Skin Changes in Skin, Blood and Lymph

Question 1

Which infections cause a “diffuse maculopapular rash”? (5)

Answer 1

Measles

Rubella

Erythema infectiosum (parvovirus B19)

Infectious mononucleosis

Lyme disease

Question 2

What symptoms should suggest measles?

How long does the “mobiliform eruption” last?

What are the severe complications?

Answer 2

Prodrome of fever, cough, coryza (inflammation of mucous membranes) and conjunctivitis.
Koplik spots on buccal mucosa.

3-5 days.

Pneumonia and post-measles encephalitis.

Question 3

Where does the rash tend to cluster in measles?

Answer 3

Face and neck - typically spares the trunk and abdomen.

Question 4

What is the presentation of rubella (German measles)?

Who should be very concerned about contracting it?

Answer 4

Short prodrome with a rash duration of 2-3 days.
Enlargement of cervical, suboccipital and postauricular glands.

Pregnant women: high risk for fetal malformations (microcephaly, CHD, deafness) in the 1st trimester.

Question 5

How is the rash in rubella described?

When does it occur?

Answer 5

Exanthem: erythematous macules and papules appearing initially on the face and spreading to trunk, arms and legs within 24 hrs. The rash on the face tends to be discrete while the rash on the trunk is more coalescent.

It occurs 14-17 days post-exposure. It usually disappears after 2-3 days. Desquamation may follow.

Question 6

What symptoms are seen in erythema infectiosum?

What virus causes it?

What does the rash look like?

Answer 6

Malaise, HA and pruritis (palms and soles), but little fever.

Parvovirus B19

Fiery red “slapped cheek” appearance withe circumoral pallor.

Question 7

What does parvovirus cause in childhood classically?

What symptoms does it tend to cause in adults?

What rash does it cause?

Answer 7

Myocarditis

A transient aplastic crisis and pure red cell aplasia.
Autoimmune disease-like symptoms.

Erythema infectiosum.

Question 8

What can parvovirus B19 cause in pregnancy?

Answer 8

Premature labor, hydrops fetalis and fetal loss.

Question 9

What is the name of the rash in Lyme disease and how does it appear?

Answer 9

Erythema migrans - a flat or slightly raised red lesion that expands with central clearing “bulls-eye lesion”.

Question 10

What oral/mucous membrane changes are seen in infectious mononucleosis?

What rash is seen?

Answer 10

Petechiae on tongue and soft palate.

Maculopapular

Question 11

What infections tend to cause “peripheral skin eruptions”? (4)

Answer 11

Meningococcemia
RMSF
Secondary syphilis
HFM disease

Question 12

How does the rash in RMSF appear?

Answer 12

It is not always found, but it presents as a faint macule that progresses to large maculopapules and often petechiae.
The rash begins on wrists/ankles (involving palms/soles) and spreads to arms, legs, and trunk.

Question 13

What skin/mucous membrane changes are seen in secondary symphilis? (3)

Answer 13

Diffuse macular, papular, pustular rash (may include palms/soles).

Codylomata lata - wart-like lesions.

Mucous patches - painless, silvery ulcerations of mucous membranes with surrounding erythema.

Question 14

What is the hallmark rash of HFMD?

Where is the rash found?

Answer 14

Vesicular eruptions on the palms and soles. Lesions begin as bright pink macules and papules that progress to 4-8 mm. vesicles with surrounding erythema.
The vesicles quickly erode and form yellow to gray, “football-shaped” erosions surrounded by a halo.

Typically it is found on palms, soles and sides of feet, buttocks and genitals.

Question 15

What infections/processes are seen with desquamative skin changes? (3)

Answer 15

TSS
Scarlet fever
Erythema multiforme

Question 16

What symptoms suggest the onset of TSS?

What type of rash is typical?

Answer 16

Abrupt onset of fever, vomiting and watery diarrhea with possible conjunctivitis.

Desquamation of the palms and soles during recovery*.
The eruptions associated with TSS vary from morbilliform, scarltiniform or even pustular.

Question 17

What is the prodrome of scarlet fever?

What is the rash?

What bug causes it?

Answer 17

Up to 2 days of malaise, sore throat, fever and vomiting.

Generalized, punctate and red. It is common in te neck, axilla, groin and skin folds. Fine desquamation may occur in the hands and feet.
“Strawberry tongue” and exudative tonsilitis.

Grp. A beta-hemolytic strep. (Strep. pyogenes)

Question 18

What 2 bugs may cause erythema multiforme?

What location is another site of lesions?

Answer 18

HSV and mycoplasma pneumoniae

Mucosa - lips, gingiva and ventral tongue. They appear as target lesions.

Question 19

What can cause vesicular and bullous lesions? (2)

Answer 19

Varicella

Pemphigus

Question 20

Where does the rash exist in varicella?

What are the hallmarks?

Answer 20

Rash begins on face and scalp and spreads to the trunk, with sparing of extremities. Lesions are scattered, not clustered.

The progress of the rash occurs sequentially from rose-colored macules to papules, vesicles, pustules and crusts. *Lesions in all stages are usually present at the same time.

Question 21

Which cause of diffuse maculopapular rash is highly associated with pharyngeal symptoms?

Answer 21

Mononucleosis

Question 22

How do lesions in pemphigus present?

What do they look like?

Answer 22

Either pruritic or painful lesions.

The are flaccid blisters which can occur anywhere on the skin (not palms/soles). They are fragile.

Question 23

Which etiologies can cause petechial and purpuric lesions? (3)

Answer 23

Gonococcemia
Meningococcemia
TTP

Question 24

What is the classic triad of gonococcemia?

What are common skin findings?

What term is used to describe the cutaneous lesions in disseminated gonoccocemia infection?

What causes the lesions to go away?

Answer 24

Dermatitis, migratory polyartritis, tenosynovitis.

Small to medium-sized macules or hemorrhagic vesicopustules on an erythematous base on palms and soles.

“Gun metal gray” appearance due to hemorrhage and necrosis.

They go away after treatment is given.

Question 25

What skin change occurs in acute meningococcemia?

How does it appear if DIC is a complication?

Answer 25

A petechial rash in the extremities.

DIC leads to purpura fulmigans, which is a retiform purpura and necrosis of the skin. It may lead to gangrene of the digits and distal extremities.

Question 26

What is the appearance of basal cell carcinoma of the skin?

Answer 26

The lesions present as a waxy, pearly appearance with telangiectatic vessels. They are almost translucent.

Question 27

What is the appearance of squamous cell carcinoma of the skin?

Answer 27

They appear as non-healing ulcers/warty nodules. They are small, red, conical, hard nodules that occaionally ulcerate.

Question 28

What is used to describe the appearance of melanoma?

Answer 28

Asymmetry

Borders are uneven

Color changes - best sensitivity/specificity of metastatic potential.

Diameter >5/6 mm.

Evolution over time