DR M. YOUSRY ABDEL-MAWLA,MD. Zagazig Faculty of Medicine 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.

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

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

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

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

Animal & Insect Contact Disorders Animal contact Q 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

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.

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.

Identification of Primary Skin Lesions

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

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

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

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

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

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

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.

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

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

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

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