Presentation
Source: Aditi Murthy, MD A 3-year-old female presented to urgent care with a 1-week history of a pruritic rash on the legs and torso. On the day of her presentation, she additionally developed two new dark brown marks on her right cheek. [healio.com]
We present a case of a female patient with Hodgkin’s lymphoma who presented with classic findings for FE after initiation of chemotherapy. [cureus.com]
A heavily pregnant woman presents with a risky rash. What is the best management? Dr Jim Newcombe 13th February 2018 0 Comments Jess, a 35-year-old woman, presents to her GP at 39 +1 weeks’ gestation in her first pregnancy. [howtotreat.com.au]
Treatment prior to presentation included diphenhydramine, cetirizine, and a 20-mg dose of prednisone without improvement. The patient was otherwise healthy with normal development and growth. [jamanetwork.com]
SOAP for Pediatrics features over 70 clinical problems with each case presented in an easy to read 2-page layout. Each step presents information on how that case would likely be handled. [books.google.de]
Entire Body System
- Pain
Rash sensations can range from pruritic to painful. Acute pain occurs in 95 percent of patients, with nearly half reporting severe pain. [journals.lww.com]
Diarrhea, abdominal pain, and vomiting may also be present. Laboratory findings are nonspecific, but lymphopenia and hypocalcemia occur in up to 79% and 55%, respectively. [academic.oup.com]
Some rashes are hot and painful. Severe inflammation may indicate disease. While scratching is hard to resist, it can lead to bleeding, making you vulnerable to infection. [metroderm.org]
At presentation, she was febrile (42°C) with pain and tenderness of the wrist, knee and ankle joints. The ankle joints showed edema, erythema [Figure 1] and restriction of movements due to pain. [ijdvl.com]
Rashes may cause the skin to change color, itch, become warm, bumpy, dry, cracked or blistered, swell and may be painful. The causes, and therefore treatments for rashes, vary widely. [alamy.es]
- Fever
Chikungunya fever is difficult to distinguish from the early stage of dengue fever. [academic.oup.com]
2015/81/5/548/158659 Sir, Adult-onset Still's disease is a rare inflammatory disorder characterized by high spiking fever, polyarthralgia/arthritis, characteristic evanescent, salmon pink rash (that fades when the fever remits and reappears with the next [ijdvl.com]
Ticks transmit bacteria, causing the rashes and other symptoms of Rocky Mountain spotted fever, Colorado tick fever, tularemia, ehrlichiosis, babesiosis, relapsing fever, and Lyme disease. [metroderm.org]
Fever and rash in a child: when to worry? Pediatr Ann. 2007;36(1):30–38. 9. Schlossberg D. Fever and rash. Infect Dis Clin North Am. 1996;10(1):101–110. 10. Croskerry P. [aafp.org]
She has a one-day prodrome of fever and malaise. Tags Infectious diseases obstetrics Neonatal [howtotreat.com.au]
- Inflammation
Treatment – We control mild inflammation with anti-fungal cream or medicated shampoo. For severe cases, we prescribe corticosteroids, topical calcineurin inhibitors, and oral anti-fungal drugs. [metroderm.org]
A short course (up to 14 days but no more) of a mild steroid cream may ease symptoms if there is inflammation of your anal skin. Steroids reduce inflammation (but should not normally be used on infected skin). [patient.info]
Generalised pruritus along with glossitis (tongue inflammation ) and angular cheilitis ( inflammation of mouth corners) are seen in iron deficiency anaemia. [dermnetnz.org]
Essay Sample Differential diagnoses for Pediatric Pruritic Rash A generalized pruritic rash in a child may have any of a number of causes, ranging from autoimmune problems, allergies, infections and infestations, endocrine and metabolic disorders, and inflammations [bestessayhelp.com]
Corticosteroids are effective in relieving itch caused by inflammation but should be avoided for conditions that have no evidence of inflammation. [merckmanuals.com]
- Falling
Similar precautions were recommended for the summer and fall of 2005. Treating the rash with calamine lotion, an oral antihistamine, or an OTC hydrocortisone product can help reduce the itching. [cdc.gov]
[…] the pedicure was in fall, 2002. I mad a mistake and wore nylon boots during a storm, the dye never fully disappeared. I would scrub the soles of my feet until I couldn't walk. [medical-dictionary.thefreedictionary.com]
However, it tends to be more common after you have been to the toilet to pass a bowel motion and at night (particularly just before falling asleep). The itch may be made worse by: Heat. Wool. Moisture or wetness around the anus. [patient.info]
The epidermis thins and the amount of collagen previously abundant within the dermis steadily falls. Characteristic wrinkles develop and the skin becomes increasingly fragile. [gmjournal.co.uk]
Many rashes and skin conditions during pregnancy fall under a general umbrella and aren’t given a specific diagnosis. PUPPS however is the most common specific skin condition during pregnancy. [mamanatural.com]
- Fatigue
She complained of severe itching, fatigue, and malaise. Her past medical history included upper-extremity osteomyelitis that had been treated with vancomycin and rifampin for the past month. [clinicaladvisor.com]
Physical examination Physical examination begins with a review of clinical appearance for signs of jaundice, weight loss or gain, and fatigue. [merckmanuals.com]
A prodrome of generalized malaise, fever, headache, fatigue, chills, and a burning or tingling pain may precede the rash by up to five days. [journals.lww.com]
Accompanying symptoms are headache, fatigue, fever, and sensitivity to light. Cause – VZV reactivates when a person’s immune system is weak. Primary factors that reduce immunity are poor diet, inadequate sleep, and stress. [metroderm.org]
[…] exanthem, nonspecific Blanchable, red, sometimes confluent macules and papules; may be indistinguishable from drug eruptions 26 ; keys to diagnosis are nonspecific generalized maculopapular rash in a child with systemic symptoms (fever, diarrhea, headache, fatigue [aafp.org]
Respiratoric
- Cough
He also noted a mild cough, but no congestion, sore throat, conjunctivitis, vomiting, or diarrhea. He reported intermittent generalized headaches, but he denied confusion, irritability, weakness, or abnormal movements. [academic.oup.com]
Gastrointestinal
- Overeating
On examination, erythematous, excoriated nodules are observed bilaterally over her lower legs, knees, forearms and the dorsal surface of her fingers (Figures 1a and b). Several of the nodules over her knees are ulcerated. [medicinetoday.com.au]
Over the course of several hours he very slowly crawled toward the house, which was about a football field away. Finally his daughter spotted him, and he was airlifted to shock trauma. [clinicaladvisor.com]
The lesions evolve over three to five days, and can coalesce into larger lesions that progress into pustules and eventually open and crust over. Rash sensations can range from pruritic to painful. [journals.lww.com]
SOAP for Pediatrics features over 70 clinical problems with each case presented in an easy to read 2-page layout. Each step presents information on how that case would likely be handled. [books.google.de]
Some people may feel itchy all over their bodies. Cause Dry, itchy skin is a side effect of ribavirin and direct acting antivirals used to treat hepatitis C. Pruritus may also occur with severe liver injury or liver failure. [catie.ca]
- Diarrhea
Diarrhea, abdominal pain, and vomiting may also be present. Laboratory findings are nonspecific, but lymphopenia and hypocalcemia occur in up to 79% and 55%, respectively. [academic.oup.com]
[…] done* Viral exanthem, nonspecific Blanchable, red, sometimes confluent macules and papules; may be indistinguishable from drug eruptions 26 ; keys to diagnosis are nonspecific generalized maculopapular rash in a child with systemic symptoms (fever, diarrhea [aafp.org]
Skin
- Pruritus
What causes pruritus ? Causes of pruritus can be classified under 5 main headings. Localised pruritus Localised pruritus is pruritus that is confined to a certain part of the body. [dermnetnz.org]
Several skin diseases are associated with pruritus; some are listed in Box 1. [clevelandclinicmeded.com]
Pruritus gravidarum is a poorly defined condition of pregnancy associated with itching without an obvious dermatosis. The term pruritus gravidarum is classically associated with pruritus in the first trimester. [aafp.org]
- Pruritic Rash
Pediatric Pruritic Rash – Essay Sample Pediatric Pruritic Rash – Essay Sample Differential diagnoses for Pediatric Pruritic Rash A generalized pruritic rash in a child may have any of a number of causes, ranging from autoimmune problems, allergies, infections [bestessayhelp.com]
We conclude that cat scratch disease should be included in the differential diagnosis of pruritic rashes in children. [ncbi.nlm.nih.gov]
[…] virus type 1, viral infections Posted in Physicians-In-Training | Permalink | Comments Off on A Man with a Pruritic Rash This entry was posted on Friday, June 24th, 2016 at 7:00 am and is filed under Physicians-In-Training. [blogs.nejm.org]
- Eczema
Eczema and dermatitis occur commonly in a podiatric practice. It is easy to get in a rut and make the diagnosis of eczema when a patient presents with a scaling rash. [podiatrytoday.com]
Eczema: This condition results from immune malfunction. Eczema arising during infancy and childhood sometimes dissipates with age. It can be cyclic in duration, flaring and then subsiding. [metroderm.org]
Note In this block the terms dermatitis and eczema are used synonymously and interchangeably. [icd10data.com]
Suggested treatments for the above causes include (Cunliffe, 2006): Eczema: Use a topical steroid—the lowest dosage that deals with the rash—allowing it to dry before following it with lots of moisturizing lotions. [bestessayhelp.com]
Aggressive treatment of the eczema may be the only way to control the pruritus in patients with atopic dermatitis. [clevelandclinicmeded.com]
- Eruptions
AB - A 56-year-old man sought treatment after a vacation for an intensely pruritic skin eruption involving the buttocks. On physical examination, annular plaques were noted. [mayoclinic.pure.elsevier.com]
Chiggers Swimmer's itch Flea bites Sea bather’s eruption Pseudomonas folliculitis Diagnosis This itching papular and pustular eruption, limited mostly to the bathing suit area following the use of a whirlpool spa, is classic for Pseudomonas folliculitis [mdmag.com]
The differential diagnosis for persistent skin lesions of adult-onset Still's disease includes lichen planus, lupus erythematosus, dermatomyositis and lichenoid drug eruption. [ijdvl.com]
Ana Baptista Sofia Madanelo Paulo Morais Case A man, 30 years of age, presented with an intensely pruritic eruption that had been evolving for approximately two months. [racgp.org.au]
Polymorphic eruption of pregnancy: clinicopathology and potential trigger factors in 181 patients. Br J Dermatol. 2006;154(1):54–60. 32. Black MM. Polymorphic eruption of pregnancy. In: Black MM, McKay M, Braude PR, et al., eds. [aafp.org]
- Blister
Until the blisters scab, shingles is contagious. Anyone not immune to chickenpox is susceptible to infection, through contact with open blisters. Treatment – At the first sign of shingles, make an appointment with us. [metroderm.org]
This article describes a patient with a progressive pruritic rash and fluid-filled blisters. [ncbi.nlm.nih.gov]
A 4-year-old boy with known G6PD deficiency is brought to the pediatrician by his mother with a blistering pruritic rash. On examination, numerous tense vesicles and bullae are seen on his neck, lower abdomen, and extremities. [amsa.org]
Key point Punch biopsies of lesional and perilesional skin are important for the diagnosis of blistering skin conditions. [racgp.org.au]
Psychiatrical
- Delusion
Long-standing itch can also cause depression Delusions of parasitosis and Morgellon's syndrome These are true psychotic disorders In delusions of parasitosis patients are convinced that a parasite / infestation is living in their skin In Morgellon's syndrome [pcds.org.uk]
Psychogenic disorders – these are mental health conditions including: Depression/anxiety Compulsive skin picking Delusions of parasitosis. [dermcoll.edu.au]
Intermittent intense itching, numbness, tingling in limbs, optic neuritis, vision loss, spasticity or weakness, vertigo MRI CSF analysis Evoked potentials Psychiatric illness Linear excoriations, presence of psychiatric condition (eg, clinical depression, delusions [merckmanuals.com]
They are associated with obsessive-compulsive disorder, depression, and delusions of parasitosis. 38 Treatment A wheal and flare response is a marker of histamine-induced pruritus in patients with urticaria or an allergic dermatitis. [aafp.org]
Neurologic
- Irritability
Passing lots of diarrhoea can irritate the anal skin and cause an itchy bottom. [patient.info]
Itching is skin tingling or irritation that makes you want to scratch the itchy area. It's a symptom of many health conditions. [icd10data.com]
Use mild bath soap that won't irritate your skin. Take a bath or shower in warm -- not hot -- water. Avoid certain fabrics, such as wool and synthetics, that can make skin itch. Switch to cotton clothing and bed sheets. [webmd.com]
Skin care (eg, limiting bathing, avoiding irritants, moisturizing regularly, humidifying environment) should be observed. Symptoms can be relieved by topical or systemic drugs. [merckmanuals.com]
[…] perineal hygiene; perianal skin damage caused by scratching, or abrasion due to use of harsh, dry paper; excess moisture caused by wearing tight, nonporous clothing; decreased resistance to fungi and yeasts during steroid therapy; ingestion of dietary irritants [medical-dictionary.thefreedictionary.com]
- Vertigo
exercise intolerance, pica, hair thinning Hb, Hct, red cell indices, serum ferritin, iron, and iron-binding capacity Multiple sclerosis Intermittent intense itching, numbness, tingling in limbs, optic neuritis, vision loss, spasticity or weakness, vertigo [merckmanuals.com]
- Dizziness
Promptly go to an urgent care center or hospital if hives are accompanied by breathing difficulty, dizziness, or swelling of the face, lips, or tongue. Psoriasis: Like eczema, an immune malfunction causes this type of rash. [metroderm.org]
Workup
Workup revealed dermatitis herpetiformis (DH) and subclinical celiac disease. [mayoclinic.pure.elsevier.com]
Erythematous, pruritic rash Keywords: Pediatric, Pediatrics, Child, Integumentary, Dermatology, Immune, Infectious, Tinea corporis, Ringworm, Rash, Integumentary/Dermatology Video Features: Vitals & Demographics Differential Diagnosis & Patient Workup [reeldx.com]
The presence of her diffuse rash along with a pulmonary cavitary lesion prompted infectious workup. [cureus.com]
Appropriate laboratory workup should be done to rule out systemic disease, and occasionally a skin biopsy is warranted if the diagnosis is uncertain. [consultant360.com]
Treatment
Treatment – Some people see improvement with dietary changes. Cool showers and moisturizers also help. We provide medications and treatments that relieve inflammation and improve cellular turnover. [metroderm.org]
Treatment of diagnoses Treatment varies according to the suspected underlying cause of the rash. [bestessayhelp.com]
AB - A 56-year-old man sought treatment after a vacation for an intensely pruritic skin eruption involving the buttocks. On physical examination, annular plaques were noted. [mayoclinic.pure.elsevier.com]
Treatment depends on the cause. Pruritus ani treatment If a cause is found A particular treatment may be advised by a doctor or pharmacist. [patient.info]
Treatment of itch. Semin Dermatol. 1995, 14: 320-325. Back to Top [clevelandclinicmeded.com]
Prognosis
The four clinical variants of adult T-cell leukemia–lymphoma — acute, lymphomatous, chronic, and smoldering — affect the clinical presentation and prognosis. [blogs.nejm.org]
[…] and anakinra. [5], [6] Acute pulmonary embolism manifested by our patient is a rare, life-threatening complication of adult-onset Still's disease. [7] Lee et al. have noted that adult-onset Still's disease associated with persistent rash has a poor prognosis [ijdvl.com]
What is the outlook (prognosis) for an itchy bottom? If a cause for the itchy bottom (pruritus ani) can be identified, it is easier to treat and relieve your symptoms. Most people respond well to treatment for an itchy bottom. [patient.info]
Pregnancy-Related Dermatoses That Cause Pruritus Condition Synonyms Timing Features Important considerations Prognosis Atopic eruption of pregnancy Prurigo, early-onset prurigo, pruritic folliculitis, or eczema of pregnancy; prurigo gestationis Second [aafp.org]
Etiology
The exact etiology of pruritic folliculitis is unknown. [aafp.org]
If blisters are present, one should have a higher degree of suspicion for a different etiology such as pemphigoid gestationis. [aocd.org]
However, when itching is accompanied by discrete skin lesions of uncertain etiology, biopsy can be appropriate. [merckmanuals.com]
This report describes the investigation in Crawford County, Kansas, by public health agencies and entomologists to identify the etiology of the pruritic rash and to assess the extent of the outbreak. [cdc.gov]
Epidemiology
Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clin Infect Dis 2009 ; 49 : 942 – 8. 4 Centers for Disease Control and Prevention. Chikungunya virus. . 5 Pan American Health Organization. [academic.oup.com]
The epidemiology of pruritus depends on its underlying cause or causes. However, in general, the incidence of chronic pruritus increases with age, it is more common in women, and in those of Asian background. [dermnetnz.org]
Epidemiological and clinical study of grain itch. JAMA 1952;150:575--9. Peter M. Beware of oak leaf gall mites; they may be coming back. K-State Research and Extension News; May 6, 2005. [cdc.gov]
In this article the epidemiology, risk factors, clinical presentation, radiographic findings and management is discussed. The majority of patients with small joint osteoarthritis respond well to non surgical treatments. [edoc.co.za]
Histopathological and epidemiological characteristics of patients with erythema exudativum multiforme major, Stevens-Johnson syndrome and toxic epidermal necrolysis. Br J Dermatol. 1996;135(1):6–11. 39. Kemmett D, Hunter JA. [aafp.org]
Pathophysiology
Dermatitis herpetiformis: pathophysiology, clinical presentation, diagnosis and treatment. An Bras Dermatol 2014;89(6):865–77. [racgp.org.au]
The exact pathophysiology and etiology of VZV reactivation is unknown, but an age-related decline in VZV-specific cell mediated immune responses appears to be important. ( JAMA 2009;302[1]:108.) [journals.lww.com]
Back to Top Pathophysiology Peripheral Mechanisms Physical Stimuli and Neural Pathways Itch can be produced by mechanical (gentle touch, pressure, vibration, and wool), thermal and electrical stimuli such as transcutaneous or direct nerve stimulation. [clevelandclinicmeded.com]
Pathophysiology Itch can be prompted by diverse stimuli, including light touch, vibration, and wool fibers. There are a number of chemical mediators as well as different mechanisms by which the sensation of itch occurs. [merckmanuals.com]
Prevention
The best way to prevent pruritus is to take care of your skin. To protect skin: Use skin creams and lotions that moisturize your skin and prevent dryness. Use sunscreens regularly to prevent sunburns and skin damage. [webmd.com]
This vaccine does not prevent infection but prevents reactivation of the latent virus by suppression because only those who have previously been infected with VZV can get shingles. [journals.lww.com]
Preventing PUPPS Since no one is really sure what causes PUPPS exactly, there isn’t a guaranteed way to prevent it. You can however make some healthy choices that may decrease or prevent your chances of getting the condition. [mamanatural.com]
Can I prevent PUPPP? Unfortunately, there are none. If you're going to get PUPPP, you're going to get it. Try to remember, though, that it's temporary and will disappear soon after your beautiful baby is born. [whattoexpect.com]
A randomized trial comparing fluconazole with clotrimazole troches for the prevention of fungal infections in patients with advanced human immunodeficiency virus infection. Página 454 - Delaney KM, Moorman AC, et al. [books.google.es]