The magic-marker rash, and other symptoms that didn’t fool the doctors of Figure 1

For April Fool’s Day, five ways healthcare professionals around the world avoid the tricks of diagnosis

Are the blue lips on this young patient a sign of cyanosis — or merely an indicator of Nerds consumption? See the original case on Figure 1.

The mysterious rash that showed up on your legs after you began wearing those new blue jeans. The brightly colored skin irritation your child developed after opening a new box of magic markers. And the strange discoloration of the tongue that presented immediately after eating a box of Nerds.

These symptoms are all best-case scenarios that ought to result in the patient being sent home with nothing more than wounded pride.

So how should healthcare professionals ensure they aren’t fooled by cases like these? In the words of one pediatric physician, “Think of the stupid and simple thing before you think of the horrible uncommon thing.”

And consider these five questions before proceeding to more complex diagnoses:

1. What did you have for lunch?
   Blood in the urine, or hematuria, is potentially a symptom of a serious condition. Much less serious is beeturia, which is a sign that you’ve recently eaten beets. In the case shown below, the “culprit was a packet of beetroot crisps [eaten] 2 hours prior to sample being produced.”

This sample of red urine? Nothing to worry about. See the original case on Figure 1.

2. Do you wear dark jeans?
Blue-jean cyanosis is a classic red herring. Cyanosis is a discoloration of the skin that, as the name suggests, looks cyan. It’s generally caused by low blood oxygenation — or in the case of blue-jean cyanosis, by the indigo dye rubbing off a new pair of denim jeans. Based on cases seen on Figure 1, patients are more likely to be fooled by blue hands, still caused by the jeans but slightly less obvious.

The rash at left was related to red pants. See the case on Figure 1. The blue fingers shown above may well be blue-jean cyanosis. See the case here. And what caused the pink rash seen on this toddler’s abdomen? Hint: No lab tests were required.

3. Has your child been around something that might rub off?
Small children are prime candidates for unusual skin colorations, and the more unusual they are, the more questions a smart healthcare professional should ask. In one case, a mysterious bruise on a toddler’s abdomen was traced back to blue juice from a birthday party. In another, a toddler brought to the ER with what her mother thought was flesh-eating bacteria was found to have dried chocolate on her leg. Which is why the follow-up question should be…

4. Do you mind if I wipe that with an alcohol swab?
The lowly swab is one of the most useful tools in a healthcare professional’s arsenal. It’s the best way to be sure that a rash is a rash, and it costs next to nothing.

5. Is this a fake injury?
The word moulage, from the French for making a mold, describes the fake wounds used to train emergency medical personnel. A seasoned healthcare professional can spot these with ease, and when examples have been posted to Figure 1, they are quickly identified. Creation of great moulage is an art that dates back centuries.

The case shown below was posted by a paramedic and received immediate praise from the medical community. “This is FANTASTIC moulage,” one medical educator wrote. “Look at the hair surrounding the ‘burn’ which is miraculously not even slightly singed nor seared. Also, that palm is far too clean with not a spot of ash on it. Great job @jwill598 . Excellent job in fact.”

This “wound” is not nearly as bad as it looks. See the original case on Figure 1.

We invite healthcare professionals to share and discuss cases on Figure 1, a global healthcare community.

Interested in learning more about Figure 1? Email us at communications@figure1.com.