Skip to Main Content


High-Yield Facts


  • Erythema nodosum (EN) is an acute panniculitis consisting of deep, painful, bilateral, erythematous nodules, usually on the lower extremities, resulting from an underlying systemic illness

  • Erythema multiforme (EM) is an acute, immune-mediated mucocutaneous condition characterized by target lesions with concentric zones of color change, most commonly associated with herpes simplex virus (HSV) infection

  • Stevens–Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe immune-mediated hypersensitivity reactions characterized by diffuse bullous lesions and mucocutaneous involvement most commonly precipitated by medications such as anticonvulsants

  • Staphylococcal scalded skin syndrome (SSSS) is characterized by an erythematous rash followed by diffuse epidermal exfoliation

  • Purpura fulminans is a severe form of rapidly progressive purpura with multiorgan failure, usually associated with meningococcemia

  • Nonaccidental trauma should be suspected if bruising occurs on nonbony prominences or in areas not normally subjected to trauma during routine child play

  • Toxic shock syndrome (TSS) is an acute, toxin-mediated illness characterized by fever, erythroderma, hypotension, multiorgan involvement, and desquamation. Streptococcal TSS (STSS) is a similar disease caused by invasive group A Streptococcus (GAS). Each of these is a shock state.

  • Necrotizing fasciitis (NF) is a rapidly progressive, life and limb threatening infection by virulent bacteria with severe inflammation of the fascia and surrounding subcutaneous tissues

  • Kawasaki disease (KD) is an acute, self-limited, vasculitic syndrome in children. The diagnosis is established clinically by the presence of prolonged fever and four of the following five clinical features: conjunctival injection, oropharynx erythema, cervical lymphadenopathy, hand and foot erythema/swelling, and rash.

  • Urticaria, often referred to as hives, appears as blanchable, pruritic, raised, well-circumscribed areas of edema and erythema involving the epidermis and dermis

  • Angioneurotic edema (AE) is a self-limited localized swelling due to extravasation of fluid into interstitial tissues, most commonly involving the head, neck, hand, and gastrointestinal tract. Laryngeal involvement is life-threatening.




Dermatologic signs of systemic disease will be the primary focus of this chapter. Many diseases have clinical presentations where the dermatologic manifestations play a role in helping the clinician make the underlying diagnosis. Table 94-1 is a list of systemic diseases with their corresponding dermatologic manifestations, and the sections below describe pediatric emergencies in which the dermatologic characteristics play a large role in diagnosis.

Table Graphic Jump Location
TABLE 94-1Characteristic dermatologic manifestations of systemic diseases

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.