Abstract
Although a very broad differential diagnosis can be reached by the type of primary lesion, it can be honed by adding various descriptive terms such as color (e.g., brown lesions, white lesions) and combining features such a fever and a rash (e.g., viral infections). A more precise differential diagnosis can also be established by identifying a particular subgroup of patients (e.g., cutaneous infections in athletes) or by underlying conditions (e.g., cutaneous manifestations in HIV infection). The distribution of the lesions can also be utilized to establish a more sophisticated differential diagnosis (e.g., photodermatoses). This chapter organizes mucocutaneous lesions into distinct groups based on these additional findings.
Keywords
athletes, exanthem, fever, hyperpigmentation, hypertrichosis, pruritus, purpura, photosensitive, stomatitis, telangiectasia
3
Anhidrosis
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Central nervous system (CNS) lesions (medulla, hypothalamus, pons)
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Congenital sweat gland disorders
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Dehydration
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Drugs (anticholinergics)
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Hysteria
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Lesions of sympathetic nerves
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Local radiant heat or pressure
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Obstruction of sweat ducts (e.g., inflammation, miliaria)
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Spinal cord lesions
4
Arthritis, Fever, and Rash
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Acute rheumatic fever
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Acute sarcoidosis
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Familial Mediterranean fever
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Gonococcemia
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Hyperimmunoglobulinemia D and periodic fever syndrome
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Kawasaki syndrome
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Lyme borreliosis
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Meningococcemia
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Parvovirus B19
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Rocky Mountain spotted fever
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Rubella
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Secondary syphilis
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Still’s disease
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Urticarial vasculitis
6
Bullous Disease, Subepidermal (Tense Blisters)
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Acute graft-versus-host reaction
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Amyloidosis
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Arthropod bite reaction
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Bullous drug reaction
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Bullous pemphigoid
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Burns
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Dermatitis herpetiformis
- •
Cicatricial pemphigoid (benign mucous membrane pemphigoid)
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Epidermolysis bullosa
- •
Herpes gestationis
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Leukocytoclastic vasculitis
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Linear IgA disease (chronic bullous disease of childhood)
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Lupus erythematosus
- •
Porphyria cutanea tarda
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Pressure necrosis
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Pseudoporphyria
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Toxic epidermal necrosis
- •
Urticaria pigmentosa
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Variegate porphyria
7
Cutaneous Color Changes
Blue
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Cardiovascular disease
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Pulmonary diseases
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Raynaud’s disease
Brown
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Adrenocorticotropic hormone (ACTH)–producing tumor (e.g., oat cell lung carcinoma)
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Liver disease
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Localized: nevi, neurofibromatosis
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Pituitary disease
Red (Erythema)
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Anxiety reaction
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Fever
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Generalized urticaria
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Localized: inflammation, infection, Raynaud’s disease
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Polycythemia
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Viral exanthems
White
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Albinism
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Raynaud’s disease
- •
Vitiligo
Yellow
- •
Anemia
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Chronic renal failure
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Hepatitis, liver disease
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Hypothyroidism
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Increased intake of vegetables containing carotene
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Localized: resolving hematoma, infection, peripheral vascular insufficiency
10
Fever and Rash
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Allergic vasculitis
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Dermatomyositis
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Drug hypersensitivity: penicillin, sulfonamides, thiazides, anticonvulsants, allopurinol
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Erythema marginatum
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Erythema multiforme
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Erythema nodosum
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Herpes zoster
- •
Other infections: meningococcemia, staphylococcemia, scarlet fever, typhoid fever, Pseudomonas bacteremia, Rocky Mountain spotted fever, Lyme disease, secondary syphilis, bacterial endocarditis, babesiosis, brucellosis, listeriosis
- •
Pityriasis rosea
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Serum sickness
- •
Systemic lupus erythematosus (SLE)
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Viral infection: measles, rubella, varicella, erythema infectiosum, roseola, enterovirus infection, viral hepatitis, infectious mononucleosis, acute human immunodeficiency virus (HIV)
12
Flushing
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Agnogenic flushing
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Anxiety
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Carcinoid syndrome
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Chronic myelogenous leukemia (CML)
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Drugs: nicotinic acid, diltiazem, nifedipine, levodopa, bromocriptine, vancomycin, amyl nitrate
- •
Ingestion of alcoholic beverages
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Ingestion of hot drinks
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Ingestion of hot peppers
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Menopause
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Monosodium glutamate ingestion
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Polycythemia, systemic mastocytosis
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Renal cell carcinoma
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VIPoma (Verner-Morrison syndrome)
13
Foot Dermatitis
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Acquired plantar keratoderma
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Allergic contact dermatitis
- •
Dyshidrotic eczema
- •
Neuropathic foot ulcers (diabetes mellitus [DM], poorly fitting shoes)
- •
Peripheral vascular insufficiency
- •
Psoriasis
- •
Sézary syndrome
- •
Tinea pedis
- •
Tylosis (mechanically induced hyperkeratosis, fissuring, and dryness)
17
Hiv Infection, Cutaneous Manifestations
Arthropod Infestations
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Scabies
Bacterial Infection
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Bacillary angiomatosis
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Staphylococcus aureus
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Syphilis
Fungal Infection
- •
Candidiasis
- •
Cryptococcosis
- •
Seborrheic dermatitis
Noninfectious
- •
Drug reactions
- •
Nutritional deficiencies
- •
Psoriasis
- •
Vasculitis
Viral Infection
- •
Herpes simplex
- •
Herpes zoster
- •
HIV
- •
Human papillomavirus
- •
Kaposi’s sarcoma (human herpesvirus 8)
- •
Molluscum contagiosum
18
Hyperpigmentation
- •
ACTH–producing or MSH–producing tumors (e.g., oat cell carcinoma of the lung) ∗
∗ Accentuation on sun-exposed surfaces.
- •
Addison’s disease ∗
- •
Arsenic ingestion
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Drug induced (e.g., antimalarials, some cytotoxic agents)
- •
Hemochromatosis
- •
Malabsorption syndrome (Whipple’s disease and celiac sprue)
- •
Melanoma
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Melanotropic hormone injection ∗
- •
Pheochromocytoma
- •
Porphyrias (porphyria cutanea tarda and variegate porphyria)
- •
Pregnancy
- •
Progressive systemic sclerosis and related conditions
- •
Psoralen and UVA (PUVA) therapy for psoriasis and vitiligo ∗
20
Hypopigmentation
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Atopic dermatitis
- •
Chemical leukoderma
- •
Idiopathic guttate hypomelanosis
- •
Nevoid hypopigmentation
- •
Oculocutaneous albinism
- •
Phenylketonuria
- •
Sarcoidosis
- •
Scleroderma
- •
SLE
- •
Tinea versicolor
- •
Vitiligo
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