Dermatologists define several broad categories of skin disease based on clinical features and pathophysiology. The categories that are of primary interest from an infectious disease perspective include bacterial and mycobacterial infections, fungal infections, protozoal infections, viral infections, reactive erythemas, drug- and viral-induced hypersensitivity syndromes, and vasculitic diseases and purpura (Table 13–1).
Table 13–1. Diagnostic Categories of Selected Infectious and Non-Infections Etiologies of Rashes |Favorite Table|Download (.pdf)
Table 13–1. Diagnostic Categories of Selected Infectious and Non-Infections Etiologies of Rashes
Bacterial and mycobacterial infections
- Staphylococcal-scalded skin syndrome
- Toxic shock syndrome
- Ecthyma gangrenosum
- Rocky mountain spotted fever
- Cutaneous tuberculosis
- Cutaneous anthrax
- Nontuberculous (atypical) mycobacterial infections
- Secondary syphilis
- Ulceroglandular tularemia
- Erythema infectiosum (parvovirus B19 infection)
- Papular purpuric socks and gloves syndrome (parvovirus B19 infection)
- Infectious mononucleosis (Epstein–Barr virus (EBV) infection)
- Roseola infantum (human herpesvirus-6 and human herpesvirus-7 infection)
- Rubeola (measles)
- Hand-foot-and-mouth disease (coxsackie virus infection)
- Herpangina (coxsackie virus infection)
- Herpes zoster
- Cutaneous herpes and herpetic whitlow
- Herpes labialis
- Herpetic gingivostomatitis
- Eczema herpeticum
- Molluscum contagiosum
- Warts (verruca vulgaris, verruca plana, verruca plantaris, condylomata acuminata)
- Dermatophyte infections (tinea capitis, tinea corporis, tinea pedis, onychomycosis)
- Tinea versicolor
- Cutaneous candidiasis
- Subcutaneous mycoses (sporotrichosis)
- Systemic mycoses (blastomycosis, histoplasmosis, coccidiomycosis)
- Opportunistic mycoses (aspergillosis, mucormycosis, cryptococcosis)
- Cutaneous leishmaniasis
- Muocutaneous leishmaniasis
- Erythema multiforme
- Serum sickness and serum sickness-like reactions
- Erythema marginatum (acute rheumatic fever)
- Erythema chronicum migrans (Lyme disease)
- Morbilliform drug eruption
- Stevens–Johnson syndrome
- Toxic epidermal necrolysis
- Drug reaction with eosinophilia and systemic symptoms
Vasculitic diseases and purpura
- Rocky mountain spotted fever
- Purpura fulminans
- Kawasaki disease
- Hypersensitivity (leukocytoclastic) vasculitis
Establishing the differential diagnosis of a rash relies both on an appropriately focused history and on correctly describing the morphology and distribution of the rash. A brief overview of common terms used in dermatology is presented in Table 13–2. Common patterns of distribution are presented in Table 13–3.
Table 13–2. Common Morphologic Patterns of Dermatologic Disease |Favorite Table|Download (.pdf)
Table 13–2. Common Morphologic Patterns of Dermatologic Disease
A flat lesion <1 cm in diameter
A raised lesion <1 cm in diameter
A flat lesion >1 cm in diameter
Erythema chronicum migrans (Lyme disease)
A raised lesion with a flat top >1 cm in diameter
A raised lesion >1 cm in diameter
A clear fluid-filled lesion <1 cm in diameter
A fluid-filled lesion >1 cm in diameter
A cloudy fluid-filled lesion <1 cm in diameter
Neonatal staphylococcal pustulosis
A loss of the epidermis (superficial)
A transient edematous lesion, often with blanching or pallor centrally with surrounding erythema
A loss of the epidermis and part of the dermis and sometimes the subcutis (deep)
A linear cleft or ulcer
Angular chelistis (Candida ...
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