0071643192.pdf

DERMATOLOGY

■ Found throughout North, Central, and South America, particularly the
southeastern parts of the United States; not particular to the Rocky
Mountain area
■ Begins with HA, N/V, fever (>39°C), and malaise. On the second to the
fourth day, erythematous macules with central petechiae appear on the
wrists and ankles and then spread onto the trunk.
■ Lesions on the palms and soles are characteristic.
■ Systemic symptoms in severe cases, most frequently neurologic (seizures,
palsies) or pulmonary (cough, dyspnea, pleural effusions)
■ Antibiotic of choice is doxycycline. Chloramphenicol is also effective but
has more severe side effects.

Scarlet Fever

■ Caused by group A streptococcus
■ Abrupt onset of fever, exudative pharyngitis (most common site of bacter-
ial invasion), palatal petechiae, strawberry tongue, and lymphadenopathy
(see Figure 17.9)
■ A characteristic trait of this disease is a fine maculopapular rash with an
erythematous background (“sandpaper rash”) and pastia lines (petechiae
in skin folds).
■ Treatment PCN
■ Complications include acute rheumatic fever and poststreptococcal
glomerulonephritis.

TABLE 17.2. Exanthems

EXANTHEM KEYASPECTS CUTANEOUSFEATURES

Rocky Mountain spotted Palm and sole involvement Petechial lesions begin on

fever wrists and ankles.

Scarlet fever Strawberry tongue Sandpaper rash, pastia lines

(red lines in skin folds)

Measles/rubeola Cough, coryza, and Lesions begin on head esp.

conjunctivitis behind the ears, then

generalize.

Roseola High fever precedes rash Fine papular rash appears

when fever defervesces

Rubella LAD Lesions begin on face,

Arthralgias generalize, then

disappear within 3 days.

Erythema infectiosum Arthralgias Slapped cheek appearance

Hand, foot, and mouth Oral lesions that ulcerate Palm and sole vesicles

disease