Differential Diagnosis




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

 





Alopecia, Nonscarring





  • Alopecia areata



  • Anagen effluvium



  • Androgenetic alopecia



  • Cosmetic treatment



  • Structural hair shaft disease



  • Telogen effluvium



  • Tinea capitis



  • Trichotillomania (hair pulling)






Alopecia, Scarring





  • Bacterial folliculitis



  • Central centrifugal scarring alopecia



  • Congenital (aplasia cutis)



  • Discoid lupus erythematosus



  • Folliculitis decalvans



  • Lichen planopilaris



  • Neoplasm



  • Tinea capitis with inflammation (kerion)



  • Trauma






Anhidrosis





  • Central nervous system (CNS) lesions (medulla, hypothalamus, pons)



  • Congenital sweat gland disorders



  • Dehydration



  • Drugs (anticholinergics)



  • Hysteria



  • Lesions of sympathetic nerves



  • Local radiant heat or pressure



  • Obstruction of sweat ducts (e.g., inflammation, miliaria)



  • Spinal cord lesions






Arthritis, Fever, and Rash





  • Acute rheumatic fever



  • Acute sarcoidosis



  • Familial Mediterranean fever



  • Gonococcemia



  • Hyperimmunoglobulinemia D and periodic fever syndrome



  • Kawasaki syndrome



  • Lyme borreliosis



  • Meningococcemia



  • Parvovirus B19



  • Rocky Mountain spotted fever



  • Rubella



  • Secondary syphilis



  • Still’s disease



  • Urticarial vasculitis






Bullous Disease, Intraepidermal (Fragile Blisters)





  • Bullous impetigo



  • Hailey-Hailey disease



  • Paraneoplastic pemphigus



  • Pemphigus foliaceus



  • Pemphigus vulgaris



  • Staphylococcal scalded skin syndrome






Bullous Disease, Subepidermal (Tense Blisters)





  • Acute graft-versus-host reaction



  • Amyloidosis



  • Arthropod bite reaction



  • Bullous drug reaction



  • Bullous pemphigoid



  • Burns



  • Dermatitis herpetiformis



  • Cicatricial pemphigoid (benign mucous membrane pemphigoid)



  • Epidermolysis bullosa



  • Herpes gestationis



  • Leukocytoclastic vasculitis



  • Linear IgA disease (chronic bullous disease of childhood)



  • Lupus erythematosus



  • Porphyria cutanea tarda



  • Pressure necrosis



  • Pseudoporphyria



  • Toxic epidermal necrosis



  • Urticaria pigmentosa



  • Variegate porphyria






Cutaneous Color Changes


Blue





  • Cardiovascular disease



  • Pulmonary diseases



  • Raynaud’s disease



Brown





  • Adrenocorticotropic hormone (ACTH)–producing tumor (e.g., oat cell lung carcinoma)



  • Liver disease



  • Localized: nevi, neurofibromatosis



  • Pituitary disease



Red (Erythema)





  • Anxiety reaction



  • Fever



  • Generalized urticaria



  • Localized: inflammation, infection, Raynaud’s disease



  • Polycythemia



  • Viral exanthems



White





  • Albinism



  • Raynaud’s disease



  • Vitiligo



Yellow





  • Anemia



  • Chronic renal failure



  • Hepatitis, liver disease



  • Hypothyroidism



  • Increased intake of vegetables containing carotene



  • Localized: resolving hematoma, infection, peripheral vascular insufficiency






Cutaneous Infections, Athletes





  • Erythrasma



  • Folliculitis



  • Furuncles



  • Herpes simplex



  • Impetigo



  • Molluscum contagiosum



  • Otitis externa



  • Tinea cruris



  • Tinea pedis



  • Verrucal vulgaris






Exanthems





  • Adenovirus



  • Enterovirus



  • Epstein-Barr virus



  • Erythema infectiosum (fifth disease)



  • Kawasaki syndrome



  • Measles



  • Meningococcemia



  • Rocky Mountain spotted fever



  • Roseola exanthema



  • Rubella



  • Scarlet fever



  • Staphylococcal scalded skin syndrome



  • Varicella






Fever and Rash





  • Allergic vasculitis



  • Dermatomyositis



  • Drug hypersensitivity: penicillin, sulfonamides, thiazides, anticonvulsants, allopurinol



  • Erythema marginatum



  • Erythema multiforme



  • Erythema nodosum



  • 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



  • Serum sickness



  • Systemic lupus erythematosus (SLE)



  • Viral infection: measles, rubella, varicella, erythema infectiosum, roseola, enterovirus infection, viral hepatitis, infectious mononucleosis, acute human immunodeficiency virus (HIV)






Finger Lesions, Inflammatory





  • Bacterial endocarditis (Osler’s nodes)



  • Dyshidrotic eczema (pompholyx)



  • Herpes simplex type 1 (herpetic whitlow)



  • Herpes zoster



  • Paronychia



  • Psoriatic arthritis






Flushing





  • Agnogenic flushing



  • Anxiety



  • Carcinoid syndrome



  • Chronic myelogenous leukemia (CML)



  • Drugs: nicotinic acid, diltiazem, nifedipine, levodopa, bromocriptine, vancomycin, amyl nitrate



  • Ingestion of alcoholic beverages



  • Ingestion of hot drinks



  • Ingestion of hot peppers



  • Menopause



  • Monosodium glutamate ingestion



  • Polycythemia, systemic mastocytosis



  • Renal cell carcinoma



  • VIPoma (Verner-Morrison syndrome)






Foot Dermatitis





  • Acquired plantar keratoderma



  • 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)






Foot Lesions, Ulcerating





  • Actinomycosis (Madura foot)



  • Cellulitis



  • Plantar fibromatosis



  • Plantar wart



  • Pseudoepitheliomatous hyperplasia



  • Squamous cell carcinoma






Genital Sores





  • Chancroid



  • Condyloma acuminatum



  • Granuloma inguinale



  • Herpes genitalis



  • Lymphogranuloma venereum



  • Neoplastic lesion



  • Syphilis



  • Trauma






Granulomatous Dermatitides





  • Annular elastolytic giant cell granuloma (actinic granuloma)



  • Cutaneous Crohn’s disease



  • Foreign body granuloma



  • Granuloma annulare



  • Necrobiosis lipoidica diabeticorum



  • Rheumatoid nodules



  • Sarcoidosis






Hiv Infection, Cutaneous Manifestations


Arthropod Infestations





  • Scabies



Bacterial Infection





  • Bacillary angiomatosis



  • Staphylococcus aureus



  • 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






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



  • Drug induced (e.g., antimalarials, some cytotoxic agents)



  • Hemochromatosis



  • Malabsorption syndrome (Whipple’s disease and celiac sprue)



  • Melanoma



  • 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






Hypertrichosis


Drugs





  • Cyclosporine



  • Dilantin



  • Hexachlorobenzene



  • Minoxidil



  • Penicillamine



Systemic Illness





  • Anorexia nervosa



  • Dermatomyositis



  • Hypothyroidism



  • Malnutrition



  • Porphyria






Hypopigmentation





  • Atopic dermatitis



  • Chemical leukoderma



  • Idiopathic guttate hypomelanosis



  • Nevoid hypopigmentation



  • Oculocutaneous albinism



  • Phenylketonuria



  • Sarcoidosis



  • Scleroderma



  • SLE



  • Tinea versicolor



  • Vitiligo


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Sep 22, 2019 | Posted by in Dermatology | Comments Off on Differential Diagnosis
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