Differential Diagnosis for a Lesion Resembling a Burn

When considering a lesion that resembles a burn, it's crucial to approach the diagnosis systematically to ensure that all potential causes are considered. The differential diagnosis can be organized into the following categories:

• Single Most Likely Diagnosis
  • Burn injury: This is the most straightforward diagnosis, given the presentation. Burns can result from thermal, electrical, chemical, or radiation exposure, and their appearance can vary widely depending on the cause and severity.
• Other Likely Diagnoses
  • Contact dermatitis: An allergic or irritant reaction to substances that come into contact with the skin, which can mimic the appearance of a burn.
  • Eczema (atopic dermatitis): A condition characterized by itchy, inflamed skin, which can sometimes be confused with burn injuries, especially if the eczema is severe or if there are secondary infections.
  • Psoriasis: An autoimmune condition that speeds up the life cycle of skin cells, causing cells to build up rapidly on the surface of the skin. The lesions can sometimes resemble burns, especially if they are inflamed.
• Do Not Miss Diagnoses
  • Infectious diseases (e.g., cellulitis, abscess): These conditions can present with redness, swelling, and warmth, similar to a burn, and require prompt antibiotic treatment.
  • Vasculitis: Inflammation of the blood vessels, which can cause skin lesions that might be mistaken for burns. Vasculitis can be serious and requires early diagnosis and treatment.
  • Malignancy (e.g., skin cancer): Although less common, some skin cancers can present with lesions that might initially be thought to resemble burns.
• Rare Diagnoses
  • Erythema multiforme: A skin condition characterized by target lesions, which can be triggered by infections or medications. It's less common but can be severe.
  • Stevens-Johnson syndrome/toxic epidermal necrolysis: Rare but life-threatening conditions usually triggered by medications or infections, characterized by widespread skin necrosis and detachment.
  • Scleroderma: A chronic disease characterized by deposition of collagen, leading to hardening and tightening of skin and connective tissues. It can cause skin lesions that might be confused with burns in some cases.

Each of these diagnoses has distinct features and requires a careful history, physical examination, and sometimes additional diagnostic tests to confirm. The key to diagnosis is a thorough evaluation of the patient's symptoms, medical history, and the characteristics of the lesion itself.