Emergency Medicine

SKIN DISORDERS

General Medical Emergencies 117

(ii) Minor signs:

(a) inflammation or elevation

(b) bleeding or crusting

(c) sensory changes, including itching

(d) diameter ≥7 mm.

Table 2.9 Common exanthematous diseases

Disease Incubation

period

(days)

Prodrome Rash Other features and

infectivity

Chickenpox 10–20 None Macules,

papules,

vesicles and

pustules of

differing ages

Infective until all

vesicles are crusted

over (usually 6 days

after last crop)

Fifth disease

(erythema

infectiosum)

7–10 Fever,

malaise

Raised red

‘slapped

cheeks’,

diffuse

maculopapular

Transient arthralgia,

then relapsing rash;

infective before

onset of rash. Fetal

abnormality

Glandular

fever

5–14 Fever,

sore

throat,

malaise

Transient

maculopapular

(rare); itchy

drug rash with

ampicillin

(common)

Tonsillar exudate,

cervical

lymphadenopathy;

hepatosplenomegaly;

infective for many

months by close

physical contact

Measles 9–14 3 days

of cough,

cold,

conjunc-

tivitis

Red, confluent,

maculopapular;

lasts 7–11 days

Koplik’s spots;

cough predominates;

may be quite ill;

infective for 5 days

after rash appears

Rubella 14–21 None Pink,

maculopapular,

discrete; lasts

3–5 days

Occipital and pre-

auricular

lymphadenopathy;

infective until rash

disappears. Fetal

abnormality

Scarlet fever 2–5 1–2 days

of sore

throat,

fever,

vomiting

Minute, red

punctuate

papules;

last 7 days

Unwell; circumoral

pallor; ‘strawberry

tongue’; infective

until negative throat

swabs following

penicillin