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Pruritic Rash


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]
  • 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]
  • 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]
  • Dermatology Quiz Case presentation A 10-year-old girl presents with a six-month history of an intensely pruritic rash mainly over the extensor surfaces of her lower legs and arms. She is otherwise well.[medicinetoday.com.au]
Candidiasis
  • アレルギー剤 asteatosis 乾皮症 atheroma 粉瘤(ふんりゅう) atopic dermatitis アトピー性皮膚炎 b Basedow's disease バセドー病 blister 水疱 bulla 水泡、ブラ c café au lait spot カフェオレ斑 cheilitis 口唇炎 chemical burn 化学熱傷 clavus 鶏眼 contact dermatitis 接触皮膚炎 crust 痂皮(かひ) cryosurgery 凍結外科 cutaneous candidiasis[tokyo-med.ac.jp]
Dermatitis
  • The diagnosis and treatment of dermatitis herpetiformis. Clin Cosmet Investig Dermatol 2015;8:257–65. Welsh B. Blistering skin conditions. Aust Fam Physician 2009;38(7):484–90. Miller JL, Zaman SAK. Dermatitis herpetiformis.[racgp.org.au]
  • Rhus dermatitis D. Non-accidental trauma E. Ink marker Case Discussion “Black spot” poison ivy is an unusual and distinctive presentation of Rhus dermatitis (C), the most common form of allergic contact dermatitis in children.[healio.com]
  • Workup revealed dermatitis herpetiformis (DH) and subclinical celiac disease.[mayoclinic.pure.elsevier.com]
  • Dermatitis herpetiformis: These patients should be referred for specialist care (Cunliffe, 2006).[bestessayhelp.com]
  • Choose one to reveal the diagnosis Erythema multiforme Pityriasis rosea Contact dermatitis Tinea corporis (ringworm) Answer: Tinea corporis (ringworm) See the full case at ReelDX[thedoctorschannel.com]
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]
  • 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]
  • Nummular eczema typically would not be this widespread on the trunk, and usually is much itchier. Tinea corporis rarely is this extensive and is more pruritic and more scaly.[thedoctorschannel.com]
  • The patient had a 10-year history of atopic eczema, with rashes primarily in flexural areas, and a history of skin reactions to earrings and rivets in her blue jeans.[mdedge.com]
  • In children with eczema and psoriasis, this can sometimes involve the use of oral immunosuppressive agents. In the case of psychological conditions, referral to a psychologist or psychiatrist may be appropriate.[medicinetoday.com.au]
Erythema
  • Cases of cat scratch disease with skin manifestations that included erythema nodosum; erythema multiforme; erythema marginatum; and non-specific maculopapular, petechial, and morbilliform rashes have been reported.[ncbi.nlm.nih.gov]
  • Short answer An erythematous papular rash has spared the periumbilical region but in places has formed areas of confluent urticated erythema, especially at the striae distensae.[bmj.com]
  • Int J Dermatol. 2017, 56:461-463. 10.1111/ijd.13523 Yamamoto T, Nishioka K: Flagellate erythema .[cureus.com]
  • Choose one to reveal the diagnosis Erythema multiforme Pityriasis rosea Contact dermatitis Tinea corporis (ringworm) Answer: Tinea corporis (ringworm) See the full case at ReelDX[thedoctorschannel.com]
  • Main differential diagnoses to be considered with usual clinical manifestations 1–3 Disease Differentiating features Dermatitis herpetiformis Pruritic, polymorphic, grouped and symmetrical lesions consisting of erythema, urticarial plaques, papules, vesicles[racgp.org.au]
Keratosis
  • […] furuncle せつ g gangrene 壊疽(えそ) granuloma 肉芽腫 h hair follicle 毛包 Hashimoto's thyroiditis 橋本甲状腺炎〈 橋本病〉 herpes 疱疹 herpes zoster 帯状疱疹 hyperkeratosis 過角化 hyperthermia 温熱療法 i ichthyosis 魚鱗癬(ぎょりんせん) impetigo 膿痂疹(のうかしん) insect bite 虫刺症 itching 掻痒(そうよう)、かゆみ k keratosis[tokyo-med.ac.jp]
  • Acrochordon 0/0 Acrocyanosis 0/0 Acrodermatitis continua of Hallopeau 0/0 Acrokeratoelastoidosis 0/0 Acrokeratosis paraneoplastica 0/0 Acrokeratosis verruciformis 0/0 Acromegaly 0/0 Acroosteolysis 0/0 Actinic cheilitis 0/0 Actinic granuloma 0/0 Actinic keratosis[visualdx.com]
  • Some Causes of Itching Cause Suggestive Findings Diagnostic Approach Primary skin disorders Atopic dermatitis Presence of erythema, possible lichenification, keratosis pilaris, xerosis, Dennie-Morgan lines, hyperlinear palms Usually a family history of[merckmanuals.com]
Dermatologic Disorder
  • A characteristic rash usually establishes the diagnosis of a primary dermatologic disorder. Several skin diseases are associated with pruritus; some are listed in Box 1 .[clevelandclinicmeded.com]
  • Testing Many dermatologic disorders are diagnosed clinically. However, when itching is accompanied by discrete skin lesions of uncertain etiology, biopsy can be appropriate.[merckmanuals.com]

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 with both topical and systemic steroids was ineffective. Following a living nonrelated renal transplant and removal of the catheter the rash and eosinophilia resolved.[ncbi.nlm.nih.gov]
  • 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 of diagnoses Treatment varies according to the suspected underlying cause of the rash.[bestessayhelp.com]
  • A skin biopsy may be appropriate if the provisional diagnosis is not clear or if the condition is refractory to treatment. Management Treatment of prurigo can be difficult. The first step is focused on preventing ongoing skin picking and scratching.[medicinetoday.com.au]
  • Peplomycin, a bleomycin analogue used in the treatment of prostate cancer, breast cancer, and HL, can also cause FE [7, 8] .[cureus.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]
  • In severe cases clonal T-cell populations can be detected in the blood or bone marrow and the prognosis is worse.3 Drug rash Drug hypersensitivity induced rashes are the commonest cause of new onset rashes in inpatients.[gmjournal.co.uk]
  • 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]

Etiology

  • The exact etiology of pruritic folliculitis is unknown.[aafp.org]
  • 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]
  • 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]
  • 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]

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]
  • 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. Available at .[cdc.gov]
  • 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]
Sex distribution
Age distribution

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

  • 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]
  • Clin Infect Dis 2009 ; 49 : 942 – 8 . 4 Centers for Disease Control and Prevention . Chikungunya virus . . 5 Pan American Health Organization . Chikungunya Fever in the Americas . . 6 .[academic.oup.com]
  • The first step is focused on preventing ongoing skin picking and scratching.[medicinetoday.com.au]
  • 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]
  • Suggested prevention measures included using a DEET-containing product before going outdoors, because DEET is known to repel some mite species ( 5 ).[cdc.gov]

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