Pediatric emergency medicine trisk 1352 1352
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CHAPTER 70 ■ RASH: PAPULOSQUAMOUS
ERUPTIONS AND VIRAL EXANTHEMS
PETER A. LIO
PAPULOSQUAMOUS ERUPTIONS
The papulosquamous eruptions describe a set of skin conditions
characterized by solid, elevated skin lesions (papules and plaques) that are
associated with scaling. The prototypical disease is psoriasis, but a variety of
skin conditions can resemble psoriasis and fall into this large category. These
disorders can often be differentiated on the basis of their morphology,
configuration, distribution, and associated symptoms and signs, but
occasionally may prove difficult to diagnose and thus may require further
serologic or histologic testing.
The size of the lesions may be helpful for diagnosis. Tiny (generally 1 to 2
mm) clustered papules may indicate lichen nitidus. Small scattered papules
resembling spattered paint could suggest guttate (from the Latin word for
“drops”) psoriasis. Larger, oval, coin-sized plaques with peripheral scaling
might point to pityriasis rosea (PR), secondary syphilis, lichen planus, or
nummular eczema. Larger, confluent plaques would be more compatible
with plaque-type psoriasis, the morphologically similar pityriasis rubra
pilaris (PRP), or lichen planus.
The color of the lesions is often helpful in differentiating papulosquamous
diseases. Salmon-colored erythema is typical of seborrheic dermatitis, while
psoriasis is often a beefy red color. An orange-red color is characteristic of
PRP, while a more purplish color with white striations is unique to lichen
planus.
Arrangement or configuration characterizes the local grouping of skin
lesions. Koebnerization refers to the eruption of skin disease findings
produced by scratching or incidental trauma, often in a linear pattern ( Fig.
70.1 ). When present, the clinician can focus on a more limited differential
diagnosis because only certain skin conditions commonly produce the
Koebner phenomenon: psoriasis, lichen planus, and lichen nitidus being
