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This is a classic differential diagnosis lecture given by Dr. Fisher (and a common presentation for hospital consult dermatology). However, the list is too extensive to be memorized. It is more of a reference list to be perused at the closest computer after examining the patient, and before writing your note.
PURPURIC (macules, papules, pustules, vesicles, or bullae):
(purpura vs. necrosis may be clinically indistinguishable)
| • | palpable purpura with fever is sepsis until proven otherwise |
| • | (but septic vasculitis is usually distal, sparse, asymmetric purpura vs. allergic vasculitis) |
| • | Pseudomonas sepsis ecthyma gangrenosum: easiest of the septic vasculitides to diagnose from lesion itself (i.e. gram stain)
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ERYTHEMATOUS (macules, papules, wheals)
| • | scarlet fever Pastia’s lines; circumoral pallor; rough sandpaper |
| • | rubeola prodrome: cough, coryza, conjuctivitis |
| • | enterovirus infections nonspecific exanthem with non-specific viral systemic symptoms (ask about N/V/D i.e. entero) |
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| • | infectious mononucleosis |
| • | HIV seroconversion oral, genital, or anal ulcers also seem to be a distinctive feature (~ 30%) |
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| • | SLE erythema between bony prominence's typically |
| • | erythema marginatum (rheumatic fever) |
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VESICLES/PUSTULES
| • | staph scalded skin syndrome |
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drug vs. infectious:
| • | drug – suddenly without prodrome (“drug red”) |
| • | infectious – often with prodrome |
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