Molluscum contagiosum - pearly or fleshy, umbilicated (ie central depression in papule).This is surrounded by an erythematous flare. The typical lesion is a central itchy white papule or plaque due to swelling of the surface of the skin (wheal). Pompholyx - an itchy vesicular eruption on the hands and/or feet.Erythema multiforme - classically appearing as target lesions (erythematous ring with central vesicle or bulla.).Lesions may become bullous and later rupture. Typically the lesion has the appearance of a target, which is considered pathognomonic. The centre of the lesions may be vesicular, purpuric or necrotic. Stevens-Johnson syndrome - involves a rash that can begin as macules that develop into papules, vesicles, bullae, urticarial plaques or confluent erythema.Probably part of a spectrum of disease which includes SSSS and Stevens-Johnson syndrome. They generally increase in number over 3-4 days (sometimes hours). Toxic epidermal necrolysis - an ill-defined red 'burning/painful' macular or papular rash, spreading from the face or the upper trunk.Staphylococcal scalded skin syndrome (SSSS) - appears as blistered scalded skin, due to focal staphylococcal infection releasing an exotoxin.Impetigo - this usually takes the form of itchy lesions with macules, vesicles, bullae, pustules and gold-coloured crusts caused by Staphylococcus aureus or group A beta-haemolytic streptococci.Herpes simplex viral (HSV) infection - eczema herpeticum (HSV infection superimposed on pre-existing, often mild, eczema causing an eruption of crusty vesicles and eczematous patches).Beware of dyspnoea/cough which may indicate varicella-zoster virus (VZV) pneumonitis. Initial fever is classically high before becoming low-grade. Crusts fall off in 1-3 weeks leaving a pink base. First appears on the face and scalp and then spreads to the trunk and extremities. Appears in crops with all stages represented. Superficial, thin-walled with surrounding erythema rapidly changing to pustules and crusts. Chickenpox (varicella) - vesicles (initially papules, often not noticed), appearing as 'drops of water'.Has the rash got fluid-filled (vesiculobullous) lesions? Clear fluid The online resources in the further reading section may be useful to find any additional images. In some cases links are to factual information needed for recognition/management of a systemic disease with dermatological manifestations. Images of the various rashes may be available by clicking links.
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