Codes

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

• Bullous impetigo – Localized with honey-colored crusted plaques, bacteria present in bullae.
• Neonatal candidiasis
• Exanthematous drug eruption
• Drug-induced erythroderma
• Collodion baby
• Conradi disease
• Leiner disease
• Lamellar ichthyosis
• Keratitis-ichthyosis-deafness syndrome (KID syndrome)
• Netherton syndrome
• Epidermolytic ichthyosis – Present at birth and persists despite appropriate antibiotics.
• Toxic epidermal necrolysis (TEN) – Nikolsky's sign only in erythematous areas and mucous membrane involvement, drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
• Ichthyosis bullosa of Siemens (see epidermolytic ichthyosis) – Present at birth and persists despite appropriate antibiotics.
• Epidermolysis bullosa simplex
• Congenital syphilis
• Boric acid poisoning
• Methylmalonic acidemia
• Toxic shock syndrome – High fevers and severe systemic symptoms including vomiting and diarrhea; hypotension quickly ensues; diffuse scarlatiniform exanthem that starts on the trunk (in contrast to face in SSSS).
• Drug hypersensitivity syndrome (DRESS)
• Stevens-Johnson syndrome – Drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
• Scarlet fever – 1 mm erythematous papules, always elevated WBC with left shift, eosinophilia in up to 20% of patients.

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Management Pearls

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Therapy

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References

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