Maculopapular Rashes - THE ALGORITHMIC APPROACH 


The term maculopapule is a portmanteau, a combination

of macule and papule (Table 1, page 8). Maculopapular

rashes are differentiated based on the

distribution of the rash and systemic toxicity (Figure 3,

page 10). Patients with centrally distributed rashes

who appear toxic and febrile have a wide differential

diagnosis; however, it is paramount that patients living

in endemic areas be assessed for Lyme disease.

Those with centrally distributed rashes but without

signs of toxicity usually present with either a drug

reaction or pityriasis rosea. Patients with peripherally

distributed rashes have a broader differential diagnosis,

which is dependent upon systemic toxicity,

presence or absence of target lesions, and whether

the rash is located on the flexor or extensor surfaces.

Target lesions are pathognomonic for SJS or EM.

Patients with peripheral lesions and systemic toxicity

but without target lesions require emergent evaluation

for meningococcemia, RMSF, and syphilis. Nontoxic

patients with a peripherally distributed rash but

without target lesions require further assessment for

flexor involvement (scabies or eczema) or extensor

involvement (psoriasis). 


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