Cutaneous manifestations of systemic infections can include: 1. Osler nodes and Janeway lesions in infective endocarditis, appearing as tender nodules on fingers or palms. 2. Rashes caused by viral exanthems like measles, rubella, enteroviruses. Measles causes Koplik's spots. 3. Fungal infections in immunocompromised patients like candidiasis, dermatophytosis, cryptococcus causing papules or plaques. 4. Bacterial infections may cause cellulitis, ecthyma gangrenosum from Pseudomonas, or disseminated lesions in meningococcemia.

1. Skin manifestations of systemic
infections
BACTERIAL
ENDOCARDITIS
Embolic Lesions: Osler Nodes
• Palpable, tender, and almost
always in the pulp of the
fingers distally and
occasionally on the toes
• Red, hemorrhagic and
infarcted
• Caused by immune
complexes

2. Janeway Lesions
• Red, macular, papular,
infarctive,nontender,
and almost always on
the palms or soles;
usually part of the
vasculitis of SBE
• caused by vascular
phenomenon

3. (Infective
endocarditis)
acute
subconjunctival
hemorrhage

4. • Subungual Splinter Hemorrhages
• Septic embolic phenomenon.
• Linear in the middle of the nailbed in acute IE
(Distal hemorrhages are traumatic.) Common
in acute S. aureus IE.
• Petechial Lesions Small, nonblanching,
reddish-brown macules. Occur on extremities,
upper chest, mucous membranes

5. Cutaneous Manifestations and Characteristics of Infective Endocarditis
Cutaneous Manifestations Palpation Morphologic Findings
Osler node Tender Erythematous papules and
nodules with white
centers;
may become necrotic
Janeway lesions Nontender Hemorrhagic papules
Splinter hemorrhages Nontender Subungual hemorrhagic
streaks

6. anthrax
• Greek word,meaning
coal
• Gram positive
rod,bacillus anthracis
• painless papule that
evolves into a
hemorragic bulla with
surrounding brawny
non-pitting edema

7. CLASSIFICATION OF CUTANEOUS
TUBERCULOSIS
Exogenous inoculation: Skin inoculation
• Primary inoculation tuberculosis (PIT), i.e.,
tuberculous chancre: occurs at inoculated site in
nonimmune host.
• Metastatic tuberculosis abscess (MTA)
• Acute miliary tuberculosis (AMT)
• Orificial tuberculosis (OT)
Tuberculosis due to BCG immunization

8. • Tuberculosis Verrucosa
Cutis
• Initial papule with
violaceous halo. Evolves to
hyperkeratotic,warty, firm
plaque. Clefts and fissures
occur from which pus and
keratinous material can be
expressed. Border often
irregular.
• Lesions are usually single,
but multiple lesions may
occur. Most commonly on
dorsolateral hands and
fingers. In children, lower
extremities,knees. No
lymphadenopathy.

9. • Lupus Vulgaris..
• Hypertrophic forms result in
soft tumorous nodules.
• Ulcerative forms present as
punched-out, often
serpiginous ulcers
surrounded by soft,
brownish infiltrate. Usually
solitary, but several sites
may occur. Most lesions on
the head and neck, most
often on nose and ears or
scalp.

10. • Scrofuloderma
• Firm subcutaneous nodule that
initially is freely movable; lesion
then becomes doughy and
evolves into
irregular,deep-seated node or
plaque that liquefies and
perforates .
• Ulcers and irregular sinuses,
usually of linear or serpiginous
shape, discharge pus or caseous
material.
• Most often occurs in the
parotidal, submandibular,and
supraclavicular regions;
• SD most often results from
contiguous spread from
affected lymph nodes or
tuberculous bones (phalanges,
sternum, ribs) or joints.

11. • Metastatic Tuberculosis Abscess
• Also called tuberculous gumma . Subcutaneous
abscess,nontender, “cold,” fluctuant. Coalescing with
overlying skin, breaking down and forming fistulas and
ulcers. Single or multiple lesions, often at sites of
previous trauma.
• Acute Miliary Tuberculosis Exanthem.
• Disseminated lesions are minute macules and papules
or purpuric lesions. Sometimes vesicular and crusted.
Removal of crust reveals umbilication.Disseminated on
all parts of body, particularly trunk.

12. tuberculids
• Demonstratable tuberculosis focus,no acid
fast bacilli in the skin lesions,strong Montoux
test and tuberculoid granuloma on biopsy
• It includes-
I. Erythema induratum
II. Papulonecrotic tuberculid
III. Lichen scrofulosorum
IV. Erythema nodosum

13. • Erythema
induratum:tender
nodules and ulcers over
calves of young ladies

14. • The lesions appear as
small firm follicular
brownish pinhead
papules that occur
symmetrically on the
limbs, mainly on the
extensor surface, trunk
and face
• Central necrosis of the
lesions may follow,
ending with small-pitted
scars

15. • Lichen scrofulosorum
• The lesion occurs over the
trunk mainly in children
having tuberculosis of the
bone or lymph nodes.
• Skin presents with firm,
flat-topped hyperkeratotic
papules surmounted by
pustule or tiny scales,
arranged in groups and have
a very chronic course.
• The lesions may undergo
spontaneous involution and
may recur again.

16. • Erythema nodosum :
tender,erythematous
nodules and plaques
over shins

17. septicaemia
• Septic vasculitis:
there may be
palpable
purpura,haemorrhag
ic vesicles,skin
infarcts

18. Disseminated
intravascular
coagulation (DIC) is
• a widespread blood
clotting disorder
• Manifested by
purpura fulminans
(cutaneous
infarctions and/or
acral gangrene) or
bleeding from
multiple sites.

19. • Meningococcaemia:
• Neisseria meningiditis
• palpable purpura with
hemorrhagic vesicles
are present over limbs

20. Pseudomonas septicaemia:necrotic ulcers with yellow green
discharge
Ecthyma gangrenosum (EG) is the necrotizing
soft tissue infection that occurs after local tissue
invasion or bacteremic seeding, associated with
blood vessel invasion, septic vasculitis, vascular
occlusion, and infarction of tissue.

21. Viral infections
1. Viremia due to many viruses:maculopapular
or papulovesicular exanthem and enanthem
2. Hepatitis B:cutaneous vasculitis

22. measles
• Rubeola [measles]
• paramyxovirus
Koplik’s spots
• Behind the
ear,hairline,forehead
• Atypical measles

23. Koplik’s spots

24. • RUBELLA
• “little red”
• Toga virus
• German measles
• Retroauricular
lympadenopathy
• Suboccipetal
lymphadenopathy

25. ERYTHEMA
INFECTIOSUM
• Parvovirus B19
• Erythema of cheeks
followed by reticulated
pattern on extremities

26. • Rubelliform and roseoliform eruptions also
seen in
• Epstein barr virus
• Echovirus
• Coxsackievirus
• Cytomgalovirus
• Adenovirus
• Denguevirus
• West Nile virus

27. Scarlet fever
• Beta hemolytic
streptococcal infection
• Scarlantiform(confluent
blanching erythema)
• White strawberry
tongue
• Red strawberry tongue

28. Kawasaki disease(mucocutaneous
lymph node syndrome)
• Morbilliform and
scarlanitiform
• b/l conjunctival
injection,erythema and
edema of hands and
feet f/b
desquammation
• Diffuse erythema of
oropharynx,red
strawberry tongue,dry
fissured lips

29. Kawasaki disease:desquamation

30. HIV
• Cutaneous Signs Of Primary HIV Infection
Macularerythematous lesions on the trunk,
roseola-like or morbilliform eruptions in the
upper body or face
• and papulosquamous manifestations of the
palms and soles

31. Secondary Mucocutaneous Signs Of
HIV Infection
• Viral Infections:Herpes
simplex
• a recurrent self-healing
blistering eruption may
occur at any stage of
HIV infection
• Erosions enlarges and
deepen into painful,
non-healing ulcers

32. Varicella-Zoster
• can occur at any stage of
HIV disease
• in the majority a typical a
vesicular eruption in a
dermatomal pattern
• some cases develop
severe haemorrhagic and
necrotic lesions that may
extend over several
dermatomes, and
eventually disseminate all
over the body

33. Molluscum Contagiosum
• include skincoloured
umbilicated papules
with one or more
central hyperkeratotic
pores
• commonly on the face ,
genital regions
• Widespread lesions are
common and highly
characteristic of HIV
disease

34. Human Papillomavirus (HPV)
• incidence of facial and
intraoral warts is
increased and
anogenital lesions may
be florid

35. Fungal infections in HIV
• Cryptococcus neoformans-painless reddish
papules and nodules
• Histoplasma capsulatum- widespread
maculopapular rash, necrotic papules and ulcers
• Sporotrix schenkii-papulonodular eruptions
• Candida spp, Dermatophytes and Malassezia
furfur infections are the most common
pathogens responsible for superficial mycoses in
HIV infected patients.

36. • Histoplasma capsulatum-
widespread
maculopapular rash,
necrotic papules and
ulcers

37. Candidiasis
• most common cause of
fungal infections
• Candida albicans,C.
tropicalis, C. kruzei and
C.glabrata
• may affect both oral
mucosa and skin
• Skin involvement includes
intertrigo, folliculitis,
paronychia, and/or
onychomycosis

38. Oropharyngeal candidiasis
• 4 patterns-
• l) pseudomembranous (thrush)
characterized by whitish or
yellowish plaques within the oral
cavity;
• 2) erythematous or atrophic,
characterized by bright red erosions
or ulcers within the oral cavity;
• 3) hyperplastic, characterized by
exuberant yellowish-whitish
plaques
• 4)angular cheilitis, characterized by
crusting, fissuring and erythema at
the angles of the mouth

39. Dermatophyte Infections
• chronic and unusually
widespread, and the
morphology may be altered
by enhancement or
diminuition of the
inflammatory component
• Nail involvement is
common often affecting all
finger nails and toe nails,
may occur in an unusual
form featuring proximal
whitening of nail plate

40. Pityriasis Versicolor
• Malassezia furfur
• pityriasiform desquamation
and hypopigmented or
hyperpigmented macules
formation, primarily
located on the chest and
back with tendency to
spread
• unusually extensive and
persistent in advanced
immunosuppression

41. scabies
• Crusted (Norwegian)
scabies in which the
number of infesting
mites can increase
enormously
• generalized
scaling-to-marked
hyperkeratosis

42. Kaposi's Sarcoma
• Skin lesions include red,
purplish or brown
coloured macules,
nodules or plaque
• Any part of the body
surface may be affected
but
• common sites are trunk,
legs, face and oral
cavity

43. Miscellaneous Disorders associated
with HIV
• Seborrhoeic Dermatitis
• Psoriasis Vulgaris
• Reiter’s Syndrome
• Ichthyosiform Dermatosis
• Papular/Pruritic Eruptions
• Eosinophilic Folliculitis
• Adverse Cutaneous Drug Reactions
• Oropharyngeal candidiasis
• Oral Hairy Leucoplakia
• Aphtous Ulcers

44. Syphilis• Primary syphilis:initial lesion,called
chancre,evolve after 3-90 days of
exposure
• classically (40% of the time) a single,
firm, painless, non-itchy skin
ulceration with a clean base and sharp
borders between 0.3 and 3.0 cm in
size
• multiple lesions may be present
(~40%),more common when
coinfected with HIV
• may be painful or tender (30%), and
they may occur outside of the genitals
(2–7%)
• most common location (in
women) cervix (44%), penis in
heterosexual men (99%),
and anally and rectally relatively
commonly in homosexual men (34%)
• lesionmay persist for three to six
weeks without treatment

45. • Secondary syphilis occurs
approximately four to ten weeks
after the primary infection
• commonly involve the
skin, mucous membranes,
and lymph nodes.
• There may be a symmetrical
reddish-pink non-itchy rash on the
trunk and extremities, including
the palms and soles. The rash may
become maculopapular or pustula
r. It may form flat, broad, whitish,
wart-like lesions known
as condyloma latum on mucous
membranes

46. Leptospirosis
• Red, irregular blotches
appear on the skin that
are dark red in color,
sometimes turning a
purple hue. They can
appear anywhere on
the body but are often
seen on the lower legs
and the palatte
• Do not blanch on
pressure

47. Fungaemia
• Cryptococcosis:
• Papules,nodules
and ulcers over
face and limbs are
seen

48. • Histoplasmosis:
Papules or nodules;
erythematous, necrotic,
• or hyperkeratotic
• Erythematous macules;
scaling

49. Parasitic infestations
• Post kala-azar dermal
leishmaniasis:
• Sequel to VL
• Lesions appear ≥1 y
after course of therapy
with macular,papular,
nodular lesions, and
hypopigmented
macules/plaques on
face, trunk, extremities.

50. • Cysticercosis:
• May present as
asymptomatic
subcutaneous nodules
over trunk