DermAtlas: Online Dermatology Image Library dermatology image,morbilliform eruption,exanthem,viral infections, exanthem,drug reaction,viral infections, exanthem,viral infections, exanthem,urticaria multiforme,hypereosinophilic syndrome

© 2001-2010, DermAtlas	*Image Name:*	macular_rash_2_091120	*File Type:*	jpg
	*Diagnosis:*	MORBILLIFORM ERUPTION / EXANTHEM / VIRAL INFECTIONS, EXANTHEM / DRUG REACTION	*Category:*	infections and infestations / reactive erythema / drug reaction
	*Body Site:*	back	*Age:*	1 years
	*Contributor:*	Tamara Hill
	*Description:*	generalized 2-4 mm red macules and papules with surrounding pallor
	*Comments:*	This healthy 1-year-old girl developed a diffuse morbilliform rash 2 days ago following a week of upper respiratory tract infection symptoms with fever. She was seen for a health check up 2 weeks ago and received her routine immunizations. She was on day 9 of a 10 day course of amoxicillin. Yesterday she had an episode of vomiting, increasing cough, and conjunctival injection, but she was eating and drinking well and behaving normally. The amoxicillin was discontinued, and she was treated with acetominophen. The skin eruption resolved over the subsequent 3-4 days. The morbilliform eruption could have been triggered by her immunization, a viral respiratory tract infection, the amoxicillin or a combination of these factors. The differential would also include mucocutaneous lymph node symdrome.
	*Related Images:*	All related Images macular_rash_1_091120 macular_rash_3_091120

© 2001-2010, DermAtlas	*Image Name:*	macular_rash_3_091120	*File Type:*	jpg
	*Diagnosis:*	MORBILLIFORM ERUPTION / EXANTHEM / VIRAL INFECTIONS, EXANTHEM / DRUG REACTION	*Category:*	infections and infestations / reactive erythema / drug reaction
	*Body Site:*	foot / sole	*Age:*	1 years
	*Contributor:*	Tamara Hill
	*Description:*	generalized 2-4 mm red macules and papules and surrounding pallor
	*Comments:*	This healthy 1-year-old girl developed a diffuse morbilliform rash 2 days ago following a week of upper respiratory tract infection symptoms with fever. She was seen for a health check up 2 weeks ago and received her routine immunizations. She was on day 9 of a 10 day course of amoxicillin. Yesterday she had an episode of vomiting, increasing cough, and conjunctival injection, but she was eating and drinking well and behaving normally. The amoxicillin was discontinued, and she was treated with acetominophen. The skin eruption resolved over the subsequent 3-4 days. The morbilliform eruption could have been triggered by her immunization, a viral respiratory tract infection, the amoxicillin or a combination of these factors. The differential would also include mucocutaneous lymph node symdrome.
	*Related Images:*	All related Images macular_rash_1_091120 macular_rash_2_091120

© 2001-2010, DermAtlas	*Image Name:*	macular_rash_1_091120	*File Type:*	jpg
	*Diagnosis:*	MORBILLIFORM ERUPTION / EXANTHEM / VIRAL INFECTIONS, EXANTHEM / DRUG REACTION	*Category:*	infections and infestations / reactive erythema / drug reaction
	*Body Site:*	back	*Age:*	1 years
	*Contributor:*	Tamara Hill
	*Description:*	generalized 2-4 mm red macules and papules and conjunctival injection
	*Comments:*	This healthy 1-year-old girl developed a diffuse morbilliform rash 2 days ago following a week of upper respiratory tract infection symptoms with fever. She was seen for a health check up 2 weeks ago and received her routine immunizations. She was on day 9 of a 10 day course of amoxicillin. Yesterday she had an episode of vomiting, increasing cough, and conjunctival injection, but she was eating and drinking well and behaving normally. The amoxicillin was discontinued, and she was treated with acetominophen. The skin eruption resolved over the subsequent 3-4 days. The morbilliform eruption could have been triggered by her immunization, a viral respiratory tract infection, the amoxicillin or a combination of these factors. The differential would also include mucocutaneous lymph node symdrome.
	*Related Images:*	All related Images macular_rash_3_091120 macular_rash_2_091120

© 2001-2010, DermAtlas	*Image Name:*	urticaria_multiforme_5_091116	*File Type:*	jpg
	*Diagnosis:*	URTICARIA MULTIFORME / URTICARIA	*Category:*	reactive erythema
	*Body Site:*	face / total body	*Age:*	12 months
	*Contributors:*	Priscilla Wong Melinda Thiam
	*Description:*	diffuse edematous red confluent plaques
	*Comments:*	Introduction: The ability to diagnose and differentiate life-threatening from benign rashes is a necessity for care providers working with children. We present two cases of urticaria multiforme (UM), a benign hypersensitivity rash commonly mistaken for more severe diseases such as erythema multiforme (EM) and conditions associated with purpuric lesions. UM has a remarkably different course and severity. Case 1: A 12-month-old previously healthy girl presented to clinic for a rash characterized by palpable pink wheels that progressed from her chest and thighs to the remainder of her extremities. The rash spared her palms, soles and mucus membranes. The child appeared well, but had been diagnosed with bilateral otitis media eight days previously and treated with amoxicillin. She also received Varicella and Mumps/Measles/Rubella vaccines the week prior and visited Ireland three weeks prior. Amoxicillin was discontinued. On day two, she returned to clinic because the rash had become intensely pruritic, the palpable pink wheels had developed central duskiness that looked similar to bruising, and her hands, feet and face were edematous. There were no target lesions. Apart from her apparent pruritis, she continued to appear well and was sent home with diphenhydramine with resolution over the next 3 days. Case 2: A 12-month-old boy presented to the emergency department (ED) for sudden onset of palpable pink wheels on his face and torso with facial erythema. His rash did not appear painful or pruritic, and his exam was otherwise remarkable only for two crusted circular lesions on his bottom lip that developed the day prior. The child was diagnosed with acute otitis media one week previously and was taking amoxicillin. The amoxicillin was discontinued. The patient returned to the ED the following morning with intense pruritus, progression of his rash to involve all extremities, significant edema of his hands, feet and face and, most notably, a dusky hue evolving over his abdomen and his lower extremities. Patient was hospitalized and treated with diphenhydramine and cetirizine. He was discharged after four days with significant improvement. Discussion: UM is a common rash that can have multiple triggers, including viral infections, vaccines, and medications, and is frequently mistaken for other diagnoses. Both of our cases can easily be distinguished from EM because the rashes lacked mucous membrane involvement, target lesions, and spared palms and soles. Though sometimes the dusky appearance may be mistaken for EM target lesions, in UM there is no central target lesion. Both of our cases were either hospitalized or referred to subspecialty care because of concern for purpura and potential for severe disease. Conditions associated with purpuric lesions, such as meningococcemia and systemic vasculitis are usually associated with ill-appearance and sepsis or other systemic symptoms. A search of PubMed and Cochrane databases using the terms �urticaria� and �urticaria multiforme� revealed only a single case series about UM. These cases of UM provide additional information on this common rash enabling providers to recognize this condition, differentiate it from other more serious diseases, ease parental anxiety and avoid unnecessary hospitalizations and repeat visits. Dr. Kimberly Wenner and Dr. LoRanee Braun also contributed to this case series.
	*Related Images:*	All related Images urticaria_multiforme_1_091116 urticaria_multiforme_2_091116 urticaria_multiforme_3_091116 urticaria_multiforme_4_091116

© 2001-2010, DermAtlas	*Image Name:*	urticaria_multiforme_4_091116	*File Type:*	jpg
	*Diagnosis:*	URTICARIA MULTIFORME / URTICARIA	*Category:*	reactive erythema
	*Body Site:*	leg / total body	*Age:*	12 months
	*Contributors:*	Priscilla Wong Melinda Thiam
	*Description:*	diffuse edematous red confluent plaques
	*Comments:*	Introduction: The ability to diagnose and differentiate life-threatening from benign rashes is a necessity for care providers working with children. We present two cases of urticaria multiforme (UM), a benign hypersensitivity rash commonly mistaken for more severe diseases such as erythema multiforme (EM) and conditions associated with purpuric lesions. UM has a remarkably different course and severity. Case 1: A 12-month-old previously healthy girl presented to clinic for a rash characterized by palpable pink wheels that progressed from her chest and thighs to the remainder of her extremities. The rash spared her palms, soles and mucus membranes. The child appeared well, but had been diagnosed with bilateral otitis media eight days previously and treated with amoxicillin. She also received Varicella and Mumps/Measles/Rubella vaccines the week prior and visited Ireland three weeks prior. Amoxicillin was discontinued. On day two, she returned to clinic because the rash had become intensely pruritic, the palpable pink wheels had developed central duskiness that looked similar to bruising, and her hands, feet and face were edematous. There were no target lesions. Apart from her apparent pruritis, she continued to appear well and was sent home with diphenhydramine with resolution over the next 3 days. Case 2: A 12-month-old boy presented to the emergency department (ED) for sudden onset of palpable pink wheels on his face and torso with facial erythema. His rash did not appear painful or pruritic, and his exam was otherwise remarkable only for two crusted circular lesions on his bottom lip that developed the day prior. The child was diagnosed with acute otitis media one week previously and was taking amoxicillin. The amoxicillin was discontinued. The patient returned to the ED the following morning with intense pruritus, progression of his rash to involve all extremities, significant edema of his hands, feet and face and, most notably, a dusky hue evolving over his abdomen and his lower extremities. Patient was hospitalized and treated with diphenhydramine and cetirizine. He was discharged after four days with significant improvement. Discussion: UM is a common rash that can have multiple triggers, including viral infections, vaccines, and medications, and is frequently mistaken for other diagnoses. Both of our cases can easily be distinguished from EM because the rashes lacked mucous membrane involvement, target lesions, and spared palms and soles. Though sometimes the dusky appearance may be mistaken for EM target lesions, in UM there is no central target lesion. Both of our cases were either hospitalized or referred to subspecialty care because of concern for purpura and potential for severe disease. Conditions associated with purpuric lesions, such as meningococcemia and systemic vasculitis are usually associated with ill-appearance and sepsis or other systemic symptoms. A search of PubMed and Cochrane databases using the terms �urticaria� and �urticaria multiforme� revealed only a single case series about UM. These cases of UM provide additional information on this common rash enabling providers to recognize this condition, differentiate it from other more serious diseases, ease parental anxiety and avoid unnecessary hospitalizations and repeat visits. Dr. Kimberly Wenner and Dr. LoRanee Braun also contributed to this case series.
	*Related Images:*	All related Images urticaria_multiforme_1_091116 urticaria_multiforme_2_091116 urticaria_multiforme_3_091116 urticaria_multiforme_5_091116

© 2001-2010, DermAtlas	*Image Name:*	urticaria_multiforme_3_091116	*File Type:*	jpg
	*Diagnosis:*	URTICARIA MULTIFORME / URTICARIA	*Category:*	reactive erythema
	*Body Site:*	leg / total body	*Age:*	12 months
	*Contributors:*	Melinda Thiam Priscilla Wong
	*Description:*	diffuse edematous red confluent plaques
	*Comments:*	Introduction: The ability to diagnose and differentiate life-threatening from benign rashes is a necessity for care providers working with children. We present two cases of urticaria multiforme (UM), a benign hypersensitivity rash commonly mistaken for more severe diseases such as erythema multiforme (EM) and conditions associated with purpuric lesions. UM has a remarkably different course and severity. Case 1: A 12-month-old previously healthy girl presented to clinic for a rash characterized by palpable pink wheels that progressed from her chest and thighs to the remainder of her extremities. The rash spared her palms, soles and mucus membranes. The child appeared well, but had been diagnosed with bilateral otitis media eight days previously and treated with amoxicillin. She also received Varicella and Mumps/Measles/Rubella vaccines the week prior and visited Ireland three weeks prior. Amoxicillin was discontinued. On day two, she returned to clinic because the rash had become intensely pruritic, the palpable pink wheels had developed central duskiness that looked similar to bruising, and her hands, feet and face were edematous. There were no target lesions. Apart from her apparent pruritis, she continued to appear well and was sent home with diphenhydramine with resolution over the next 3 days. Case 2: A 12-month-old boy presented to the emergency department (ED) for sudden onset of palpable pink wheels on his face and torso with facial erythema. His rash did not appear painful or pruritic, and his exam was otherwise remarkable only for two crusted circular lesions on his bottom lip that developed the day prior. The child was diagnosed with acute otitis media one week previously and was taking amoxicillin. The amoxicillin was discontinued. The patient returned to the ED the following morning with intense pruritus, progression of his rash to involve all extremities, significant edema of his hands, feet and face and, most notably, a dusky hue evolving over his abdomen and his lower extremities. Patient was hospitalized and treated with diphenhydramine and cetirizine. He was discharged after four days with significant improvement. Discussion: UM is a common rash that can have multiple triggers, including viral infections, vaccines, and medications, and is frequently mistaken for other diagnoses. Both of our cases can easily be distinguished from EM because the rashes lacked mucous membrane involvement, target lesions, and spared palms and soles. Though sometimes the dusky appearance may be mistaken for EM target lesions, in UM there is no central target lesion. Both of our cases were either hospitalized or referred to subspecialty care because of concern for purpura and potential for severe disease. Conditions associated with purpuric lesions, such as meningococcemia and systemic vasculitis are usually associated with ill-appearance and sepsis or other systemic symptoms. A search of PubMed and Cochrane databases using the terms �urticaria� and �urticaria multiforme� revealed only a single case series about UM. These cases of UM provide additional information on this common rash enabling providers to recognize this condition, differentiate it from other more serious diseases, ease parental anxiety and avoid unnecessary hospitalizations and repeat visits. Dr. Kimberly Wenner and Dr. LoRanee Braun also contributed to this case series.
	*Related Images:*	All related Images urticaria_multiforme_1_091116 urticaria_multiforme_2_091116 urticaria_multiforme_4_091116 urticaria_multiforme_5_091116

© 2001-2010, DermAtlas	*Image Name:*	urticaria_multiforme_2_091116	*File Type:*	jpg
	*Diagnosis:*	URTICARIA MULTIFORME / URTICARIA	*Category:*	reactive erythema
	*Body Site:*	face / total body	*Age:*	12 months
	*Contributors:*	Priscilla Wong Melinda Thiam
	*Description:*	diffuse edematous red confluent plaques
	*Comments:*	Introduction: The ability to diagnose and differentiate life-threatening from benign rashes is a necessity for care providers working with children. We present two cases of urticaria multiforme (UM), a benign hypersensitivity rash commonly mistaken for more severe diseases such as erythema multiforme (EM) and conditions associated with purpuric lesions. UM has a remarkably different course and severity. Case 1: A 12-month-old previously healthy girl presented to clinic for a rash characterized by palpable pink wheels that progressed from her chest and thighs to the remainder of her extremities. The rash spared her palms, soles and mucus membranes. The child appeared well, but had been diagnosed with bilateral otitis media eight days previously and treated with amoxicillin. She also received Varicella and Mumps/Measles/Rubella vaccines the week prior and visited Ireland three weeks prior. Amoxicillin was discontinued. On day two, she returned to clinic because the rash had become intensely pruritic, the palpable pink wheels had developed central duskiness that looked similar to bruising, and her hands, feet and face were edematous. There were no target lesions. Apart from her apparent pruritis, she continued to appear well and was sent home with diphenhydramine with resolution over the next 3 days. Case 2: A 12-month-old boy presented to the emergency department (ED) for sudden onset of palpable pink wheels on his face and torso with facial erythema. His rash did not appear painful or pruritic, and his exam was otherwise remarkable only for two crusted circular lesions on his bottom lip that developed the day prior. The child was diagnosed with acute otitis media one week previously and was taking amoxicillin. The amoxicillin was discontinued. The patient returned to the ED the following morning with intense pruritus, progression of his rash to involve all extremities, significant edema of his hands, feet and face and, most notably, a dusky hue evolving over his abdomen and his lower extremities. Patient was hospitalized and treated with diphenhydramine and cetirizine. He was discharged after four days with significant improvement. Discussion: UM is a common rash that can have multiple triggers, including viral infections, vaccines, and medications, and is frequently mistaken for other diagnoses. Both of our cases can easily be distinguished from EM because the rashes lacked mucous membrane involvement, target lesions, and spared palms and soles. Though sometimes the dusky appearance may be mistaken for EM target lesions, in UM there is no central target lesion. Both of our cases were either hospitalized or referred to subspecialty care because of concern for purpura and potential for severe disease. Conditions associated with purpuric lesions, such as meningococcemia and systemic vasculitis are usually associated with ill-appearance and sepsis or other systemic symptoms. A search of PubMed and Cochrane databases using the terms �urticaria� and �urticaria multiforme� revealed only a single case series about UM. These cases of UM provide additional information on this common rash enabling providers to recognize this condition, differentiate it from other more serious diseases, ease parental anxiety and avoid unnecessary hospitalizations and repeat visits. Dr. Kimberly Wenner and Dr. LoRanee Braun also contributed to this case series.
	*Related Images:*	All related Images urticaria_multiforme_1_091116 urticaria_multiforme_3_091116 urticaria_multiforme_4_091116 urticaria_multiforme_5_091116

© 2001-2010, DermAtlas	*Image Name:*	urticaria_multiforme_1_091116	*File Type:*	jpg
	*Diagnosis:*	URTICARIA MULTIFORME / URTICARIA	*Category:*	reactive erythema
	*Body Site:*	face / total body	*Age:*	12 months
	*Contributors:*	Priscilla Wong Melinda Thiam
	*Description:*	diffuse edematous red confluent plaques
	*Comments:*	Introduction: The ability to diagnose and differentiate life-threatening from benign rashes is a necessity for care providers working with children. We present two cases of urticaria multiforme (UM), a benign hypersensitivity rash commonly mistaken for more severe diseases such as erythema multiforme (EM) and conditions associated with purpuric lesions. UM has a remarkably different course and severity. Case 1: A 12-month-old previously healthy girl presented to clinic for a rash characterized by palpable pink wheels that progressed from her chest and thighs to the remainder of her extremities. The rash spared her palms, soles and mucus membranes. The child appeared well, but had been diagnosed with bilateral otitis media eight days previously and treated with amoxicillin. She also received Varicella and Mumps/Measles/Rubella vaccines the week prior and visited Ireland three weeks prior. Amoxicillin was discontinued. On day two, she returned to clinic because the rash had become intensely pruritic, the palpable pink wheels had developed central duskiness that looked similar to bruising, and her hands, feet and face were edematous. There were no target lesions. Apart from her apparent pruritis, she continued to appear well and was sent home with diphenhydramine with resolution over the next 3 days. Case 2: A 12-month-old boy presented to the emergency department (ED) for sudden onset of palpable pink wheels on his face and torso with facial erythema. His rash did not appear painful or pruritic, and his exam was otherwise remarkable only for two crusted circular lesions on his bottom lip that developed the day prior. The child was diagnosed with acute otitis media one week previously and was taking amoxicillin. The amoxicillin was discontinued. The patient returned to the ED the following morning with intense pruritus, progression of his rash to involve all extremities, significant edema of his hands, feet and face and, most notably, a dusky hue evolving over his abdomen and his lower extremities. Patient was hospitalized and treated with diphenhydramine and cetirizine. He was discharged after four days with significant improvement. Discussion: UM is a common rash that can have multiple triggers, including viral infections, vaccines, and medications, and is frequently mistaken for other diagnoses. Both of our cases can easily be distinguished from EM because the rashes lacked mucous membrane involvement, target lesions, and spared palms and soles. Though sometimes the dusky appearance may be mistaken for EM target lesions, in UM there is no central target lesion. Both of our cases were either hospitalized or referred to subspecialty care because of concern for purpura and potential for severe disease. Conditions associated with purpuric lesions, such as meningococcemia and systemic vasculitis are usually associated with ill-appearance and sepsis or other systemic symptoms. A search of PubMed and Cochrane databases using the terms �urticaria� and �urticaria multiforme� revealed only a single case series about UM. These cases of UM provide additional information on this common rash enabling providers to recognize this condition, differentiate it from other more serious diseases, ease parental anxiety and avoid unnecessary hospitalizations and repeat visits. Dr. Kimberly Wenner and Dr. LoRanee Braun also contributed to this case series.
	*Related Images:*	All related Images urticaria_multiforme_2_091116 urticaria_multiforme_3_091116 urticaria_multiforme_4_091116 urticaria_multiforme_5_091116

© 2001-2010, DermAtlas	*Image Name:*	hypereosinophilic_syndrome_1_090821	*File Type:*	jpg
	*Diagnosis:*	HYPEREOSINOPHILIC SYNDROME	*Category:*	reactive erythema / cutaneous sign of systemic disease / hypersensitivity
	*Body Site:*	total body / arm	*Age:*	40 years
	*Contributors:*	Daniel Chang Chris Bengson
	*Description:*	scattered widely disseminated 0.5-1.5 cm red plaques with dusky centers
	*Comments:*	A 40-year-old woman, who was diagnosed with hypereosinophilic syndrome, was admitted on multiple occasions for angioedema of face, throat, hands, and legs, diffuse abdominal pain, and urticarial edematous plaques on her arms, trunk, and thighs. She complained of itching and then burning pain in skin lesions which persisted for 2-3 days and recurred episodically. Acute symptoms were controlled with high dose oral steroids and antihistamines. The hypereosinophilic syndromes are a heterogeneous group of disorders characterized by three common features: peripheral eosinophil count of > 1500/�L for longer than six months, evidence of end organ involvement (excluding benign eosinophilia), and absence of other causes of eosinophilia (drugs, parasites, malignancy). Skin involvement is seen in 50% of patients. Typical cutaneous features include urticaria and angioedema as well as fixed urticarial papules and plaques. Treatment of the eosinophilia usually results in improvement in cutaneous and systemic symptoms.

© 2001-2010, DermAtlas	*Image Name:*	hypereosinophilic_syndrome_2_090821	*File Type:*	jpg
	*Diagnosis:*	HYPEREOSINOPHILIC SYNDROME	*Category:*	reactive erythema / cutaneous sign of systemic disease / hypersensitivity
	*Body Site:*	total body / arm	*Age:*	40 years
	*Contributors:*	Daniel Chang Chris Bengson
	*Description:*	scattered widely disseminated 0.5-1.5 cm red plaques with dusky centers
	*Comments:*	A 40-year-old woman, who was diagnosed with hypereosinophilic syndrome, was admitted on multiple occasions for angioedema of face, throat, hands, and legs, diffuse abdominal pain, and urticarial edematous plaques on her arms, trunk, and thighs. She complained of itching and then burning pain in skin lesions which persisted for 2-3 days and recurred episodically. Acute symptoms were controlled with high dose oral steroids and antihistamines. The hypereosinophilic syndromes are a heterogeneous group of disorders characterized by three common features: peripheral eosinophil count of > 1500/�L for longer than six months, evidence of end organ involvement (excluding benign eosinophilia), and absence of other causes of eosinophilia (drugs, parasites, malignancy). Skin involvement is seen in 50% of patients. Typical cutaneous features include urticaria and angioedema as well as fixed urticarial papules and plaques. Treatment of the eosinophilia usually results in improvement in cutaneous and systemic symptoms.