# Internal Medicine/Skin Manifestations of Internal Disease
## Papulosquamous Skin Lesions

Papulosquamous skin lesions encompass a broad category of skin conditions characterized by the presence of raised, scaly bumps (papules) often accompanied by flaking or peeling of the skin (desquamation). These lesions result from various underlying causes and can manifest in different patterns and locations on the body. Understanding the diverse spectrum of papulosquamous skin lesions is crucial for accurate diagnosis and appropriate management.
* Psoriasis: Psoriasis is a chronic autoimmune skin disorder characterized by well-defined, raised, red plaques covered with silvery-white scales. It commonly affects the scalp, elbows, knees, and lower back. Psoriasis is associated with an accelerated skin cell turnover rate, leading to the rapid buildup of skin cells on the surface. The condition can be mild to severe and may involve joints, leading to psoriatic arthritis.
* Seborrheic Dermatitis: Seborrheic dermatitis presents with yellowish, greasy, scaly patches on the scalp, face (especially the eyebrows and nasolabial folds), chest, and back. It is often associated with an overgrowth of the yeast Malassezia on the skin.
* Pityriasis Rosea: Pityriasis rosea typically begins with a single, large, scaly, pink or red patch called the "herald patch," followed by the development of smaller, similar lesions in a Christmas tree-like pattern on the trunk and limbs. The exact cause of this condition is unclear but is believed to be related to viral infections.
* Lichen Planus: Lichen planus presents as pruritic, flat-topped, polygonal, purple papules with white, reticulated (lacy) lines on the skin's surface. It can affect the skin, mucous membranes (oral, genital), hair, and nails. Lichen planus is an inflammatory condition with various triggers, including medications and infections.
* Cutaneous T-cell Lymphoma (Mycosis Fungoides): Cutaneous T-cell lymphoma is a rare type of non-Hodgkin lymphoma that initially appears as scaly, red-brown patches or plaques. Over time, it may progress to form tumors. Early diagnosis is essential for optimal treatment outcomes.
* Secondary Syphilis: Secondary syphilis can manifest as papulosquamous lesions, often presenting as reddish-brown papules with a coppery hue on the palms and soles (palmar and plantar syphilids). Syphilis is a sexually transmitted infection caused by Treponema pallidum.
* Tinea Corporis (Ringworm): This superficial fungal infection results in circular or annular, scaly, erythematous patches with central clearing. It can occur anywhere on the body and is highly contagious.
* Drug Eruptions: Certain medications can lead to papulosquamous eruptions, typically as an adverse drug reaction. The presentation can vary widely and often necessitates discontinuation of the offending medication.
* Nummular Dermatitis: Nummular dermatitis presents as coin-shaped, scaly plaques that can be intensely pruritic. It often occurs on the extremities and is associated with dry skin.
* Actinic Keratosis: Actinic keratosis represents precancerous lesions caused by chronic sun exposure. These lesions appear as rough, scaly patches or papules and are at risk of progressing to squamous cell carcinoma.
Diagnosis and management of papulosquamous lesions involve a thorough clinical evaluation, often requiring a skin biopsy for definitive diagnosis. Treatment approaches depend on the underlying cause and may include topical or systemic medications, phototherapy, lifestyle modifications, or addressing any triggering factors.

## Erythroderma

Erythroderma is a rare but serious skin condition characterized by widespread redness, inflammation, and scaling of the skin's surface, often involving more than 90% of the body. This dermatological emergency requires immediate medical attention due to its potential complications and underlying causes, which can range from severe skin diseases to systemic illnesses.
* Psoriasis: Erythrodermic psoriasis is a severe form of psoriasis characterized by the abrupt onset of erythroderma. It can be life-threatening if not promptly managed. Patients may experience fever, chills, and metabolic disturbances.
* Drug Reactions: Some medications, particularly antibiotics and anticonvulsants, can trigger drug-induced erythroderma. The condition may develop rapidly after drug exposure and can be associated with mucous membrane involvement.
* Cutaneous T-cell Lymphoma (CTCL): Erythroderma can be a manifestation of advanced CTCL, particularly Sézary syndrome. This aggressive lymphoma involves circulating malignant T-cells and requires specialized oncological care.
* Atopic Dermatitis: Severe cases of atopic dermatitis, especially in infants, can progress to erythroderma. The skin barrier is compromised, leading to increased susceptibility to infections.
* Contact Dermatitis: Erythroderma may result from severe contact dermatitis reactions, such as in the case of a widespread allergic response to an allergen like poison ivy.
* Systemic Illnesses: Conditions like congestive heart failure, thyroid disorders, or lymphoproliferative diseases can lead to erythroderma.
* Idiopathic Erythroderma: In some cases, the underlying cause of erythroderma remains unknown, leading to a diagnosis of idiopathic erythroderma.
Management of erythroderma involves hospitalization and addressing the underlying cause, if identified. Patients often require intensive supportive care, including fluid and electrolyte management, wound care, and treatments to alleviate symptoms and control inflammation.

## Alopecia

Alopecia, or hair loss, can affect the scalp or other body areas and can result from a variety of causes. Understanding the underlying factors is essential for appropriate management.
* Androgenetic Alopecia: Also known as male-pattern or female-pattern baldness, this hereditary condition is the most common cause of hair loss. It typically results in gradual thinning of the hair and a receding hairline in men, while women may experience diffuse thinning.
* Alopecia Areata: Alopecia areata is an autoimmune condition characterized by the sudden onset of well-defined, round or oval areas of hair loss on the scalp or other body areas. It can affect individuals of all ages and may lead to complete hair loss (alopecia totalis) or loss of all body hair (alopecia universalis).
* Telogen Effluvium: Telogen effluvium is a temporary hair loss condition often triggered by physical or emotional stress, surgery, illness, childbirth, or medications. Hair shedding is diffuse and occurs several months after the triggering event.
* Traction Alopecia: Traction alopecia results from constant pulling or tension on the hair shafts, commonly due to tight hairstyles like braids or cornrows. It is often preventable with changes in hairstyling practices.
* Scarring Alopecia: Scarring alopecia encompasses a group of conditions in which hair follicles are permanently destroyed, leading to irreversible hair loss. Lichen planopilaris and frontal fibrosing alopecia are examples.
* Trichotillomania: Trichotillomania is a psychological disorder characterized by the urge to pull out one's hair, resulting in hair loss. Treatment typically involves cognitive-behavioral therapy.
* Nutritional Deficiencies: Inadequate intake of essential nutrients, particularly iron and biotin, can contribute to hair loss. Addressing nutritional deficiencies can promote hair regrowth.
Management of alopecia depends on the specific type and underlying cause. Treatments may include medications (e.g., minoxidil, finasteride), topical therapies, lifestyle modifications, and addressing any associated medical conditions.

## Figurate Skin Lesions

Figurate skin lesions are distinctive, often geometrically shaped patterns or configurations that appear on the skin. These lesions can result from various underlying causes, and recognizing the specific pattern is crucial for accurate diagnosis.
* Erythema Annulare Centrifugum (EAC): Erythema annulare centrifugum presents as expanding, annular (ring-shaped) erythematous plaques with central clearing. The cause is often unknown, but it may be associated with infections, medications, or underlying malignancies.
* Erythema Marginatum: Erythema marginatum is a rare skin manifestation of acute rheumatic fever, typically appearing as pink, non-pruritic, serpiginous (snake-like) plaques on the trunk and inner thighs.
* Necrobiosis Lipoidica: Necrobiosis lipoidica manifests as well-defined, yellowish-brown plaques with atrophic centers, often on the shins. It is associated with diabetes mellitus.
* Granuloma Annulare: Granuloma annulare presents as raised, flesh-colored or erythematous papules or plaques arranged in a ring or arc shape. The cause is often unknown, but it can be associated with autoimmune diseases.
* Erythema Migrans: Erythema migrans is the characteristic skin rash of Lyme disease. It appears as a red, expanding, circular rash with central clearing, often resembling a "bull's-eye" target.
* Urticarial Vasculitis: Urticarial vasculitis combines features of urticaria (hives) and vasculitis, resulting in urticarial lesions that persist for longer durations and may leave purpura (purple discolorations) as they resolve.
* Fixed Drug Eruption: Fixed drug eruptions are recurring skin reactions to specific medications. Lesions appear as well-defined, round or oval erythematous plaques and tend to recur in the same locations upon re-exposure to the offending drug.
* Erythema Gyratum Repens: This rare skin condition is characterized by concentric, whorled, and rippling erythematous bands resembling wood grain. It can be associated with internal malignancies.
Diagnosis and management of figurate skin lesions require a thorough evaluation, including a detailed medical history and, in some cases, skin biopsy. Identifying and addressing any underlying causes is essential for effective treatment and preventing recurrence.

## Acne

Acne is a common skin condition that primarily affects adolescents but can persist into adulthood. It results from the blockage of hair follicles by oil, dead skin cells, and bacteria, leading to the formation of various types of lesions.
* Comedones: Comedones are non-inflammatory acne lesions and can be open (blackheads) or closed (whiteheads). They result from the clogging of hair follicles by sebum and dead skin cells.
* Papules: Papules are small, red, tender bumps that develop when blocked follicles become inflamed.
* Pustules: Pustules are similar to papules but contain pus. They are often seen as yellow or white lesions with a red base.
* Nodules: Nodules are large, painful, solid lumps beneath the skin's surface. They result from deep inflammation and can lead to scarring.
* Cysts: Cysts are the most severe form of acne lesions and appear as large, pus-filled lumps. They often cause significant scarring.
Acne can have various triggers, including hormonal fluctuations, genetics, and certain medications. Effective acne management involves a multi-faceted approach:
* Topical Treatments: These include over-the-counter or prescription creams, gels, and lotions containing ingredients like benzoyl peroxide, salicylic acid, or retinoids to target acne lesions.
* Oral Medications: In severe cases, healthcare providers may prescribe antibiotics, oral contraceptives, or isotretinoin (Accutane) to address acne.
* Lifestyle Modifications: Practices like gentle skin cleansing, avoiding excessive scrubbing, and using non-comedogenic (non-pore-clogging) skincare products can help manage acne.
* Procedures: Dermatological procedures like chemical peels, microdermabrasion, or laser therapy may be recommended to treat acne and reduce scarring.
Treatment plans are often tailored to the severity and type of acne, as well as individual patient factors.

## Pustular Lesions

Pustular lesions are characterized by the presence of pus-filled vesicles or papules on the skin's surface. These lesions can arise from various causes, including infections, autoimmune conditions, and medication reactions.
* Acne Pustules: Acne vulgaris can result in pustules, which are inflamed, pus-filled lesions commonly seen in acne-prone areas of the face, chest, and back.
* Impetigo: Impetigo is a contagious bacterial infection that leads to the formation of honey-colored, crusted pustules, often seen in children.
* Folliculitis: Folliculitis is an infection or inflammation of hair follicles that can result in pustules. It may be caused by bacteria, fungi, or other factors.
* Pyoderma Gangrenosum: Pyoderma gangrenosum is a rare, ulcerating skin condition that often starts as painful, pustular lesions before progressing to larger ulcers with undermined borders.
* Palmoplantar Pustulosis: This chronic skin condition primarily affects the palms and soles, leading to the development of sterile pustules and hyperkeratotic (thickened) skin.
* Pustular Psoriasis: Pustular psoriasis is a type of psoriasis characterized by the presence of pustules on red, inflamed skin. It can be localized or generalized.
* Drug-Induced Pustules: Some medications, such as certain antibiotics or immunosuppressants, can lead to drug-induced pustular eruptions as adverse reactions.
* Behçet's Disease: Behçet's disease, a systemic autoimmune condition, can cause oral and genital ulcers along with skin manifestations, including pustules.
Management of pustular lesions depends on the underlying cause. Treatment may involve antibiotics for infections, topical or systemic medications for inflammatory conditions, and discontinuation of offending drugs in drug-induced cases.

## Telangiectasias

Telangiectasias refer to the dilation of small blood vessels, resulting in visible, fine, red or purple lines or patterns on the skin. These vascular abnormalities can arise from various causes and may be a cosmetic concern or associated with underlying medical conditions.
* Rosacea: Rosacea is a chronic skin condition characterized by facial flushing, persistent redness, papules, and pustules. Telangiectasias, often called "spider veins," frequently appear on the nose and cheeks of individuals with rosacea.
* Hereditary Hemorrhagic Telangiectasia (HHT): HHT is a genetic disorder that leads to the development of numerous telangiectasias on the skin and mucous membranes. It can also affect internal organs and cause bleeding issues.
* Liver Disease: Advanced liver disease, such as cirrhosis, can result in spider angiomas, a type of telangiectasia often seen on the face, chest, and upper body.
* Sun Damage: Chronic sun exposure can cause telangiectasias, particularly on sun-exposed areas like the face and neck.
* Aging: As skin ages, the natural collagen support weakens, making blood vessels more prone to dilation and the development of telangiectasias.
* Radiation Therapy: Individuals who have undergone radiation therapy may develop telangiectasias in the irradiated area.
Management of telangiectasias may involve laser therapy, electrocautery, or sclerotherapy to reduce their appearance. Treatment of any underlying conditions contributing to telangiectasia development is also essential.

## Hypopigmentation

Hypopigmentation refers to areas of the skin that are lighter in color than the surrounding skin. This can result from a variety of causes, including skin conditions, infections, and autoimmune disorders.
* Vitiligo: Vitiligo is an autoimmune condition that leads to the destruction of melanocytes, the pigment-producing cells in the skin. This results in well-defined, depigmented patches that can appear anywhere on the body.
* Pityriasis Alba: Pityriasis alba primarily affects children and is characterized by pale, scaly patches on the face. These patches are often round or oval and may be mistaken for eczema.
* Tinea Versicolor: Tinea versicolor is a fungal infection that can cause hypopigmented or hyperpigmented patches on the skin. These patches often appear on the chest, back, and upper arms.
* Post-Inflammatory Hypopigmentation: After certain skin injuries, such as burns, abrasions, or inflammatory skin conditions, hypopigmentation can develop as a result of decreased melanin production in the affected areas.
* Halo Nevus: A halo nevus is a mole (nevus) surrounded by a depigmented ring or halo. The exact cause is unknown, but it may be related to an autoimmune response against the mole.
* Idiopathic Guttate Hypomelanosis (IGH): IGH presents as small, white, flat spots on the arms and legs. It is more common in fair-skinned individuals and often associated with sun exposure.
Management of hypopigmentation depends on the underlying cause. In some cases, treatment may focus on managing the underlying condition, while other treatments aim to repigment the affected areas, such as topical corticosteroids or phototherapy.

## Hyperpigmentation

Hyperpigmentation refers to areas of the skin that are darker in color than the surrounding skin. This can occur due to an overproduction of melanin or the presence of excess melanin in the skin. Hyperpigmentation can result from various factors, including:
* Melasma: Melasma is a common condition characterized by brown or gray-brown patches, often on the face. It is associated with hormonal changes, sun exposure, and genetic factors.
* Post-Inflammatory Hyperpigmentation (PIH): PIH occurs after skin inflammation or injury, such as acne, burns, or insect bites. Darker patches develop in the affected areas as part of the healing process.
* Freckles: Freckles are small, concentrated areas of increased melanin production. They are often genetic and become more prominent with sun exposure.
* Age Spots (Solar Lentigines): Age spots, also known as liver spots, are flat, brown, or black spots that typically appear on sun-exposed areas of the skin, such as the hands, face, and shoulders.
* Café-au-Lait Spots: Café-au-lait spots are light to dark brown patches that can be present at birth or develop during childhood. They are often associated with neurofibromatosis.
* Medication-Induced Hyperpigmentation: Certain medications, such as minocycline and amiodarone, can cause hyperpigmentation as a side effect.
* Addison's Disease: Addison's disease, a hormonal disorder affecting the adrenal glands, can lead to generalized hyperpigmentation, particularly on areas exposed to sun.
Management of hyperpigmentation may involve topical treatments (e.g., hydroquinone, retinoids), chemical peels, laser therapy, or addressing underlying medical conditions. Sun protection is essential to prevent worsening of hyperpigmentation.

## Vesicles/Bullae

Vesicles and bullae are fluid-filled lesions that can develop on the skin. Understanding their characteristics and causes is crucial for accurate diagnosis and appropriate management.
* Herpes Simplex Virus (HSV) Infections: HSV infections can cause clusters of small, clear vesicles on red bases. These vesicles often appear on or around the lips (cold sores) or in the genital area.
* Varicella-Zoster Virus (VZV) Infections: VZV, which causes chickenpox during primary infection and shingles (herpes zoster) upon reactivation, leads to the development of vesicles. In chickenpox, vesicles are widespread, while in shingles, they follow a dermatomal distribution.
* Bullous Impetigo: Bullous impetigo is a bacterial skin infection, primarily seen in children, characterized by large, fluid-filled bullae that rupture to form crusted lesions.
* Pemphigus: Pemphigus is a group of autoimmune blistering disorders that result in the formation of flaccid bullae and erosions on the skin and mucous membranes. Pemphigus vulgaris and pemphigus foliaceus are examples.
* Bullous Pemphigoid: Bullous pemphigoid is another autoimmune blistering disorder that primarily affects the elderly. It leads to tense, subepidermal bullae and can cause intense itching.
* Dermatitis Herpetiformis: Dermatitis herpetiformis is a skin manifestation of celiac disease characterized by intensely pruritic papules and vesicles, often on the elbows, knees, and buttocks.
* Porphyria Cutanea Tarda (PCT): PCT, a disorder of heme metabolism, can cause vesicles and bullae on sun-exposed areas due to the accumulation of porphyrins in the skin.
* Linear IgA Bullous Dermatosis: This autoimmune blistering disorder results in the formation of linear IgA deposits at the basement membrane zone and the development of tense bullae.
Diagnosis and management of vesicles and bullae depend on their underlying cause. Treatment may involve antiviral medications for viral infections, antibiotics for bacterial infections, immunosuppressive therapy for autoimmune blistering disorders, and addressing any triggering factors.

## Urticaria

Urticaria, commonly known as hives, is a skin condition characterized by the sudden appearance of raised, itchy, red or pink welts (wheals) on the skin. These wheals can vary in size and shape and often resolve within hours to days, but they can be extremely uncomfortable.
* Acute Urticaria: Acute urticaria is often caused by allergens, such as certain foods, medications, insect stings, or infections. It can develop suddenly and typically resolves within a few weeks.
* Chronic Urticaria: Chronic urticaria is defined as hives that persist for six weeks or longer. It can be more challenging to identify the underlying cause, and autoimmune factors may play a role in some cases.
* Physical Urticaria: Physical urticaria is triggered by physical stimuli, such as pressure (dermatographism), cold (cold urticaria), heat (heat urticaria), or exercise (exercise-induced urticaria).
* Dermatographism: Dermatographism is a type of physical urticaria where stroking or scratching the skin results in the formation of raised, red lines.
* Cholinergic Urticaria: Cholinergic urticaria is provoked by an increase in body temperature, often due to sweating, exercise, or stress. It presents as small, itchy hives.
* Angioedema: Angioedema is a related condition characterized by the swelling of deeper layers of the skin and mucous membranes. It often occurs in conjunction with urticaria.
* Idiopathic Urticaria: In many cases, the cause of urticaria remains unknown, leading to a diagnosis of idiopathic urticaria.
Management of urticaria involves identifying and addressing triggers when possible. Antihistamines are the primary treatment for symptom relief. Chronic urticaria may require more extensive evaluation and treatment, potentially including immunosuppressive medications in severe cases.

## Papulonodular Skin Lesions

Papulonodular skin lesions are characterized by raised, solid, and often palpable bumps (papules and nodules) on the skin's surface. These lesions can result from a wide range of underlying causes and may vary in size, color, and distribution.
* Acne Vulgaris: Acne vulgaris often presents with papules, pustules, and nodules, primarily affecting the face, chest, and back. It is associated with sebaceous gland activity and bacterial colonization of hair follicles.
* Dermatofibroma: Dermatofibromas are benign skin lesions that appear as firm, brownish papules or nodules. They often have a central dimple or depression when squeezed (buttonhole sign).
* Neurofibromas: Neurofibromas are associated with neurofibromatosis and manifest as soft, rubbery nodules on or under the skin. They can occur singly or in multiples.
* Lipomas: Lipomas are benign fatty tumors that form soft, movable nodules beneath the skin. They are usually painless and grow slowly.
* Molluscum Contagiosum: Molluscum contagiosum is a viral skin infection that leads to the development of small, dome-shaped papules with central indentations (umbilicated papules). It is highly contagious.
* Xanthomas: Xanthomas are lipid-filled nodules that can develop on the skin, tendons, or other tissues. They are often associated with underlying lipid metabolism disorders.
* Cutaneous Lymphoma: Cutaneous lymphomas, including mycosis fungoides, can present as papules and nodules that may mimic other benign skin conditions.
* Merkel Cell Carcinoma: Merkel cell carcinoma is a rare, aggressive skin cancer that typically appears as firm, flesh-colored or red-purple nodules on sun-exposed skin.
* Granuloma Annulare: Granuloma annulare can manifest as skin-colored or reddish papules arranged in a ring or arc shape. The cause is often unknown, but it is believed to have autoimmune or inflammatory origins.
* Fibromas: Fibromas are benign connective tissue tumors that can develop in various locations, including the skin, oral cavity (fibroma molle), or reproductive organs (uterine fibroids).
* Keloids: Keloids are raised, firm nodules that result from abnormal wound healing. They often develop at the site of previous skin injuries.
* Eruptive Xanthomas: Eruptive xanthomas are small, yellowish papules or nodules that appear suddenly and are associated with severe hyperlipidemia.
Diagnosis and management of papulonodular skin lesions depend on the underlying cause. In some cases, a biopsy may be necessary for definitive diagnosis. Treatment may include conservative observation, excision, cryotherapy, or other interventions tailored to the specific condition.

## Purpura

Purpura refers to the presence of small hemorrhages beneath the skin, resulting in red or purple discolorations that do not blanch when pressed. Purpuric lesions can be indicative of various underlying conditions and may vary in size and distribution.
* Petechiae: Petechiae are tiny, pinpoint purpuric lesions that result from bleeding within the capillaries. They are often seen in conditions associated with platelet abnormalities or vasculitis.
* Ecchymosis: Ecchymosis are larger, subcutaneous purpuric lesions that result from bleeding into the deeper layers of the skin. They can occur after trauma or in bleeding disorders.
* Idiopathic Thrombocytopenic Purpura (ITP): ITP is an autoimmune disorder characterized by low platelet counts, leading to petechiae, purpura, and an increased risk of bleeding.
* Henoch-Schönlein Purpura (HSP): HSP is a vasculitis that primarily affects children and can cause palpable purpura, joint pain, abdominal symptoms, and renal involvement.
* Cryoglobulinemia: Cryoglobulinemia is associated with the presence of abnormal proteins in the blood that can precipitate in cold temperatures, leading to purpura, joint pain, and organ involvement.
* Drug-Induced Purpura: Certain medications, such as anticoagulants or antiplatelet drugs, can increase the risk of bleeding and purpura.
* Vasculitis: Various forms of vasculitis, including leukocytoclastic vasculitis, can cause purpuric lesions due to inflammation of blood vessel walls.
* Thrombotic Thrombocytopenic Purpura (TTP): TTP is a rare blood disorder characterized by widespread microvascular thrombosis, leading to purpura, anemia, and organ dysfunction.
* Disseminated Intravascular Coagulation (DIC): DIC is a complex coagulation disorder that can cause both bleeding and clotting, leading to purpura and organ failure.
* Platelet Disorders: Inherited or acquired platelet disorders, such as von Willebrand disease or Bernard-Soulier syndrome, can result in purpura due to impaired platelet function.
Management of purpura depends on the underlying cause. Treatment may involve addressing the primary condition, such as managing vasculitis or administering platelet transfusions in cases of severe thrombocytopenia.

## Ulcers

Ulcers are open sores or lesions that develop on the skin or mucous membranes. They can result from various underlying factors, including infection, vascular insufficiency, trauma, or systemic diseases.
* Venous Ulcers: Venous ulcers typically occur in the lower legs and are often associated with chronic venous insufficiency. They result from impaired blood flow, leading to tissue damage and poor wound healing.
* Arterial Ulcers: Arterial ulcers develop in areas with compromised arterial blood supply, commonly on the feet or lower legs. These ulcers are often painful and slow to heal.
* Diabetic Foot Ulcers: Diabetic foot ulcers are a complication of diabetes and neuropathy, often occurring on the soles or pressure points of the feet.
* Pressure Ulcers (Bedsores): Pressure ulcers result from prolonged pressure on the skin, typically in individuals with limited mobility. They are commonly seen in bedridden or wheelchair-bound patients.
* Mouth Ulcers (Aphthous Ulcers): Aphthous ulcers are shallow, painful sores that develop on the mucous membranes of the mouth, lips, or throat. They can be triggered by various factors, including stress, injury, or certain foods.
* Gastric Ulcers: Gastric ulcers are open sores that develop in the stomach lining. They can cause abdominal pain and discomfort.
* Genital Ulcers: Genital ulcers can result from sexually transmitted infections (e.g., herpes, syphilis) or other skin conditions affecting the genital area.
* Pyoderma Gangrenosum: Pyoderma gangrenosum can lead to rapidly progressing skin ulcers with undermined borders. It is associated with various underlying conditions, including inflammatory bowel disease.
* Livedo Vasculitis: Livedo vasculitis is characterized by livedo reticularis (a mottled, net-like skin pattern) and can lead to skin ulcers in severe cases.
Diagnosis and management of ulcers involve identifying the underlying cause and implementing appropriate wound care measures, infection control, and treatments specific to the condition. Chronic or non-healing ulcers often require multidisciplinary care.

## Fever and Rash

Fever accompanied by a rash can be indicative of various infectious or systemic conditions. The combination of these symptoms can provide valuable diagnostic clues.
* Measles: Measles is a highly contagious viral infection characterized by high fever, cough, coryza (runny nose), conjunctivitis, and a characteristic maculopapular rash that starts on the face and spreads.
* Scarlet Fever: Scarlet fever is caused by streptococcal bacteria and presents with a high fever, sore throat, and a distinctive rash consisting of small, red papules that feel like sandpaper.
* Rubella (German Measles): Rubella is a viral infection with symptoms including a mild fever and a rash of pink, flat spots that start on the face and spread.
* Roseola: Roseola is a viral illness that typically affects infants and young children. It is characterized by high fever, followed by the sudden appearance of a rash once the fever resolves.
* Dengue Fever: Dengue fever is a mosquito-borne viral infection that can cause a sudden high fever and a rash, often described as a "dengue rash."
* Rocky Mountain Spotted Fever: Rocky Mountain spotted fever, transmitted by ticks, can lead to high fever, headache, and a spotted rash that usually starts on the wrists and ankles and spreads to the trunk.
* Kawasaki Disease: Kawasaki disease primarily affects children and is characterized by prolonged fever, red eyes, swollen lymph nodes, and a rash, often on the trunk and extremities.
* Systemic Lupus Erythematosus (SLE): SLE is an autoimmune disease that can cause a fever, joint pain, and a butterfly-shaped rash on the face.
* Rickettsial Infections: Various rickettsial infections, such as typhus, can result in fever and a maculopapular rash.
* Drug Reactions: Some medications can lead to fever and various types of rashes, including morbilliform eruptions (measles-like rash) or Stevens-Johnson syndrome (a severe, blistering rash).
The evaluation of fever and rash often requires a thorough medical history, physical examination, and diagnostic tests, such as blood cultures, serological tests, or skin biopsies, depending on the suspected cause. Prompt diagnosis and treatment are essential, especially in cases of potentially serious infections or autoimmune diseases.