Erythematous Rashes

Question 1

Generalized erythema

Answer 1

Erythematous macules/papules that are widesrpread and often become confluent

Question 2

Drug eruptions…what to look for, type of txn, appearance nad location

Answer 2

Sudden onset of a symmetric morbilliform rash

Antibiotics, NSAIDS, furosemide, hydrochlorothaizide

Most common cutaneous drug reaction

Not a true allergy, but a delayed type hypersensitivity rsxn from drug specific T cells

Usually sudden appearance with instense red macules on the trunk…over next seveeal days may coalesece and spread to extrimities

Question 3

Diagnosis of drug eruption

Answer 3

Diagnosis in individuals who develop red eruption across trunk with areas of confluence 1-2 after starting a new med…stop the offending drug

Question 4

DRESS…type of rxns, drugs, timeline

Answer 4

Drug reaction wit heosinophilia and systemic sympomts

Delayed- type hypersnesitivity rxns

Anti-epileptics, sulfonomaides, allopurinol

2-6 weeks after drug initiaion

Morbilliform pattern with systemic sx…may also get hematologic abnormalities

Question 5

Organ dysfunction of DRESS and amagement

Answer 5

Liver- hepatomegaly, elevated ALT or bilirubin
Kidney - acute intersitital nephritits
Lung - tachypnea, dyspnea, hypoxemia

Discontinue

Question 6

SJS and TEN…pathology, timeline, sx

Answer 6

Stevens-johnson and toxic epidermal necrolysis

Drug eruptions…cell-mediated reactions leads to massive keratinocyte apoptosis of cutanoues and mucosal epidermis

2-6 weeks and same drugs as DRESS

Influenza-like illness

Skin will be tender to touch and can blister

Question 7

SJS and TEN differences, managment

Answer 7

SJS is less than 10% blistering…TEN is more than 30…overlap in between

Discontinue but may take 2-4 weeks for full healing

Question 8

Viral exanthem

Answer 8

One of the most common childhood diseases`

Question 9

Morbillivius dz and characteristics

Rubivirus dz and characteristics

Answer 9

Measles - fever, cough, coryza and conjunctivities (3 Cs)

Rubella - self-limited of low grade fever and mild rash for 1-3 days

Question 10

Parvovirus and HHV 6 dz and characteristics

Answer 10

Erythema infectiosum (Fifth-s dz) - edematous, erythematous plaques on cheeks (slapped cheeks) and red macuklar/reticular rash on trunk and extremities (lace-LIke)

Roseola infantum (exanthem subitum) - prodrome of fever, irritability, and malaise about 4 days…once fever usbsides, macules nad papules form

Question 11

Enterovirus and EBV dz and cahracteristics

Answer 11

Vrious…some can be vesicular

MONO - fever, malaise, tonsillitis, pharyngitics…rash after B-lactams

Question 12

Viral exanthem patho

Answer 12

Gain entery through resp (most) or GI (enterO), a viremic phase allows dissemination to the skin…most present with prodrome of fever and const sx

Question 13

Measles ….org, transmission, course, complications

Answer 13

Infection with morbillivirus rubeola

Highly contagious with airborne transmission

2-4 days prodrome of fever, malaise, and anorexia followed by cough, coryza and conjuntivities…get Koplik’s spots on buccal mucosa

Then get rash on face that spreads to trunk and extrimities…recovery occurs after appearance of the rash

Can get pulm and neuro infection

Penumoniia most common cause of death

Encephalitis, subactue scleorsing panencepahitlis

Question 14

Measles dx

Answer 14

Unimmunized with maculopapular rahs for over 3 days with fever and 3 Cs…can test for measles IgM

Question 15

Rubella…course, time, complications

Answer 15

Mild ilness with fever, cough, ad ncoryza followed by macules and papules on face, trunk and extremities for 1-3 days

Adults can get post-viral arthritis

Infection during pregnancy can get ocngnenital rubella syndrome

Question 16

Erythema infectiosum…org, transmission, course, hallmark, comps

Answer 16

Parvovirus B19
Enters through resp and replicate in erythroid progenitor cells in bone marrow

Mild febrile with prodrome of fever, coryza, HA, N and diarrhea

Slapped cheecks with lacy rash

Most recover over next week but some with arthritis

If hands, wrists, knees, feet hurt, then intial manifestations of rheumatoid arthritis

If chronic hemolysis then can get aplastic chrisis…pallor and lethargy with anemia

Question 17

Roseola infantum…org, age, sx, course, comp

Answer 17

HHV6…under 2 y/o

High fever, conjunctivitis, and pharyngitis for 3-5 days…as fever resolves, get rash…rash self limitied

Seizures are comp

Question 18

Enterovirus infection…course and sx

Answer 18

Wide variety…most have mild febrile illness…normally prodrome of 1-2 days followed by development of macules and papuleson trunk and moving to extremitieis

Question 19

Mono…org, what to look for

Answer 19

EBV

Prodrome of fever, HA, low grade fever with tonsillits, pharyngitis and cervical lymph node nelargemnt

Rash is uncommon…100% will develop a rash after Beta-lactams due to misdiagnosis of strep

Question 20

Scarlet fever…patho, course, sx,

Answer 20

S. pyogenes with production of erythrogenic exotoxin

Results in pharyngitis and erythematous exanthema

Diffuse plaques that feel like “sandpaper”

Starts in flexurla and moves to trunk and extrmeities

Pastia’s sign - accented in flexural