Acne*
Candidiasis*
Carbuncle
Cellulitis*
Dermatitis (atopic, contact, seborrheic)*
Drug-induced*
Folliculitis*
Furunculosis*
Impetigo
Intertrigo
Pityriasis rosea*
Stasis dermatitis*
Tinea infections (barbae, capitis, corporis, cruris, manum, pedis)*
Tinea versicolor*
Urticaria (angioedema)*
Varicella-zoster*
Actinic keratosis
Basal cell carcinoma
Bullous pemphigoid
Pemphigus vulgaris
Chancroid
Collagen vascular disorders (systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, vasculitis)
Diaper-related dermatitis
Erysipelas
Erythema chronicum migrans (Lyme disease)*
Erythema infectiosum
Erythema nodosum
Henoch-Schönlein purpura
Herpetic infections
Insect bites
Lichen planus
Lymphogranuloma venereum
Melanoma
Mycosis fungoides
Necrobiosis lipoidica
Pediculosis*
Pigmented nevus
Pretibial myxedema
Psoriasis
Roseola infantum
Sarcoidosis
Scabies*
Seabather’s eruption*
Seborrheic keratosis
Squamous cell carcinoma
Thrombocytopenia
Toxic epidermal necrolysis
Trichophyton infestations
Verruca (wart)
Vitiligo
Xanthelasma/xanthoma
use) and a history of recent exposure to persons with an infectious illness associated with rash. Other elements of the history useful in distinguishing among causes of rash include any changes in the appearance of the eruption, the manner of progression and distribution of the rash, and the presence of any associated symptoms that may suggest an underlying systemic illness. When severe pruritus confined to the area of skin involvement is the primary complaint, an allergic cause should be strongly considered.
Table 65-1 Lesion Description | ||||||||||||||||||||||||||||||||||||
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Table 65-2 Distribution Pattern | ||||||||||||||||
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Table 65-3 Rashes with Fever | ||||||||
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The closed comedo (whitehead) is the initial lesion, after which if the follicular contents extrude, the open comedo (blackhead) develops. Inflammatory papules, pustules, cysts, or abscesses may also evolve. Lesions generally occur on the face and neck but may also involve the back and chest.
Initial therapy in patients with mild (primarily noninflammatory) involvement includes the use of comedolytic or antibiotic agents, including alcohol-based benzoyl peroxide (once or twice per day), retinoic acid, or topical clindamycin (1%-3%) or oral tetracycline or erythromycin (250 mg twice daily or four times daily, depending on severity). Those with severe disease should be referred to a dermatologist.
Treatment depends on the clinical presentation and whether the immune system is compromised. Patients with temperatures greater than 101°F, other evidence of systemic toxicity (rigors, malaise, or significant leukocytosis), extensive involvement, established lymphangitis, or immune compromise (e.g., diabetes) commonly require hospitalization for the initiation of intravenous antibiotic therapy. Cellulitis due to animal or human bites, particularly when the hand is involved, should routinely be admitted; a culture should be obtained, the wound left open, surgical consultation and intravenous antibiotics instituted early with ampicillin/sulbactam (Unasyn) 1.5 g every 6 hours, or cefoxitin (Mefoxin) 2 g intravenous every 8 hours, cellulitis not associated with bite wounds. Patients who do not appear systemically ill and are not immunocompromised, are treated with oral antibiotics, cephalexin 500 mg every 6 hours for 7 to 10 days or Augmentin 875 mg twice daily for 7 to 10 days. For penicillin-allergic patients, use erythromycin. If MRSA is suspected, clindamycin is indicated. Heat and elevation are useful adjunctive measures. A wound check in 24 to 48 hours should be recommended. Orbital cellulitis can extend into the cavernous sinus, and these patients should be considered for inpatient therapy with a cephalosporin. Children with periorbital cellulitis should be evaluated for sepsis.
Atopic dermatitis (eczema) is a chronic pruritic eruption characterized by itching. Approximately one half of children with atopic dermatitis develop asthma or allergic rhinitis, and approximately two thirds have a positive family history.
The clinical presentation depends on age, with infants demonstrating primary involvement of the chest, face, scalp, neck, and the extensor surface of the extremities with papules, vesicles, oozing lesions, and crusts. In children aged 4 to 10, lesions are less acute, are localized to the flexor folds of the elbows, wrists, and knees, and become progressively lichenified and excoriated. During adolescence and early adulthood, the final phase of the disorder is characterized by densely lichenified, hyperpigmented plaques occurring periorbitally and in the flexor areas.
Treatment is symptomatic and involves preventive measures (avoidance of excess humidity and excess bathing), the judicious use of antihistamines, and application of Burow solution to weeping areas for 20 minutes four times daily. In persistent cases, topical corticosteroids, three to six times per day, are used. Only low-potency corticosteroids (i.e., 0.5%-1% hydrocortisone) should be used on the face to minimize steroid-induced atrophic changes in this cosmetically important area.
Itching is the most prominent symptom. When erythematous eruptions contain sharp cutoffs, or clearly demarcated borders (often corresponding to protection provided by clothing), or when straight-line or linear lesions are noted, contact dermatitis should be strongly suspected. Environmental irritants or allergic sensitizers are most often responsible for these eruptions. Nickel dermatitis at the site of a watchband on the wrist, hand dermatitis in individuals whose hands are exposed to chemical or abrasive agents in the workplace, and dermatitis about the periphery of the face adjacent to the hairline in response to hair sprays are three common forms of irritant contact dermatitis, all of which respond to avoidance of the irritant agent (if it can be tentatively identified) and topical corticosteroids.Related posts:
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