Codes

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

• Bullous impetigo – Localized with honey-colored crusted plaques, bacteria present in bullae.
• Toxic shock syndrome – High fevers and severe systemic symptoms including vomiting and diarrhea; hypotension quickly ensues; diffuse scarlatiniform exanthem that starts on the trunk (in contrast to face in SSSS).
• Sunburn
• Kawasaki disease – Fever lasting more than 5 days with oral mucosal changes, conjunctival injection, and cervical lymphadenopathy.
• Drug hypersensitivity syndrome (DRESS)
• Exanthematous drug eruption
• Drug-induced erythroderma
• Toxic epidermal necrolysis (TEN) – Drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
• Stevens-Johnson syndrome – Drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
• Scarlet fever – 1 mm erythematous papules, always elevated WBC with left shift, eosinophilia in up to 20% of patients.
• Erythrodermic psoriasis
• Atopic dermatitis
• Contact dermatitis
• Ichthyosis
• Lupus erythematosus
• Pemphigus erythematosus
• Pityriasis rubra pilaris
• Scabies
• Seborrheic dermatitis
• Lymphomas
• Urticaria
• Erysipelas
• Necrotizing fasciitis – Rapidly progressing necrosis of fascia and subcutaneous fat.

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Management Pearls

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Therapy

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References

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