3-113
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Disease Macules Vesicles, Purpuric Macules,
or Bullae, or Papules, or
Papules Pustules Vesicles
Erythema Infectiosum X
Erythema Multiforma (HSV) X X
Herpes Simplex / Disseminated X
Herpes Zoster / Generalized X
Measles (rubeola) X
Rubella (German measles) X
Varicella (Chicken Pox) X X
OTHER:
Drug Hypersensitivity X X X
Kawasaki Disease X
(mucocutaneous lymph node syndrome)
Lyme Disease X
Psoriasis
Secondary Syphilis X
Serum Sickness X
Steven Johnson Syndrome X X
Systemic Lupus Erythematosus X X X
Toxic Epidermal Necrosis X X
Pruritus (Itching)
Lt Col Gerald Peters, USAF, MCIntroduction: Rash and pruritus sometimes present together and may be related (see Rash Symptom Section
for additional guidance). The intensity of itching can vary from mild to severe, and can interfere with sleep at
night and the ability to focus during the day. Suicide due to intractable pruritus has been reported. In some
cases, the cause may be obvious, such as exposure to an irritant or allergen known to the patient. Other
cases, especially the more chronic and generalized ones may be more difficult to understand and/or treat.
A thorough history and physical is often needed to unravel such cases. Begin by determining whether the
pruritus is due to a local skin condition or a systemic problem.
Subjective: Symptoms (in addition to itching)
Variable: Pain, insomnia, rash (virtually any type of skin lesion), fever, erythema
Focused History: Have you been in contact with plants, chemicals, shoes or other sources of leather or
rubber? (suspect contact dermatitis). Do you have any personal history or family history of allergy, asthma, hay
fever or childhood eczema? (suggests atopic allergic diagnosis) Have you changed medications or dosages
lately? Have you had significant, recent exposure to sunlight, biting insects or sick people? (may suggest
diagnosis) Have you had a viral illness in the last 2-6 weeks? (Pityriasis rosea is characterized by herald
patch and pruritus.) Have you noticed any hair loss, dry skin or pigment changes? (consider thyroid disease).
Have you had any jaundice, or clay-colored stools? (consider liver disease) Where have you noticed the rash?
(Specific sites are more likely in some conditions, e.g., finger web spaces, axillae, nipples, umbilicus and
genitals for scabies; sun-exposed areas for sunburn, some drug reactions.)
Objective: Signs
Using Basic Tools: Agitation, excoriation, thickened and/or hyperpigmented skin, fatigue, possible rash
(varied presentations, but if there are no lesions where the patient cannot reach [e.g., mid-back], the condition