Differential Diagnosis for Raised Flesh-Colored Scaly Itchy Painful Rash
Single Most Likely Diagnosis
- Shingles (Herpes Zoster): This is the most likely diagnosis given the description of a painful rash with tingling pain, especially in an elderly patient. Shingles typically presents as a unilateral rash that follows a dermatomal distribution, often accompanied by severe pain and tingling.
Other Likely Diagnoses
- Eczema (Dermatitis): Could present with itchy, scaly lesions, though the pain and tingling are less typical. Elderly patients can have various forms of eczema, including nummular eczema or asteatotic eczema.
- Psoriasis: Characterized by well-delineated, erythematous, scaly plaques. While it can be itchy, the presence of significant pain and tingling is less common but possible, especially if there's a component of psoriatic arthritis.
- Contact Dermatitis: An allergic or irritant reaction to something that has come into contact with the skin, which can cause itchy, scaly, and painful lesions.
Do Not Miss Diagnoses
- Squamous Cell Carcinoma: Though less likely to present as a rash, certain types like Bowen's disease can appear as large, scaly patches. Given the potential for malignancy, it's crucial not to miss this diagnosis.
- Lymphoma (Cutaneous T-Cell Lymphoma): Can present with skin lesions that are itchy and scaly. Mycosis fungoides, a type of cutaneous T-cell lymphoma, is a consideration, especially if the rash is persistent and unresponsive to typical treatments.
- Infections (e.g., Cellulitis, Abscess): Bacterial infections of the skin can cause redness, swelling, warmth, and pain. While they might not typically present with a scaly rash, certain infections like erythrasma can have a scaly component.
Rare Diagnoses
- Pityriasis Rubra Pilaris: A rare skin disorder characterized by constant scaling, palmoplantar keratoderma, and sometimes erythema. It's less likely but could be considered if other diagnoses are ruled out.
- Keratosis Pilaris: Presents with small, rough, sandpapery bumps, often on the arms, legs, buttocks, and cheeks, but can be itchy and might fit the description in some cases, though it's less likely to cause significant pain or tingling.