Case report: A rash to refer

I believe that it is important to follow up on conditions which are not definitively diagnosed and/or not stable or improving. A rash followed by our walk-in clinic over recent weeks, is a case in point. The rash was described in my case study published April 1, 2022 – entitled “A migrating rash.” Since the itchy, non-painful but evolving rash described on the leg of a healthy young man, was still present, I reassessed the lesion once again. The rash (see picture) had changed dramatically. Despite oral and topical antibiotic therapy, the rash had spread, become crusted and begun to ooze at times. Read: Dr. Robert Dickson: Case report: On my back too? The patient was pleased that such an interest was being shown about his problem—he was not concerned, since my treatment of what appeared to be an identical rash on his left leg one year previously, had been successful (see picture). However, the status of the rash was increasingly concerning. With the etiology unknown and the problem not only migrating, but also worsening, I concluded that it was time to refer the patient for a dermatological opinion. Now that material could be obtained from liquid (swab) and tissue (biopsy), it would be hoped that a definitive diagnosis and treatment will be obtained. In my opinion, the case highlights an important aspect of all medical care. Although I prefer to diagnose and treat problems (not just rashes) without referral to a consultant, I believe that it is critical to be aware of the limits of one’s own experience and expertise. When I reach a point where I am no longer exploring options as to cause or treatment, the time has come to seek assistance. This case definitely reached the point where my comfort level was exceeded. Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: A rash to refer

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