Rash R21.x0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Exanthema diseases; Exantheme; Rash; Skin rash

Definition
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Exanthema" (from gr. exantheo I bloom) refers to a group of infectious and non-infectious, inflammatory, temporary "skin rashes". Exanthema is characterized by a dynamic, often intermittent course (either one or several episodes). They are generalized or spread over larger areas, usually symmetrical ( rubella, measles), less often asymmetrical (e.g. exanthema, unilateral laterothoracic in childhood). Exanthema is composed of different types of efflorescence (urticae, papules, vesicles, pustules). The dominating type is taken into account in the name for a more detailed clinical description: urticarial exanthema, macular exanthema, pustular exanthema, etc. If the course of an exanthema is characterised by multiple attacks, a "colourful" clinical aspect with different types of efflorescence may occur (example: varicella exanthema).

Classification
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Etiopathogenesis
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Due to their morphology, some exanthema are characteristic of certain viral and bacterial infections (measles, scarlet fever). Others accompany as "parainfectious" exanthems various infectious diseases (e.g. Gianotti-Crosti syndrome). Exanthema also occurs in allergic, pseudoallergic and rheumatic diseases. Exanthems can be classified according to their etiology:

    • Infectious exanthema
      • Viral exanthema (most common form of exanthema in children)
      • Bacterial and other infectious exanthema
    • Parainfectious exanthema/enzyme defects
    • Allergic/pseudoallergic exanthema
    • Idiopathic exanthema
    • Exanthema for rheumatic diseases
    • Autoimmunological exanthema
    • Toxic exanthema
    • Pseudoexanthema caused by external infections

Efflorescence(s)
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Exanthema can include all types of efflorescence. They usually show a synchronous monomorphism. A typical exception is varicella or PLEVA ( Pityriasis lichenoides et varioliformis acuta) with a synchronous polymorphism. Typical for varicella is the "starry sky" (several thrusts or continuous thrust activity over a longer period of time).

Differential diagnosis
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For practical reasons of differential diagnosis, exanthema diseases can also be classified according to their main age of manifestation:
  • neonatal exanthema
  • Exanthema in pre-school and school age
  • Adult exanthema.

Note(s)
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  • When assessing an exanthema, the first and most important step towards a valid diagnosis is the basic distinction between an infectious and a non-infectious exanthema. Careful analysis of signs of infection such as fever, AZ disorder, lymphadenopathy, hepatosplenomegaly, blood count and the evaluation of an infection scenario can help here. Only after exclusion of an infectious exanthema can a non-infectious exanthema be considered. The most frequent infectious exanthema are viral exanthema.

Literature
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  1. Föster-Holst R (2007) Virus exanthema. dermatologist 55: 804-817

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 29.10.2020