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
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