RASH DIAGNOSIS CHEAT SHEET SIGNS/SYMPTOMS TREATMENT SJS/TEN SJS/TEN Emergency Necrotizing Fasciitis Most common cause: medications Stop suspected medication All over body rash DRESS Syndrome Blistering, mucosal involvement Hospital admission Systemic symptoms Staphylococcal Scalded Skin Syndrome Patient feels "very ill" Consider IVIG, IV prednisone or cyclosporine Acute onset and fast progression Eczema Herpeticum Necrotizing Fasciitis Involvement of mucosal tissues RMSF Intense pain Surgical emergency New medications Meningococcemia Skin findings may be minima IV antibiotics Cezary Syndrome Most common site: leg Consider IVIG, Hyperbaric Oxygen Streptococcal Toxic Shock Syndrome Pediatric Patients Gianotti-Crosti Gianotti-Crosti Hypersensitivity reaction to bacteria or virus Resolves on its own in 2-3 weeks HFMD Extremities, face, no mucosal lesions PO antihistamines, topical steroids Molluscum Contagiosum Asymptomatic or mildly itchy Reassurance Id reaction HFMD Pityriasis Rosea Enterovirus (coxsackie) Resolves on its own in 10-14 days Erythema Infectiosum Sore throat, fever or asymptomatic Pain and fever relief, hydration, Magic Mouthwash Non-emergency Roseola Kids under 5, more severe in adults PO antihistamines, topical steroids Pregnant Patients PUPPP PUPPP Caused by skin stretching, 3rd trimester Resolves 4-8 weeks after delivery Atopic Eruption of Pregnancy Very itchy PO antihistamines, topical steroids Pemphigoid Gestationis Starts in stretch marks Oral prednisone in severe cases Pustular Psoriasis of Pregnancy Atopic Eruption of Pregnancy Intrahepatic Cholestasis of Pregnancy Most common pregnancy rash, 1-2 trimester PO antihistamines, topical steroids Prurigo gestationis More common with h/o eczema Good skin care Can become secondarily infected PO antibiotics if needed Acneiform Folliculitis (bacterial or yeast) Folliculitis Most common bacterial cause staph Topical broad-spectrum antimicrobials Rosacea Immunosuppression, recent PO abx PO antibiotics if severe bacterial Periorofacial Dermatitis More common with h/o eczema Topical steroids if irritant Miliaria Yeast often itchy Topical and/or oral antifungal for yeast Keratosis Pilaris Steatocystoma Multiplex Hidradenitis Suppurativa Acne Keloidalis Nuchae Eczematous Contact Dermatitis (allergic and irritant) Contact dermatitis Frequent cause: personal care products Gentle skin care, topical steroids Pityriasis Lichenoides Chronica More common with h/o eczema Oral prednisone when severe (not dosepak) Stasis Dermatitis More common in areas of friction/sweating Patch testing when recurrent Scabies Atopic Dermatitis Tinea Psoriasis Pityriasis Rosea Blistering Bullous Impetigo Bullous Impetigo MSSA or MRSA Wound care+topical antibiotic+PO antibiotic Herpes Simplex H/o eczema or immunocompromised Good personal hygiene Varicella Zoster Lymphadenopathy +/- Check for nasal colonization Dermatitis Herpetiformis Can occur on intact skin Treat underlying condition if needed Plant Dermatitis Erythema Multiforme Bullous Pemphigoid Eczema Herpeticum Purpuric Capillaritis Capillaritis Consider biopsy and labs PO antihistamines and topical steroids Schamberg's More common on lower extremities Citrus bioflavonoids Lichen Aureus Venous stasis, diabetes, hypertension, exercise Treat underlying disease Henoch-Schonlein Purpura Urticarial Vasculitis RMSF Meningococcemia Hereditary Hemorrhagic Telangiectasia © 2018 Lidia Pomaville, PA-C, MPAS All Rights Reserved.