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Exanthem – Causes, Symptoms & Treatment
An exanthem is a widespread skin rash that typically appears suddenly and can have many causes. It is often a sign of an infectious disease or an allergic reaction.
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An exanthem is a widespread skin rash that typically appears suddenly and can have many causes. It is often a sign of an infectious disease or an allergic reaction.
What Is an Exanthem?
The term exanthem (from Greek: exanthein = to bloom out) refers to a widespread skin rash that appears suddenly and may cover large areas of the body. It is not a disease in itself but a symptom of various underlying conditions. Exanthems can present as redness, spots, papules, blisters, or pustules and are often accompanied by itching, burning, or fever.
Causes
Exanthems can be triggered by a wide range of causes:
- Viral infections: measles, rubella, chickenpox, fifth disease (erythema infectiosum), Epstein-Barr virus (infectious mononucleosis)
- Bacterial infections: scarlet fever, Lyme disease, meningococcal infections
- Allergic reactions: to medications (drug-induced exanthem), foods, or contact substances
- Autoimmune conditions: e.g., systemic lupus erythematosus
- Unknown causes: idiopathic exanthems
Symptoms
The appearance of an exanthem can vary widely depending on the cause. Common features include:
- Flat red spots or patches (macules)
- Raised bumps (papules)
- Fluid-filled blisters (vesicles)
- Pustules or crusting
- Itching, burning, or pain
- Associated fever, swollen lymph nodes, or general malaise
Diagnosis
Diagnosis is primarily based on a thorough physical examination and a detailed medical history. Key questions include:
- When and where did the rash begin?
- Is it spreading?
- Are there accompanying symptoms such as fever or itching?
- Have any new medications been taken recently?
- Has there been contact with an infected person?
Additional investigations such as blood tests, swab cultures, allergy testing, or a skin biopsy may be used to determine the exact cause.
Treatment
Treatment of an exanthem depends on its underlying cause:
- Viral exanthems: mostly symptomatic treatment (antipyretics, antipruritic agents); antiviral medications for specific infections such as herpes zoster
- Bacterial exanthems: antibiotic therapy (e.g., for scarlet fever)
- Allergic exanthems: removal of the triggering substance, antihistamines, corticosteroids in severe cases
- Autoimmune-related exanthems: immunosuppressive therapy
In most cases, exanthems resolve without lasting damage. Sudden, severe rashes accompanied by fever, mucosal involvement, or difficulty breathing require immediate medical attention.
When to See a Doctor
The following warning signs require prompt medical evaluation:
- Rapid spread of the rash over large body areas
- High fever or severe general illness
- Involvement of mucous membranes (mouth, eyes, genitals)
- Purpuric discoloration (non-blanching red spots) – possible sign of meningococcal infection
- Difficulty breathing or circulatory symptoms
References
- Braun-Falco, O. et al.: Dermatology and Venereology. Springer Medizin Verlag, 6th edition, 2018.
- Robert Koch Institut (RKI): Infectious Diseases A–Z, www.rki.de (accessed 2024).
- Sterry, W., Burgdorf, W., Paus, R.: Checklist Dermatology. Georg Thieme Verlag, 7th edition, 2020.
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