitis
  • Diabetes or immunocompromised
  • Face, hand, perianal, breast, or genital location
  • Suitability for clinic drainage
Clinic Direction
  • True abscess may need drainage, not antibiotics alone
  • Use local protocol and NAG guidance
  • Send pus culture if available and clinically indicated
  • Review if worsening or recurrent
Escalate if: large abscess, systemic symptoms, high-risk patient, difficult site, facial/perianal/genital involvement, deep infection concern, or not suitable for clinic drainage.
🐾

Bite Wound / Infected Wound

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Likely Pattern
  • Cat, dog, or human bite
  • Puncture wound or crush injury
  • Infected traumatic wound
  • Increasing redness, swelling, pain, or discharge
Quick Check
  • Time since bite or injury
  • Hand, face, genital, joint, or tendon involvement
  • Depth, foreign body, neurovascular status
  • Tetanus status
  • Rabies risk based on local public health advice
  • Diabetes or immunocompromised
Clinic Direction
  • Clean and irrigate wound appropriately
  • Assess tetanus need
  • Use NAG/local protocol for antibiotics when indicated
  • Document wound site, depth, neurovascular status, and advice given
Escalate if: hand bite, deep puncture, joint/tendon/bone involvement, facial/genital wound, spreading infection, systemic symptoms, immunocompromised, or uncertain rabies/tetanus risk.
⭕

Tinea Corporis / Cruris / Pedis

⌄
Likely Pattern
  • Annular scaly rash
  • Active raised edge
  • Central clearing
  • Groin, feet, body, or nail involvement
Quick Check
  • Steroid-worsened rash
  • Household or contact spread
  • Feet or nail reservoir
  • Diabetes or immunocompromised
  • Extent and recurrence
Clinic Direction
  • Treat as fungal if typical
  • Avoid steroid monotherapy if tinea is likely
  • Keep area dry and avoid sharing towels
  • Review if not improving or diagnosis uncertain
Escalate / review if: widespread disease, recurrent disease, immunocompromised, failed treatment, uncertain diagnosis, nail involvement needing longer plan, or scalp involvement.
💇

Tinea Capitis

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Likely Pattern
  • Scalp scaling with hair loss
  • Broken hairs or black dots
  • Kerion: boggy inflammatory swelling
  • More common in children
Quick Check
  • Patchy alopecia
  • Occipital or cervical lymph nodes
  • Household or school spread
  • Inflammation, pus, or kerion
  • Scarring risk
Clinic Direction
  • Do not treat as simple dandruff if hair loss or broken hairs
  • Topical-only treatment is usually insufficient if true tinea capitis suspected
  • Consider referral or systemic treatment pathway according to local practice
Escalate if: kerion, severe inflammation, scarring alopecia, diagnostic uncertainty, immunocompromised patient, or treatment failure.
🌙

Scabies ± Secondary Infection

⌄
Likely Pattern
  • Severe itch, worse at night
  • Household or close contact itch
  • Finger webs, wrists, axilla, waistline, genital area
  • Excoriations or burrows
  • May have secondary impetigo
Quick Check
  • All household members symptomatic?
  • Institutional outbreak risk
  • Infant, pregnant, elderly, or immunocompromised
  • Crusted scabies suspicion
  • Secondary bacterial infection
Clinic Direction
  • Treat close contacts together if scabies likely
  • Give clear application and cleaning instructions
  • Explain itch may persist after treatment
  • Use infection pathway if impetiginised
Escalate if: crusted scabies, institutional outbreak, infant/pregnancy complexity, severe secondary infection, immunocompromised, or failed treatment.
⚡

Herpes Zoster / HSV

⌄
Likely Pattern
  • Painful grouped vesicles
  • Dermatomal unilateral rash suggests zoster
  • Recurrent local grouped vesicles may suggest HSV
  • May have burning or neuralgic pain
Quick Check
  • Onset less than 72 hours
  • Eye, forehead, or nose involvement
  • Immunocompromised
  • Disseminated lesions
  • Severe pain or neurological symptoms
Clinic Direction
  • Eye involvement is a red flag
  • Uncomplicated trunk shingles may be outpatient
  • Consider antiviral pathway according to timing and risk
  • Advise avoidance of vulnerable contacts if active vesicles
Escalate if: eye involvement, disseminated rash, immunocompromised patient, severe neurological symptoms, pregnancy concern, or severe uncontrolled pain.

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