Skip to main content
SpringerLink
Log in

Rash

  • Chapter
  • First Online:
Dermatology in Public Health Environments

  • 1532 Accesses

Abstract

Rashes are the most common dermatologic sign that leads patients to seek medical attention, regardless of their cause. Usually they represent a major diagnostic challenge for general practitioners, emergency physicians, and even dermatologists, since different diseases can clinically yield very similar rashes, and the same disease can be differently displayed on the skin. Moreover, many of these diseases need a very quick and accurate diagnosis for prompt therapeutic management. In this chapter the etiology of rash is divided into adult and pediatric causes. Drugs reactions are the main cause of rash and exanthem in the adult population and infections, usually the viral ones, account for the greater number of these occurrences in children.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Drago F, Rampini P, Rampini E, Rebora A. Atypical exanthems: morphology and laboratory investigations may lead to an aetiological diagnosis. About 70% of cases. Br J Dermatol. 2002;147:255–60.

    Article  CAS  PubMed  Google Scholar 

  2. Ely JW, Stone MS. The generalized rash: differential diagnosis. Am Fam Physician. 2010;81(6 Pt 1):735–9.

    PubMed  Google Scholar 

  3. Ely JW, Stone MS. The generalized rash: diagnostic approach. Am Fam Physician. 2010;81(6 Pt 2):726–34.

    PubMed  Google Scholar 

  4. Fleischer AB, Feldman SR, Bullard CN. Patients can accurately identify when they have a dermatologic condition. J Am Acad Dermatol. 1999;41:784–6.

    Article  PubMed  Google Scholar 

  5. Chan KP, Goh KT, Chong CY, Teo ES, Lau G, Ling AE. Epidemic hand, foot and mouth disease caused by human enterovirus 71, Singapore. Emerg Infect Dis. 2003;9(1):78–85. doi:https://doi.org/10.3201/eid1301.020112.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Stock I. Hand, foot and mouth disease -more than a harmless “childhood disease”. Med Monatsschr Pharm. 2014;37(1):4–10. quiz 11-2

    PubMed  Google Scholar 

  7. Chatproedprai S, Tempark T, Wanlapakorn N, Puenpa J, Wananukul S, Poovorawan Y. Unusual skin manifestation of hand, foot and mouth disease associated with coxsackievirus A6: cases report. Springer Plus. 2015;4:362. doi:https://doi.org/10.1186/s40064-015-1143-z.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chang L-Y, et al. Clinical features and risk factors of pulmonary edema after enterovirus-71-related hand, foot, and mouth disease. Lancet. 1999;354:1682–6.

    Article  CAS  PubMed  Google Scholar 

  9. Neal S, Young MD, Kevin E, Brown MD. Parvovirus B19. N Engl J Med. 2004;350:586–97.

    Article  Google Scholar 

  10. Azzi A, Morfini M, Mannucci PM. The transfusion-associated transmission of par- vovirus B19. Transfus Med Rev. 1999;13:194–204.

    Article  CAS  PubMed  Google Scholar 

  11. Naides SJ. Rheumatic manifestations of parvovirus b19 infection. Rheum Dis Clin N Am. 1998;24(2):375–401.

    Article  CAS  Google Scholar 

  12. Magro CM, Dawood MR, Crowson N. The cutaneous manifestations of humanparvovirus B19 infection. Hum Pathol. 2000;31(4):488–97.

    Article  CAS  PubMed  Google Scholar 

  13. Naides SJ, Piette W, Veach LA, Argenyi Z. Human parvovirus B19-induced vesiculopustular skin eruption. Am J Med. 1988;84(5):968–72.

    Article  CAS  PubMed  Google Scholar 

  14. Brown KE, Young NS. Parvovirus B19 infection and hematopoiesis. Blood Rev. 1995;9(3):176–82.

    Article  CAS  PubMed  Google Scholar 

  15. Setúbal S, Adelmo GHD, Nascimento JP, Oliveira SA. Aplastic crisis caused by parvovirus B19 in an adult patient with sickle-cell disease. Rev Soc Bras Med Trop. 2000;33(5):477–81. [online] [acesso 23 Sep 2015].

    Article  PubMed  Google Scholar 

  16. Stoeckle MY. The spectrum of human herpesvirus 6 infection: from roseola infantum to adult disease. Annu Rev Med. 2000;51:423–30.

    Article  CAS  PubMed  Google Scholar 

  17. Zerr DM, et al. A population-based study of primary human herpesvirus 6 infection. N Engl J Med. 2005;352:768–76.

    Article  CAS  PubMed  Google Scholar 

  18. Sadao S, Kyoko S, Masaru I, Tetsushi Y, Yuji K, Takao O, et al. Clinical characteristics of febrile convulsions during primary HHV-6 infection. Arch Dis Child. 2000;82:62–6.

    Article  Google Scholar 

  19. Larry J, Strausbaugh MT, Caserta DJM, Stephen D. Human herpesvirus 6. Clin Infect Dis. 2001;33(6):829–33.

    Article  Google Scholar 

  20. Chiou CS, et al. Epidemiology and molecular characterization of Streptococcus pyogenes recovered from scarlet fever patients in central Taiwan from 1996 to 1999. J Clin Microbiol. 2004;42(9):3998–4006.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Escarlatina: orientações para surtos. Boletim Epidemiológico Paulista. [online] [acesso em em Mar 09] SES; 49(46). Disponível em http://periodicos.ses.sp.bvs.br/pdf/bepa/v4n46/v4n46a03.pdf. ISSN 1806.423-X, n.d.

  22. Stevens DL. Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med. 1989;321:1–7.

    Article  CAS  PubMed  Google Scholar 

  23. Dong H, et al. β-Haemolytic group A streptococci emm75 carrying altered pyrogenic exotoxin A linked to scarlet fever in adults. J Infect. 2008;56(4):261–7.

    Article  PubMed  Google Scholar 

  24. Lobo IM, Santos ACL, Júnior JAS, Passos RO, Pereira CU. Vírus varicela zoster. RBM rev. bras. med. 2015;72(6):231–38.

    Google Scholar 

  25. Oliveira MJC, et al. Frequency of measles, rubella, dengue and erythema infectiosum among suspected cases of measles and rubella in the State of Pernambuco between 2001 and 2004. Rev Soc Bras Med Trop. 2008;41(4):338–44.

    Article  PubMed  Google Scholar 

  26. American Academy of Pediatrics. Varicella-zoster infections. In: Pickering LK, editor. Red book: 2012 report of the committee on infectious diseases, vol. 2012. 29th ed. Elk Grove Village: American Academy of Pediatrics. p. 774–89.

    Google Scholar 

  27. Moss WJ, Griffin DE. Measles. Lancet. 2012;379(9811):153–64.

    Article  PubMed  Google Scholar 

  28. World Health Organization. Measles. 2015. [online]. Disponível em URL: http://www.who.int/mediacentre/factsheets/fs286/en./.

  29. Centers for Disease Control and Prevention. Measles United States. 2015 Jan 4/Apr 2.[acesso Mar 9]; Centers for Disease Control and Prevention, Atlanta. Disponível em URL:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6414a1.htm.

  30. Muscat ML, Bang H, Wohlfahrt J, Glismann S, Molbak K. Measles in Europe: an epidemiological assessment. Lancet. 2009;373(9661):383–9.

    Article  PubMed  Google Scholar 

  31. Rosa C. Rubella and rubeola. Semin Perinatol. 1998;22(4):318–22.

    Article  CAS  PubMed  Google Scholar 

  32. Orenstein WA, Perry RT, Halsey NA. The clinical significance of measles: a review. J Infect Dis. 2004;189(Suppl 1):S4–16.

    Google Scholar 

  33. Lambert N, Strebel P, Orenstein W, Icenogle J, Poland GA. Rubella. Lancet. 2015;385(9984):2297–307.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Centers for Disease Control and Prevention. Manual for the surveillance of vaccine-preventable diseases, Atlanta. 2012. Disponível em URL: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt14-rubella.html.

  35. Kawasaki T. Kawasaki disease. Int J Rheum Dis. 2014;17:597–600.

    Article  PubMed  Google Scholar 

  36. Castro PA, Urbano LMF, Costa IMC. Doença de Kawasaki. An Bras Dermatol. 2009;84(4):317–31.

    Article  PubMed  Google Scholar 

  37. Ayusawa M, Sonobe T, Uemura S, Ogawa S, Nakamura Y, Kiyosawa N, et al.; Kawasaki Disease Research Committee. Revision of diagnostic guidelines for Kawasaki disease (5th revised edition). Pediatr Int. 2005;47:232–34.

    Google Scholar 

  38. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young. Am Heart Assoc. 2004;110(17):2747–71.

    Google Scholar 

  39. Brewer JD, et al. Staphylococcal scalded skin syndrome and toxic shock syndrome after tooth extraction. J Am Acad Dermatol. 2008;59(2):342–6.

    Article  PubMed  Google Scholar 

  40. Patel GKL, Finlay AY. Staphylococcal scalded skin syndrome: diagnosis and management. Am J Clin Dermatol. 2003;4(3):165–75.

    Article  PubMed  Google Scholar 

  41. Patel NN, Patel DN. Staphylococcal scalded skin syndrome. Am J Med. 2010;123(6):505–7.

    Article  PubMed  Google Scholar 

  42. Caputo R, Gelmetti C, Ermacora E, et al. Gianotti-Crosti syndrome: a retrospective analysis of 308 cases. J Am Acad Dermatol. 1992;26:207–10.

    Article  CAS  PubMed  Google Scholar 

  43. Chuh AA. Diagnostic criteria for Gianotti-Crosti syndrome: a prospective case-control study for validity assessment. Cutis. 2001;68:207–13.

    PubMed  CAS  Google Scholar 

  44. Lima DA, Rocha DM, Miranda MFR. Gianotti-Crosti syndrome: clinical, laboratorial features, and serologic profiles of 10 cases from Belém, State of Para, Brazil. An Bras Dermatol. 2004;79(6):699–707. Rio de Janeiro.

    Article  Google Scholar 

  45. Nguyen TA, Ortega-Loayza AG, Stevens MP. Miliaria-rash after neutropenic fever and induction chemotherapy for acute myelogenous leukemia. An Bras Dermatol. 2011;86(4 Suppl 1):104–6.

    Article  Google Scholar 

  46. Al-Hilo MM, Al-Saedy SJ, Alwan AI. Atypical presentation of miliaria in Iraqi patients attending Al -Kindy Teaching Hospital in Baghdad: a clinical descriptive study. Am J Dermatol Venereol. 2012;1(3):41–6.

    Google Scholar 

  47. Kirk JF, Wilson BB, Chun W, Cooper PH. Miliaria profunda. J Am Acad Dermatol. 1996;35(5 Pt 2):854–6.

    Article  CAS  PubMed  Google Scholar 

  48. Rosenstein NE. Meningococcal disease. N Engl J Med. 2001;344:1378–88.

    Article  CAS  PubMed  Google Scholar 

  49. Dwilow R, Fanella S. Invasive meningococcal disease in the 21st century – an update for the clinician. Curr Neurol Neurosci Rep. 2015;15(3):2.

    Article  PubMed  Google Scholar 

  50. Sabatini C, et al. Clinical presentation of meningococcal disease in childhood. J Prev Med Hyg. 2012;53:116–9.

    PubMed  CAS  Google Scholar 

  51. Hill WR, Kinney TD. The cutaneous lesions in acute meningococcemia: a clinical and pathologic study. JAMA. 1947;134(6):513–8.

    Article  CAS  Google Scholar 

  52. Mockenhaupt M. Epidemiology of cutaneous adverse drug reactions. Chem Immunol Allergy. 2012;97:1–17.

    Article  PubMed  Google Scholar 

  53. Borch JE, Andersen KE, Bindslev-Jensen C. The prevalence of acute cutaneous drug reactions in a Scandinavian university hospital. Acta Derm Venereol. 2006;86:518–22.

    Article  PubMed  Google Scholar 

  54. Roujeau JC, Stern RS. Severe adverse cutaneous reactions to drugs. N Engl J Med. 1994;331:1272–84.

    Article  CAS  PubMed  Google Scholar 

  55. Hernandez-Salazar A, Ponce-de-Leon Rosales S, Rangel-Frausto S, et al. Epidemiology of adverse cutaneous drug reactions: a prospective study in hospitalized patients. Arch Med Res. 2006;37:899–902.

    Article  PubMed  Google Scholar 

  56. Sharma VK, Sethuraman G, Kumar B. Cutaneous adverse drug reactions: clinical pattern and causative agents – a 6 year series from Chandigarh, India. J Postgrad Med. 2001;47:95–9.

    PubMed  CAS  Google Scholar 

  57. Zaraa I, Jones M, Trojjet S, Cheikh Rouhou R, El Euch D, Mokni M, et al. Severe adverse cutaneous drug eruptions: epidemiological and clinical features. Int J Dermatol. 2011;50:877–80.

    Article  PubMed  Google Scholar 

  58. Bolognia JL, Jorizzo JL, Rapini R. Dermatologia. Reações a medicamentos. 2nd . Rio de Janeiro: Elsevier Saunder; 2012. p. 301–320. Cap. 22.

    Google Scholar 

  59. Grando LR, Schmitt TAB, Bakos RM. Severe cutaneous reactions to drugs in the setting of a general hospital. An Bras Dermatol. 2014;89(5):758–62.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Djien V, Bocquet H, Dupuy A, et al. Symptomatology and markers of the severity of erythematous drug eruptions. Ann Dermatol Venereol. 1999;126:247–50.

    PubMed  CAS  Google Scholar 

  61. Marzano AV, Borghi A, Cugno M. Adverse drug reactions and organ damage: the skin. Eur J Intern Med. 2015;7(15):00414–8. pii: S09536205.

    Google Scholar 

  62. Szatkowski J, Schwartz RA. Acute generalized exanthematous pustulosis (AGEP): a review and update. J Am Acad Dermatol. 2015;73(5):843–8.

    Article  PubMed  Google Scholar 

  63. Duarte IAG, Lazzarini R, Bedikrow RB, Pires MC. Contact dermatitis. An Bras Dermatol. 2000;75(5):529–48.

    Google Scholar 

  64. Peiser M, Tralau T, Heidler J, et al. Allergic contact dermatitis: epidemiology, molecular mechanisms, in vitro methods and regulatory aspects. Current knowledge assembled at an international workshop at BfR, Germany. Cell Mol Life Sci. 2012;69(5):763–81. doi:https://doi.org/10.1007/s00018-011-0846-8. Epub 2011 Oct 14.

    Article  PubMed  CAS  Google Scholar 

  65. Martin SF. New concepts in cutaneous allergy. Contact Dermatitis. 2014;72:2–10.

    Article  PubMed  Google Scholar 

  66. Bolognia JL, Jorizzo JL, Rapini R. Dermatologia. Local New York: Publisher Elsevier 2nd ed; 2012. p. 209–30. Cap.15 e 16.

    Google Scholar 

  67. Brasch J, Becker D, Aberer W, et al. Guideline contact dermatitis. Allergo J Int. 2014;23:126–38.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Chuh AA, Chan HH. Prospective case-control study of chlamydia, legionella and mycoplasma infections in patients with pityriasis rosea. Eur J Dermatol. 2002;12:170–3.

    PubMed  Google Scholar 

  69. Bitencourt MSM, Delmaestro D, Miranda PB, Filgueira AL, Pontes LFL. Pityriasis rosea. An Bras Dermatol. 2008;83(5):461–9.

    Article  Google Scholar 

  70. Stulberg DL, Wolfrey J. Pityriasis rosea. Am Fam Physician. 2004;69(1):87–91.

    PubMed  Google Scholar 

  71. Fuente MJ. Syphilis a resurgent disease. Actas Dermosifiliogr. 2010;101(10):817–9.

    Article  CAS  PubMed  Google Scholar 

  72. Gállego-Lezáun C, Arrizabalaga Asenjo M, González-Moreno J, et al. Syphilis in men who have sex with men: a warning sign for HIV infection. Actas Dermosifiliogr. 2015;106(9):740–5.

    Article  PubMed  Google Scholar 

  73. Tuddenham S, Ghanem KG. Emerging trends and persistent challenges in the management of adult syphilis. BMC Infect Dis. 2015;15:351.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. James WD, Berger T, Elston D. Andrew’s doenças da pele – dermatologia clínica. 10th ed. Rio de Janeiro: Elsevier Editora Ltda; 2007.

    Google Scholar 

  75. Dupin N, Farhi D. Syphilis. Presse Med. 2013;42(4 Pt 1):446–53.

    Article  PubMed  Google Scholar 

  76. Dylewski J, Duong M. The rash of secondary syphilis. CMAJ. 2007;176(1):33–5.

    Article  PubMed  PubMed Central  Google Scholar 

  77. World Health Organization. Dengue control. 2016. Disponível em URL: http://www.who.int/denguecontrol/en/.

  78. Centers for Disease Control and Prevention. Dengue. Clinical guidance. Atlanta. 2014. Disponível em URL: http://www.cdc.gov/dengue/clinicalLab/clinical.html http://www.cdc.gov/dengue/clinicalLab/clinical.html.

  79. Lupi O, Carneiro CG, Coelho ICB. Manifestações mucocutâneas da dengue. An Bras Dermatol. 2007;82(4):291–305.

    Article  Google Scholar 

  80. Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol. 2016;47:6–7.

    Article  CAS  PubMed  Google Scholar 

  81. Mlakar J, et al. Zika virus associated with microcephaly. N Engl J Med. 2016;374(10):951–8.

    Article  CAS  PubMed  Google Scholar 

  82. Pialoux G, Gaüzère B, Jauréguiberry S, Strobel M. Chikungunya, an epidemic arbovirosis. Lancet Infect Dis. 2007;7:319–27.

    Article  PubMed  Google Scholar 

  83. Bellini WJ, Helfand RF. The challenges and strategies for laboratory diagnosis of measles in an international setting. J Infect Dis. 2003;187(Suppl 1):S283–90.

    Article  PubMed  Google Scholar 

  84. Levin C, Maibach HI. An overview of the eficacy of topical corticosteroids in experimental human nickel contact dermatitis. Contact Dermatitis. 2000;43:317–21.

    Article  CAS  PubMed  Google Scholar 

  85. Saripalli YV, Gadzia JE, Belsito DV. Tacrolimus ointment 0.15 in the treatment of nickel-induced allergic contact dermatitis. J Am Acad Dermatol. 2003;49:477–82.

    Article  PubMed  Google Scholar 

  86. Eritro Leenutaphong V, Jiamton S. UVB phototerapy for pityriasis rosea: a bilateral comparison study. J Am Acad Dermatol. 1995;33:996–9.

    Article  Google Scholar 

  87. Bukhari IA. Oral erythromicin is ineffective in the treatment of pityriasis rosea. J Drugs Dermatol. 2008;7(7):625.

    PubMed  Google Scholar 

  88. Drago F, Vecchio F, Rebora A. Use of high-dose acyclovir in pityriasis rosea. J Am Acad Dermatol. 2006;54(1):82–5.

    Article  PubMed  Google Scholar 

  89. Morales-Múnera CE, Fuentes-Finkelstein PA, Vall MM. Update on the diagnosis and treatment of syphilis. Actas Dermosifiliogr. 2015;106(1):68–9.

    Article  PubMed  Google Scholar 

  90. World Health Organization. Guidelines for the management of sexually transmitted infections. Geneva: World health organization; 2003.

    Google Scholar 

Suggested Literature

Download references

Author information

Authors and Affiliations

  1. Dermatology Service of UFCSPA, Porto Alegre, Brazil

    Isadora da Rosa Hoeffel & Barbara Lovato

  2. Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil

    Marina Resener de Moraes

Authors
  1. Isadora da Rosa Hoeffel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marina Resener de Moraes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Barbara Lovato
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Isadora da Rosa Hoeffel .

Editor information

Editors and Affiliations

  1. Dermatology Service of Clinical, Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Renan Rangel Bonamigo

  2. Health Secretary of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    Sergio Ivan Torres Dornelles

Glossary

Biett’s collarette

A syphilitic symptom characterized by a thin white ring of scales on the surface of a macule or papule.

Filatov sign

A typical sign of scarlet fever characterized by paleness around the mouth and congestion of the cheeks.

Koplik spots

Spots characterized by clustered, small, white lesions on the buccal mucosa (opposite the upper first and second molars), pathognomonic for measles. The spots resemble tiny grains of white sand, each surrounded by a red ring.

Papular-purpuric gloves and socks syndrome

An acute dermatosis characterized by a papular-purpuric edematous rash in a distinct “gloves and socks” distribution often accompanied by fever, asthenia, and lymphadenopathies. It is mainly caused by parvovirus B19 (B19V) although other viruses and drugs may be involved.

Pastia’s lines

A clinical sign whereby pink or red lines formed of confluent petechiae occur in areas of skin creases, such as the axilla, the neck, the antecubital fossa, and the popliteal fossa. This is a typical sign of scarlet fever.

Primary skin lesions

Blister: Raised lesion, more than 1 cm wide, with internal liquid content.

Macula: Flat nonpalpable lesions, less than 1 cm wide, showing inconspicuous texture and/or color change.

Nodule: Palpable raised and indurated lesion usually deeper than the papule.

Patch: Flat nonpalpable lesion, more than 1 cm wide, showing discrete texture and/or color change.

Papule: Circumscribed palpable lesion, above skin surface, less than 1 cm wide.

Plaque: Palpable and raised lesion, above skin surface, more than 1 cm wide.

Pustule: Raised surface lesion with internal yellow content (pus).

Vesicle: Raised lesion, less than 1 cm wide, with internal light liquid content.

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing Switzerland

About this chapter

Cite this chapter

da Rosa Hoeffel, I., de Moraes, M.R., Lovato, B. (2018). Rash. In: Bonamigo, R., Dornelles, S. (eds) Dermatology in Public Health Environments. Springer, Cham. https://doi.org/10.1007/978-3-319-33919-1_59

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-33919-1_59

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33917-7

  • Online ISBN: 978-3-319-33919-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation