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Causes of Exanthems

  1. Morbilliform
    1. Drugs
    2. viral
      1. Rubeola (measles)
      2. Rubella
      3. Erythema infectiosum      
      4. Epstein-Barr virus, echovirus, coxsackievirus, and adenovirus
      5. Early HIV (plus mucosal ulcerations)
    3. Bacterial
      1. Typhoid fever     
      2. Early secondary syphilis     
      3. Early rickettsia  
      4. Early meningococcemia
    4. Acute graft-versus-host disease
    5. Kawasaki’s disease
  2. Scarlatiniform
    1. Scarlet fever
    2. Toxic shock syndrome
    3. Kawasaki’s disease
  1. Viral Exanthems.
    1. Drug history may also be important, especially with infectious mononucleosis, in which only 3% of patients have maculopapular or petechial eruption, but, with the administration of ampicillin, the frequency approaches 100%.
    2. In measles (rubeola) and rubella, the erythematous macules and papules begin on the face and spread to the trunk and extremities, fading with desquamation in 6 days in rubeola and on the third day in rubella In measles, Koplik’s spots, tiny gray-white papules on an erythematous base, are found on the buccal mucosa opposite the molars. An erythematous, maculopapular rash that begins peripherally on the palms and soles and then spreads to the trunk is seen in atypical measles, which is a hypersensitivity reaction to wild measles virus in a partially immune, vaccinated host.
    3. The rashes associated with enterovirus infection are most commonly rubella-like but occasionally are purpuric.
    4. Exanthem subitum (roseola infantum) displays fleeting, discrete, red papules surrounded by a whitish halo that begins on the trunk and then evolves on the neck.
  2. Erythema infectiosum (fifth disease) is an alarming-appearing red, slapped cheek rash over the face with reticulate maculopapular lesions on the extremities that clear in 3 to 6 days; mucous membranes are sometimes involved. In rubella, red spots occur on the soft palate.
  3. Verruca vulgaris and molluscum contagiosum are two examples of viral infections that are confined to the skin and that elicit unique papular lesions.
  4. Wart papillomavirus induces various forms of warts: Common warts, which are dome-shaped papules with corrugated, hyperkeratotic surfaces; flat warts, which are slightly raised, smooth, flat-topped papules often on the hands and face; plantar warts, which are painful papules on the soles of the feet covered by a thick callus with black puncta within the lesion; and condylomata acuminata, or veneral warts, which are soft and moist and appear on genital areas.
  5. Verruca vulgaris lesions respond to a variety of nonspecific destructive techniques, including liquid nitrogen cryotherapy, salicylic and lactic acid combinations, cantharidin, and podophyllin.
  6. Molluscum contagiosum is caused by a DNA poxvirus that infects epidermal cells to induce smooth, dome-shaped, translucent papules with a central umbilication from which a cheesy core can be expressed. Molluscum contagiosum lesions are removed by curettage of the central core, liquid nitrogen freezing, or cantharidin application for short periods of time (15 to 30 minutes).

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