# 254 Odd rashes, itching, scratching
Don't forget a very useful ED tool is the (typically) illuminating magnifying glass with a Wood's (long-wave ultraviolet A) Lamp. There's usually one, sometimes in a supply room, or in a pediatric room.
Frequently used to check for ringworm (tinea capitis), with the UV lamp, or for sexual assault exams (wounds & fluorescence of semen; however, more specific light frequencies and filters are now recommended), it's useful to detect Ethylene Glycol ("anti-freeze intoxication) in urine by its fluorescence.
The unexplained 'fingernail cellulitis' from scratching the itch may be explained by finding the bites that caused it. Using magnification with good light, or UV when indicate, makes inspection easier and more detailed.
Patients with "invisible" bites and lesions ("Don't you see them? They're going in and out of my skin.") can be assured of your carefulness by a conspicuous exam with the lighted magnifier and Wood's Lamp. ("No, I can't see them, even with this special light, but I do believe that what you're feeling is bothering you. I'd like you to follow up with someone who can help more.")
Dogs, cats, and birds have long been pets. More exotic pets (reptiles, rodents) are joined now by increasing numbers 'backyard chickens" and other animals who share their owners' lives as pets, more than livestock. Infestations of mites and other 'critters', now enter the differential of bites, skin irritations, or worse, lung infections from avian dander, and allergens that exacerbate asthma, and other less urban substances. Remember to ask about 'other' animals, as a generic 'pets' question may only elicit the household animals.
Worms in some animals, can be acquired by humans also, and should be sought where indicated. Modern suburban practice is truly a blend of urban and semi-rural concerns.
Lynnerup, N., Hjalgrim, H., & Eriksen, B. (1995). Routine use of ultraviolet light in medicolegal examinations to evaluate stains and skin trauma. Medicine, Science and the Law, 35(2), 165-168. {Abstract, References & Paywall}
Chuena, L. W., & Eea, K. B. (2010). Forensic light sources for detection of biological evidences in crime scene investigation: a review. A Message from the Editor-in-Chief 1 From Narcotics Case Files, 17.
Pearson, M. L., Selby, J. V., Katz, K. A., Cantrell, V., Braden, C. R., Parise, M. E., ... & Hightower, A. W. (2012). Clinical, epidemiologic, histopathologic and molecular features of an unexplained dermopathy. PLoS One, 7(1), e29908.
Aleccia, J. (2012). Mystery skin disease Morgellons has no clear cause, CDC study says. msnbc. com. Retrieved, 26.
Illinois Department of Public Health; Prevention & Control. (No Date) Mites Affecting Humans. Accessed April 21, 2018.
Cranshaw, W. (2011). A review of nuisance invader household pests of the United States. American Entomologist, 57(3), 165-169.
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