DD of Maculo-papular Rash with Fever Chickenpox Measles Mononucleosis
Common Exanthematous Diseases Measles Maculopapular (5 days) IP (10-14 days) Koplik’s spots, Prodromal illness, complications are common. Rubella Macular --> maculopapular (3 ds) IP (14-21 days) Malaise, little or no fever Chickenpox Maculer --> Papules --> Viscles --> IP (1-14 days) Crust (7ds) No other symptoms apart from rash & low grade fever
ChickenpoxIncubation period: 1-14 days :Complications Secondary infection :Rare Encephalomyelitis
German measles Incubation period: 14-21 days Days of illness Progression over 4 days Maculopapular ComplicationsRashIng. Nodes Rare:Malaise ArthritisURTI Encephalitis Purpura
DD. Of Generalized Skin Rash This 32-year-old extravenous drug abuser complained of headaches and arthralgia & maculopapular rash This may occur shortly before seroconversion in HIV-infected individuals
DD of Maculo-papular Rash with Fever Typhoid fever
Typhoid feverDistribution of rose-spot rash: The typical rash oftyphoid fever may appear towards the end of the first weekbut it has been recorded as late as the 20th day. It is presentin about half the adults with typhoid but is less common inchildren. Rose spots are difficult to detect on dark skins.
DD of Maculo-papular Rash with Fever Secondary syphilisErythemainfectious(5th)Earlymeningitis
Early rash of meningitis:Fleeting macular or papular rash.This may occur alone or proceedinghemorrhagic eruption by few hours
Suspected Meningococcal Infection Immediate Treatment Adult and children older that 10 years 1200 mg Benzyl penicillin. IM Children aged 1-9 years 600 mg Benzyl penicillin. IM Infants aged less than 1 year 300 mg Benzyl penicillin. IM
Secondary Syphilis-rashThe rash may be papules or pustules and crusts
DD of Papulosquamous Exanthems Secondary syphilis
DD of Papulosquamous Exanthems * Figure 5. Drug eruption * Figure 6. Erythrodermic drug eruption 5 6 * Figure 7. Psoriasis * Figure 8. Lichen planus 7 8
DD of Pustular Lesions Non-infective ConditionsLarge, tense blisters in bullous pemphigoid
Pemphigus vulgaris demonstrating Bullous pemphigoid with flaccid bullae which are easily tense vesicles and bullae ruptured, resulting in multiple on an erythematous, erosions and crusted plaques. urticarial base.
DD of Pustular LesionsNon-infective Conditions Linear blistering lesions in primula dermatitis Bullae occurring as a reaction to flea bites on the ankle
BlistersVasculobullous lesions on Phototoxic bullaethe palm, Characteristic associated with of pompholyx nalidixic acid
DD of Pustular Lesions Infective ConditionsSepticemia, probably gonococcal.
Purpuric or Petechial Rash Differential Diagnosis Infections : Bacteremia (with or without DIC) o Infectious endocarditis o Meningococcemia o Gonococcemia or other pathogenic bacteria Enteroviral infection Dengue fever Hepatitis Rubella Infectious Mononucleosis
DD of Purpuric or Petechial Rash Rash of meningitis
Purpuric or Petechial Rash Differential Diagnosis Non-infectious causes : Allergy Low platelets of any cause Scurvy Henoch-Schonlain purpura Vasculitis Acute rheumatic fever Hyperglobulinemia
Purpuric Rash Bruises (ecehymoses) in a patient with coagulation meningococcal defects due toHenoch- septicemia - often acute hepaticSchonlein disease sparse and need to be necrosis looked for carefully
Purpuric Rash Vasculitis. Palpable purpuric papules on the lower legs are seen in this patient with coetaneous small vessel vasculitis.
Patient with rash Warning Presentation Associated symptoms suggestive of serious illness. Purpuric or petechial rash Generalized pustular rash Infection in dangerous area E.g.. eyes, dangerous area of the face. Very toxic patient
Pruritus History Duration, localization & character of the itch. Provocating factors Diurnal variation Sleep disturbance Occupational history Itchy contact
PruritusExamination & warning presentation Examination : Patient general condition Characteristic of the skin lesion e.g. o Burrows of scabies o Lichenification of eczema o Skin discoloration o Scaly lesion Warning presentation : No overt skin disease Ill elderly patient (cancer)
Some common dermatological conditions associated with itching Severe Moderate Infestation : Scabies, lice Psoriasis Insect bites Fungal infections Eczema Pityriasis rosea Articaria Pemphigiod Dermatitis herpetiformis Xerosis (dry skin) Lichen planus Localized Itching Lichen simplex Pruritus ani Drug reactions Pruritus vulvae
Some common dermatologicalconditions associated with itching Severe Infestation : Scabies, lice Insect bites Eczema Urticaria Dermatitis herpetiformis Lichen planus Lichen simplex Drug reactions
The head louse: Head lice need relativelyPhysical evidence of prolonged head-to-beadliving lice is required contact. Estimates suggest itbefore treatment takes of least 30 seconds forbegins, but they con lice to move from one besidebe difficult to detect to another
Dermatological conditions associated with severe itchingChildhood atopic eczema. Facial atopic eczema.
Dermatological conditions associated with severe itching Eczema Hyperkeratotic hand Vesicular hand dermatitis eczema. (pompholyx). Infected hand eczema (Ring) dermatitis
Dermatological conditions associated with severe itching Urticaria
Dermatological conditions associated with severe itching Urticaria showing charac- teristic discrete and confluent, edematous, erythematous papules and plaques.
Dermatological conditions associated with severe itching ScabiesWidespread pruritis rash of scabies. Characteristic burrow ofscabies..
Dermatological conditions associated with severe itching Dermatitis herpetiformisHerpes simplex infection associated with atopic dermatitisIt was misdiagnosed as pyoderma and treated withantibiotics for more than 2 weeks
Dermatological conditions associated with severe itchingDermatitis herpetiformis manifested bypruritic, grouped vesicles in a typical location.The vesicles are often excoriated and may occuron knees, buttocks, and posterior scalp.
Dermatological conditions associated with severe itching lichen planus Flat-topped violaceous Wickhams striae papules of lichen planus. (lichen planus).
Dermatological conditions associated with severe itching Lichen planus showing multiple flat-topped, violaceous papules and plaques. Nail dystrophy as seen in this patients thumbnail may also he a feature.
Dermatological conditions associated with severe itching Lichen simplexlichen simplex Lichen simper of Lichenificationchronicus scrotum from constant rubbing
Dermatological conditions associated with severe itching Angio-edema Most drugs have the potential to cause angio-edema, urticaria, pruritus and maculopopular rash
Dermatological conditions associated with severe itching Widespread urticaria Severe angio-oedema
Some common dermatologicalconditions associated with itching Moderate: Psoriasis Fungal infections Pityriasis rosea Pemphigiod Xerosis (dry skin)
Some common dermatological conditions associated with moderate itching Pityriasis rosea Psoriasis
Common Cause of Local Itching Pruritus ani - perianai dermatitis.
Aphthus UlcerAphthous ulcers: Small ulcers, 1 – 4 mm in diameter mayoccur on healthy persons as a recurrent, painful, self-limiting problem lasting five to six days, aetiology unknown.An aphthous-like ulcer may occur on the pharynx ininfectious mononucleosis