The distribution or direction of spread of an eruption and the number and type of lesions can help to narrow the diagnosis of fever and rash, but by itself it rarely suggests a single diagnosis. The presence of other lesions, most notable target lesions, may suggest a single diagnosis.
In the latter group, infections are frequently the cause of the underlying disease. Table II provides the most common infectious and non-infectious causes of rashes.
The distribution of spread of an eruption is highly informative. Most drug and viral infection-associated eruptions begin on the face and trunk and spread outward. The number of lesions may help to distinguish within and between infections.
In patients with Salmonella, those who have paratyphoid fever usually have more skin lesions than those with typhoid fever. In contrast, brucellosis may be associated with only one or a few clinically subtle skin lesions. It must be emphasized that non-infectious diseases with skin rash can also present with fever and should be considered in the differential diagnosis.
A drug reaction must be considered in those patients with a generalized maculopapular rash, especially if associated with palmoplantar involvement.
It is critical to determine the types of lesions that make up the eruption. Morphologic types of primary skin lesions include macules, papules, nodules, vesicles, bullae, pustules, and plaques. Table I summarizes the descriptions of the lesions. Table II describes the rash pattern and the most frequent associated diseases. Physicians often have difficulty diagnosing generalized rash, because many different conditions produce similar rashes and a single condition can result in different rashes with varied appearances.
Although it is important to begin the evaluation with an inclusive differential diagnosis, a focused history and looking for clinical features are key points. One important feature is the timing of the onset in relation to fever, and other symptoms associated with the rash e. Exposure to sexually transmitted disease, including risk factors for infection with human immunodeficiency virus HIV. Season of the year dramatically affects the epidemiology of febrile rashes of infectious origin.
Epidemiology varies according to each category. A comprehensive history and physical examination is cornerstone in establishing the diagnosis. Infectious diseases are the most common causes related with fever and rash, but it is also important to consider rheumatic and neoplastic diseases, drugs, allergens, and sometimes idiopathic causes. A variation by geographic region has also been observed i. Table III provides information related to history and physical examination oriented to some categories is provided.
There are multiple causes of fever and rash. The risk for developing a specific disease varies according to age; race; exposure to drugs, allergens; and chemicals; geographic location; and season, particularly important for infectious diseases. Fever and rash caused by infectious agents are frequent. The distribution of the eruption central versus peripheral and the type of lesions, along with the clinical syndrome and history taking, are cornerstone in establishing the diagnosis.
In addition to causes previously described, fever and rash in selected populations needs to be mentioned, as more patients with immune suppression are being seen and international travel is more common. In immunocompromised patients, the clinical picture might be more aggressive, and it is not uncommon to find a non-characteristic presentation. A detailed epidemiologic history is of utmost importance for returning travelers. The most common infectious diseases with fever and rash are transmitted by vector: Typhus, rickettsial spotted fever, Rocky Mountain spotted fever, Lyme disease, ehrlichiosis, and tularemia.
Immunocompromised patients are most susceptible to herpes-virus dissemination, ecthyma gangrenosum, Streptococcal, and Staphylococcal toxic shock syndrome.
There are non-infectious diseases that can also show with fever and rash. A differential diagnosis with infectious causes should be addressed. Table V the most frequent non-infectious causes of fever and rash according to type and distribution of rash.
Most patients with fever and rash do not need any laboratory tests, as most of them are self-limited with a relatively benign course i. However, in some diseases confirmation is required. In some conditions, basic non-specific laboratory tests should be ordered i.
In life-threatening situations, such as meningococcemia, in addition to non-specific laboratory tests, cultures and skin biopsy are done. The relative frequency of the causes of rash and fever in each category is the basis for a diagnostic approach. Table VI illustrates information on laboratory tests for selected infectious causes. Table VII provides information on laboratory tests for other non-infectious causes of fever and rash.
Imaging tests are not cornerstone in the diagnostic work-up of an uneventful episode of fever and rash. Imaging studies are usually ordered in life-threatening conditions, patients with serious underlying diseases i. The disorders responsible for fever and rash are numerous, and their manifestations protean; therefore, multiple specialists are frequently involved on the diagnostic approach.
Depending on the clinical condition and severity of the disease, Rheumatologists, Intensive Care doctors and Oncologists may also be involved during the diagnostic work-up and treatment. In some life-threatening disorders, such as necrotizing fasciitis, surgeons must be consulted.
The utility of empiric therapy is limited to a few causes, because many agents causing fever and rash are of viral etiology. When patients have a life-threatening condition, empiric therapy is of high priority and should be started even before a diagnostic culture or biopsy can be taken.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy.
Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions. In this series. In this article What is a viral rash? Are viral rashes serious? In summary. Viral Rashes In this article What is a viral rash? Our picks for Viral Rashes. What to do when your child has a rash As a parent, it's hard not to panic when your child develops a rash.
What to do when your child has a rash. Why isn't the chickenpox vaccine available on the NHS? Why measles is more serious than you think. Suffer from dermatitis? Book a private appointment with a local pharmacist today to discover treatment options Book now. Next article Measles. Further reading and references. Join the discussion on the forums.
Health Tools Feeling unwell? The risk of reactivating the virus increases with age, and 1 out of every 2 people in the United States will develop shingles in their lifetime, according to the CDC. When the virus reactivates, it travels down your nerves to your skin. As the virus spreads there, the shingles rash begins to form.
Though similar to chickenpox spots in children, the shingles rash and illness are often more severe in adults. Older adults may also be at risk for complications such as nerve pain, blindness, and neurological conditions.
People who develop shingles often note that pain occurred at the site where the rash develops. Unlike the rash caused by a chickenpox infection, a shingles rash typically occurs on one side of the body, often in a single area or stripe. Hand, foot, and mouth disease is caused by viruses in the enterovirus family.
It commonly affects children under age 5, but it can affect people of any age. It can be very contagious but does not typically cause serious illness. You can get hand, foot, and mouth disease by coming into contact with the bodily fluids of a person who has the virus. This includes:. Like its name suggests, the rash associated with hand, foot, and mouth disease often occurs on those parts of the body. People with the virus can develop painful sores on the back of the mouth and a rash on their skin.
This rash can look like flat, red to purple spots or liquid-filled blisters. While it often appears on the palms of the hands and the soles of the feet, it can show up on other parts of the body as well. Per the CDC , this might include the:. Fifth disease is a viral illness that can cause a red rash on the cheeks or limbs. It is also known as slapped cheek disease.
This virus spreads through bodily fluids, such as the respiratory particles in saliva and mucus, when a person with the virus coughs or sneezes. It can also be passed during pregnancy to an unborn child and by blood. The rash caused by fifth disease more commonly appears in children, per the CDC. It may be itchy or go through periods of itchiness. Some people may develop a second rash on another part of the body a few days later.
Roseola, also known as sixth disease, is a contagious illness that typically affects children 6 months to 2 years old. The virus enters the body through the nose and mouth from the respiratory droplets of a person with the virus. Children with roseola often experience a rash after symptoms of high fever and mild respiratory illness. The rash caused by roseola tends to first appear on the trunk of the body before spreading to the arms and legs.
When touched, the spots may become lighter in color, a sign that the small capillaries are dilated. On darker skin, this may be harder to see. The West Nile virus is caused by the bite of an infected mosquito. It can affect people of all ages. But 1 in 5 people may develop a fever that occurs with other symptoms, including a rash. The West Nile virus can cause a maculopapular rash , with both flat discolored spots and raised bumps. A GP in London previously warned that kids with Omicron had presented with rashes , but it hadn't been seen as prevalent in adults until recently.
Dr David Lloyd said he had seen about 15 per cent of youngsters with confirmed Omicron cases developing spots. They also suffered with fatigue, headaches and a loss of appetite - which seems to fit with the most common variant symptoms reported so far in adults. Chilblains look similar to Covid toes - which have been a long reported symptom of people contracting other variants of Covid Although in reports it seems children and teens suffer more with the condition.
Data from the app shows people who catch the Omicron variant usually present with symptoms within 48 hours of catching the bug.
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