Top 10 Rash Documentation Mistakes (and what to write instead)

You know the moment: the waiting room is humming, triage has just found three more "quick ones," and you're staring at a patch of skin that is… red? bumpy? not the same as the other bit?

The temptation is to type "maculopapular rash on arm" and move on. Then future-you meets audit-you, and neither is impressed.

This is a short, practical guide to getting skin notes right the first time—fast, defensible, and easy for the next clinician to follow.

What a good skin note actually does

It tells the reader where the thing is, what the thing is, how big and how many there are, how they're arranged, and what the surface and borders look like.

It also owns what you couldn't assess from a photograph or a two-minute consult. That's it.

No drama, no guesswork, no diagnosis-by-paragraph—just a clear description that stands up in handover and in a month's time when someone checks whether it's changed.

The mistakes we all make (and the cleaner wording that fixes them)

1. Maculopapular bingo

"Maculopapular" is a reflex, not a description. Say what you can actually see: macules and papules, 2–5 mm, grouped, right extensor forearm, ill-defined borders, fine scale; size not assessable (no ruler). It reads like you looked, not like you punted.

2. Vague geography

"On the arm" won't help anyone find it later. Lead with site and side, and if you can, a landmark: right extensor forearm, mid-shaft radius level, six centimetres distal to elbow crease.

3. Millimetres from thin air

If there's no ruler, don't guess. Record the truth: 7 mm (scale present) or size not assessable (no ruler). If you used a coin or known object, say so: proxy scale (AUD 10c piece).

4. Colour words that mean different things to different people

"Red" is not the same on every skin tone. Use derm words that travel: erythematous, violaceous, hyperpigmented, hypopigmented, blue-black, purpuric/non-blanching. If you didn't test blanching, write blanching not assessable and move on.

5. Distribution gets forgotten

Is it localised or generalised? Acral or truncal? Flexural or extensor? A single word here changes the whole picture. Try localised, acral or generalised, photo-distributed over forearms.

6. Arrangement disappears

Linear, grouped, annular, reticular, dermatomal—these aren't fancy; they're useful. Grouped vesicles on an erythematous base (acral) tells a very different story to scattered vesicles, generalised.

7. Border blindness

Borders carry a lot of meaning. Well-defined or ill-defined is the start; add regular or irregular/notched, and whether the edge is raised or rolled. It's two seconds that saves ten later.

8. Flat rashes that aren't flat

Surface matters. Scaly, crusted, smooth, verrucous; erosion or ulceration present/absent. You'll be surprised how often noting fine scale or honey-coloured crust clarifies the whole note.

9. No sense of number or density

"Widespread" means different things to different readers. Give a feel for volume: few, multiple, innumerable or a quick estimate: ~20 lesions over anterior shins.

10. Diagnosing in the documentation

Keep the note safe and objective. Instead of "atypical naevus", try pigmented papule with ABCDE features documented; evolution not assessable from single image. You've captured what matters without locking the reader into your hunch.

Two worked paragraphs to steal shamelessly

Papulosquamous, busy clinic version

Bilateral antecubital fossae (flexural, symmetrical) with erythematous plaques, ill-defined, fine scale, scattered excoriations; multiple lesions 5–30 mm; size not assessable (no ruler). Surrounding skin mildly oedematous.

Pigmented lesion, documentation-only version

Left upper back pigmented papule, 7 mm (scale present), asymmetric, irregular/notched border, colour variegation (light brown to black), no ulceration. ABCDE recorded as observations; evolution not assessable from a single image.

When you can't assess something

Say it plainly and carry on. Blanching not assessable from photograph. Palpation findings not assessable in image-only review. Size not assessable (no ruler).

Clarity beats creativity.

The one sentence that speeds everything up

Paste this into your EMR and edit the braces without thinking too hard:

{site and laterality}. {count} {primary lesion type(s)} measuring {mm if scale present; else "size not assessable"}, {colour(s)}, {shape}, {border}, {surface}. Distribution {localised/generalised/acral/flexural/etc.}, arrangement {linear/grouped/annular/dermatomal/etc.}. Surrounding skin {normal/oedematous/indurated/eczemosed}. Secondary change {scale/crust/erosion/ulceration/none}. Photos saved (de-identified). {Blanching/palpation: not assessable}.

A quick word on photos

If you can add a ruler, add a ruler; keep it on the same plane as the skin and shoot straight-on once, oblique once.

Crop to the lesion, keep faces and unique tattoos out, and name the file like someone else will need to find it: YYYY-MM-DD_site_laterality_caseID.jpg.

If you forgot a ruler and can't re-shoot, say so and don't invent numbers.

Bottom line

Good skin notes aren't clever. They're consistent.

Site and side up front; what you see in standard terms; size with a method or an honest "not assessable"; a few words on distribution, arrangement, borders and surface; and a nod to what you couldn't check.

Do that, and your future self—and the person reading your notes at 3 am—will thank you.