Typical maculopapular exanthem |
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Drug-induced exanthem | Types | Simple drug-induced exanthem Hypersensitivity to Drugs 1 2
- Resembling measles, morbilliform
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Multiform drug-induced exanthem
- Annular lesions 3 4
- Rosette lesions 5
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Severe drug reactions
- Often also mucosal lesions 6
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Most common causes in Finland | Antimicrobial drugs
- Beta-lactam antibiotics, sulfonamides, fluoroquinolones and terbinafine
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NSAIDs |
Drugs with CNS effect
- Phenytoin, carbamazepine 7 and lamotrigine are the most common
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Exanthems triggered by infections | Most common causes in Finland | Mononucleosis Mononucleosis
- 10 to 15% of those with mononucleosis develop an exanthem.
- If amoxicillin is administered, nearly every patient develops an exanthem 8.
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Streptococcal infections in connection with tonsillitis Pharyngitis and Tonsillitis in Children, for instance
- Classic scarlet fever, for example, causing scaling of the palms and soles while healing
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Viral infections of the upper respiratory tract
- Influenza, parainfluenza, adenoviruses, coronaviruses, e.g. COVID-19, etc.
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Gastrointestinal virus infections
- E.g. enteroviruses and arboviruses
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Bacterial infections of the upper respiratory tract
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Rare causes | Borreliosis
- Multilocular erythema migrans 9 Lyme Borreliosis (LB) with several larger erythematous lesions may trigger a reactive exanthem.
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Acute cytomegalovirus infection |
Acute HIV infection HIV Infection
- Typical roseola-like rash
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Viral hepatitis Viral Hepatitis |
Secondary syphilis Syphilis
- Syphilis II, roseola-like rash 10
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Toxic exanthems caused by Staphylococcus infections
- Toxic shock syndrome, staphylococcal scalded skin syndrome in the newborn
- Impaired general condition, large erythematous lesions on the trunk and limbs, on recovery scaling of the palms and soles, for example
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Classic pox diseases (check vaccination)
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Tularaemia Tularaemia 13
- Ulcerous papule at site of infection, enlarged regional lymph nodes
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Pogosta disease Pogosta Disease 14
- Pogosta disease, exanthem with small lesions and few systemic symptoms
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Causes in children | Exanthema subitum Exanthema Subitum 15 16 |
Erythema infectiosum Erythema Infectiosum 17
- Some patients have fever, a sore throat and muscle pain before developing the exanthem.
- The exanthem usually begins on the face ("slapped cheek") and spreads in a few days to the upper and sometimes lower limbs.
- It may show a lacy, net-like pattern.
- The exanthem may disappear and reappear repeatedly for several weeks.
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Kawasaki disease Kawasaki Disease
- Fever, enlarged lymph nodes, conjunctival, oral and pharyngeal symptoms
- Complex exanthem, usually consisting of flushing erythematous lesions, erythema and swelling of the hands and feet
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Atypical exanthem |
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Exanthem with blisters or papulopustules (vesicular or pustular) | Common | Chickenpox 18
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Extensive hand, foot and mouth disease 19 20
- May spread from palms and soles to other sites on the limbs and sometimes also to the trunk.
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Extensive folliculitis (furunculosis) 21 |
Rare | Pustular or acneiform exanthems triggered by medication
- Caused, for instance, by systemic glucocorticoids
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Papular exanthem | Types | Papular acrodermatitis of childhood (Gianotti-Crosti syndrome) 22 23
- Buttocks, elbows and knees, can also appear in cheeks, often symmetric
- Often triggered by a viral respiratory infection
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Laterothoracic exanthem of childhood
- Unilateral, asymmetric, primarily on the trunk, for example on one flank
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Molluscum contagiosum (wide-spread) 24 |
Purpuric exanthem (petechiae and extensive purpura in addition to the exanthem) | More common | Purpuric exanthems triggered by infections
- Viral respiratory and intestinal tract infections
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Parvovirus B19 infections
- Various types, such as the purpuric gloves and socks syndrome (symmetric purpuric exanthem of hands and feet)
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Epidemic nephropathy (Puumala virus infection)
- Purpuric exanthem in about 5 to 10% of cases
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Drug rashes Hypersensitivity to Drugs |
Pigmented purpuric dermatoses |
Rare | Thrombocytopenia |
Vasculitis
- Leukocytoclastic vasculitis of the skin 25
- Henoch-Schönlein purpura 26
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Septic infections, such as
- meningococcal meningitis (impaired general condition, neurological symptoms, purpuric exanthem, extensive haemorrhagia on the skin)
- gonococcus
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