From the Guidelines
Exanthema is a skin rash that presents as follicular papules and pustules, typically developing in areas with high sebaceous gland density, such as the face, and can be associated with pruritus, stinging, and pain 1.
Definition and Presentation
Exanthema can appear as a red, flat, or slightly raised rash covering large body areas, with various patterns like maculopapular or vesicular, depending on the underlying cause, which may include viral or bacterial infections, or reactions to certain medications 1.
Causes and Triggers
The rash often develops suddenly, accompanied by fever, fatigue, and other systemic symptoms, and its appearance can vary based on the cause, such as viral infections (measles, rubella, chickenpox, roseola) or bacterial infections (scarlet fever) 1.
Treatment and Management
Treatment focuses on addressing the underlying cause, such as antiviral medications for viral infections or antibiotics for bacterial infections, along with supportive care to manage symptoms, and the rash typically resolves as the underlying condition improves 1. Some key management strategies for papulopustular exanthema include:
- Initiation or escalation of topical corticosteroids for grade 1 and 2 rash 1
- Initiation of oral tetracycline antibiotics for at least 6 weeks for grade 1 and 2 rash 1
- A short course of systemic corticosteroids and interruption of the offending agent until the rash improves for grade 3 rash 1 It is crucial to obtain bacterial cultures and administer antibiotics based on sensitivities when infection is suspected, and additional treatments like oral retinoids or dapsone may be considered in specific cases 1.
From the Research
Definition of Exanthema
- An exanthem is a skin rash that may be associated with mucous membrane eruption, fever, or other symptoms 2.
- It may develop as a manifestation of an infectious disease or as an adverse reaction to drugs 2, 3.
Causes of Exanthema
- Exanthems can be caused by various factors, including viral, bacterial, parasitic, and helminth infections 2.
- Drugs, such as beta-lactams and non-steroidal anti-inflammatory drugs, can also induce exanthema 3.
- Viruses, such as Epstein-Barr virus, human herpesvirus 6, and cytomegalovirus, can cause exanthema either from the infection itself or due to interaction with drugs 3.
Diagnosis of Exanthema
- Determining the exact diagnosis of exanthema requires a careful clinical history and thorough physical examination 3, 4.
- Haematological and biochemical investigations and histology may not always be helpful in differentiating between viral and drug-induced exanthema 3.
- Serological and polymerase chain reaction assays can be helpful, although a concomitant acute infection does not exclude drug hypersensitivity 3.