Approach to the Differential Diagnosis of an Exanthematous Drug Reaction - Flowchart
Approach to the Differential Diagnosis of an Exanthematous Drug Reaction - Flowchart Exanthematous Drug Reaction Exanthematous Drug Reaction
«Flowchart»

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Sterile pustules

Sterile pustules

Sterile pustules

Vesicles, bullae, erosions, crusts

Vesicles, bullae, erosions, crusts

Vesicles, bullae, erosions, crusts

Petechiae, purpura (in morbilliform drug eruptions, can be seen on lower legs)

Petechiae, purpura (in morbilliform drug eruptions, can be seen on lower legs)

Petechiae, purpura (in morbilliform drug eruptions, can be seen on lower legs)

Favors back in bedridden patient (drug eruption can first appear in this location)

Favors back in bedridden patient (drug eruption can first appear in this location)

Favors back in bedridden patient (drug eruption can first appear in this location)

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AGEP
Pustular psoriasis
DRESS/DIHS (less common finding)
Sweet syndrome

AGEP
Pustular psoriasis
DRESS/DIHS (less common finding)
Sweet syndrome

AGEP
Pustular psoriasis
DRESS/DIHS (less common finding)
Sweet syndrome

AGEP
Pustular psoriasis


Varicella, other viral exanthems (e.g., coxsackievirus)
EM/SJS/TEN
Staphylococcal scalded skin syndrome
Disseminated zoster or herpes simplex**
Insect bite reactions, including scabies
DRESS/DIHS (less common finding)
Drug-induced autoimmune bullous disorders
Sweet syndrome
PLEVA
Lupus erythematosus (e.g., Rowell syndrome)
Severe GVHD
Langerhans cell histiocytosis

Varicella, other viral exanthems (e.g., coxsackievirus)
EM/SJS/TEN
Staphylococcal scalded skin syndrome
Disseminated zoster or herpes simplex**
Insect bite reactions, including scabies
DRESS/DIHS (less common finding)
Drug-induced autoimmune bullous disorders
Sweet syndrome
PLEVA
Lupus erythematosus (e.g., Rowell syndrome)
Severe GVHD
Langerhans cell histiocytosis

Varicella, other viral exanthems (e.g., coxsackievirus)
EM/SJS/TEN
Staphylococcal scalded skin syndrome
Disseminated zoster or herpes simplex**
Insect bite reactions, including scabies
DRESS/DIHS (less common finding)
Drug-induced autoimmune bullous disorders
Sweet syndrome
PLEVA
Lupus erythematosus (e.g., Rowell syndrome)
Severe GVHD
Langerhans cell histiocytosis

Varicella, other viral exanthems (e.g., coxsackievirus)
EM/SJS/TEN

Staphylococcal scalded skin syndrome
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Viral exanthem (e.g., enterovirus, parvovirus)
Meningococcemia
Rocky Mountain spotted fever and other rickettsioses
Viral hemorrhagic fevers
Vasculitis
Acute hemorrhagic edema of infancy

Viral exanthem (e.g., enterovirus, parvovirus)
Meningococcemia
Rocky Mountain spotted fever and other rickettsioses
Viral hemorrhagic fevers
Vasculitis
Acute hemorrhagic edema of infancy

Viral exanthem (e.g., enterovirus, parvovirus)
Meningococcemia
Rocky Mountain spotted fever and other rickettsioses
Viral hemorrhagic fevers
Vasculitis
Acute hemorrhagic edema of infancy






Acute hemorrhagic edema of infancy

Miliaria
Grover disease
Folliculitis

Miliaria
Grover disease
Folliculitis

Miliaria
Grover disease
Folliculitis



**Immunocompromised host

AGEP = acute generalized exanthematous pustulosis

DIHS = drug-induced hypersensitivity syndrome

DRESS = drug reaction with eosinophilia and systemic symptoms (additional findings include lymphadenopathy, atypical lymphocytosis, hepatitis, myocarditis and renal dysfunction as well as facial swelling > vesicles or sterile pustules)

EM/SJS/TEN = erythema multiforme/Stevens–Johnson syndrome/toxic epidermal necrolysis

GVHD = graft-versus-host disease

PLEVA = pityriasis lichenoides et varioliformis acuta

**Immunocompromised host

AGEP = acute generalized exanthematous pustulosis

DIHS = drug-induced hypersensitivity syndrome

DRESS = drug reaction with eosinophilia and systemic symptoms (additional findings include lymphadenopathy, atypical lymphocytosis, hepatitis, myocarditis and renal dysfunction as well as facial swelling > vesicles or sterile pustules)

EM/SJS/TEN = erythema multiforme/Stevens–Johnson syndrome/toxic epidermal necrolysis

GVHD = graft-versus-host disease

PLEVA = pityriasis lichenoides et varioliformis acuta

**Immunocompromised host

**

AGEP = acute generalized exanthematous pustulosis

DIHS = drug-induced hypersensitivity syndrome

DRESS = drug reaction with eosinophilia and systemic symptoms (additional findings include lymphadenopathy, atypical lymphocytosis, hepatitis, myocarditis and renal dysfunction as well as facial swelling > vesicles or sterile pustules)

EM/SJS/TEN = erythema multiforme/Stevens–Johnson syndrome/toxic epidermal necrolysis

GVHD = graft-versus-host disease

PLEVA = pityriasis lichenoides et varioliformis acuta