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FEVER AND SKIN RASH

FEVER AND SKIN RASH. DR M. YOUSRY ABDEL-MAWLA,MD. Zagazig Faculty of Medicine. INTRODUCTION. The differential diagnosis for febrile patients with a rash is extensive. Diseases that present with fever and rash are usually classified according to the morphology of the primary lesion.

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FEVER AND SKIN RASH

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  1. FEVER AND SKIN RASH DR M. YOUSRY ABDEL-MAWLA,MD. Zagazig Faculty of Medicine

  2. INTRODUCTION • The differential diagnosis for febrile patients with a rash is extensive. • Diseases that present with fever and rash are usually classified according to the morphology of the primary lesion.

  3. MORPHOLOGIC CLASSIFICATION of RASH • Maculopapular . • Petechial. • Diffusely erythematous with desquamation. • Vesiculobullouspustular . • Nodular.

  4. AETIOLOGICAL CLASSIFICATION • Viruses. • Bacteria. • Spirochetes. • Rickettsiae. • Medications • IMMUNOLOGIC-MEDIATED DISORDERS

  5. HISTORY • A detailed history can be quite helpful in identifying the cause of fever and a rash. • A history of recent travel. • Animal exposure and inscet bites. • Drug ingestion • Contact with ill persons should be noted. • The time of year can be a clue to certain diagnoses • Any rash that is sudden in onset and covers a large part of the body • Any rash that starts either shortly after a flu-like illness begins, or a rash that starts after a flu-like illness goes away

  6. Some disorders among travellers • Lyme disease. • Strongyloides stercoralis. • HIV/AIDS. • Rocky Mountain spotted fever. • Leishmaniasis. • Leprosy • STDs

  7. Animal & Insect Contact Disorders • Animal contactQ fever.Anthrax.Viral hemorrhagic fevers.Cat scratch disease • Insect exposure: Mosquitoes:Malaria.Dengue. FilariasisYellow fever. Ticks :Tick typhus . Rocky Mountain spotted fever Lyme disease . Sand flies :Leishmaniasis&Sandfly fever Black flies :Onchocerciasis

  8. Speacial care to the following • Conditions associated with valvular heart disease, • Sexually transmitted diseases or • Immunosuppression from chemotherapy. • Immune status is particularly important because many of the diseases that result in fever and a rash present differently in immunocompromised patients.

  9. Details about the rash : • Site of onset, • Rate . • Direction of spread, • Presence or absence of pruritus. • Temporal relationship of rash and fever. • It is also important to know whether any topical or oral therapies have been attempted.

  10. Identification of Primary Skin Lesions

  11. MACULE • Circumscribed area of change in normal skin color, with no skin elevation or depression; may be any size

  12. PAPULE • Solid, raised lesion up to 0.5 cm in greatest diameter

  13. NODULE • Similar to papule but located deeper in the dermis or subcutaneous tissue; differentiated from papule by palpability and depth, rather than size

  14. PLAQUE • Elevation of skin occupying a relatively large area in relation to height; often formed by confluence of papules

  15. VESICLE • Circumscribed, elevated, fluid-containing lesion less than 0.5 cm in greatest diameter; may be intraepidermal or subepidermal in origin

  16. BULLA • Same as vesicle, except lesion is more than 0.5 cm in greatest diameter

  17. LOOK FOR • The patient's vital signs and general appearance. • Signs of toxicity. • Adenopathy. • Oral, genital or conjunctival lesions. • Hepatosplenomegaly. • ]Evidence of excoriations or tenderness. • Signs of neck rigidity or neurologic dysfunction.

  18. LABORATORY DATA The complete blood count with differential, an erythrocyte sedimentation rate, A chemistry panel, liver function tests. Blood and urine cultures Aspirates, scrapings and pustular fluid may be obtained for Gram staining and culture. Tzanck test may : unroofing a lesion and taking a scraping of the lesion base. Biopsy samples : from nonhealing or persistent purpuric lesions. Biopsy of inflammatory dermal nodules and ulcers

  19. Specific diagnoses that may be confirmed histologically • Rocky Mountain spotted fever, herpetic infections, systemic lupus erythematosus, erythema multiforme, allergic vasculitis, secondary syphilis and deep fungal infections

  20. Serologic tests • Systemic lupus erythematosus. • Other collagen vascular disorders • Syphilis. • Rheumatoid arthritis . • Human immunodeficiency virus infection.

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