Rash with fever resident survival guide
Synonyms and keywords: Approach to febrile rash, Approach to Rash

# Overview
A patient with fever may often come with rash.There are several causes for rash in febrile patients.Rash caused by infectious agents may have mild to severe outcome,so it is very important to diagnose the cause and treat accordingly.There can be some non-infectious causes as well.To diagnose efficiently a complete history must be taken which includes history of recent travel, contact with animals, medications, and exposure to forests and other natural environments. Additionally, time of onset of symptoms and morphology, location, distribution of the rash are be helpful in the clinical diagnosis.The most common causes are Dengue hemorrhagic fever, Rocky Mountain spotted fever (RMSF), Scarlet fever, Toxic Epidermal Necrolysis (TEN),Stevens-Johnson Syndrome (SJS), Henoch-Schonlein Purpura (HSP), Kawasaki disease, Lyme disease, Endocarditis, Disseminated gonococcal infection,Autoimmune vasculitis, Systemic lupus erythematosus (SLE),Rheumatoid arthritis,Sjogrens syndrome, Varicella, Necrotizing fasciitis, Rubella, Measles.Usually,skin rashes are nonspecific and self-limited.If it is caused by viral infections unlike bacterial infections, they do not respond to antibiotics, so treatment usually focuses on relieving symptoms.If it  is caused by bacterial infection specific antibiotic is prescribed.The treatment of non-infectious rashes depend on the underlying cause.

# Causes

## Life Threatening Causes
Life-threatening causes of febrile rashes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Meningococcemia or Meningoencephalitis
- Thrombotic Thrombocytopenic Purpura (TTP)
- Disseminated Intravascular Coagulation (DIC)
- Bacterial sepsis(Pneumococcal, Staphylococcal)

## Common Causes
Common causes of rash with fever are given below :
- Typhoid fever
- Dengue hemorrhagic fever
- Rocky Mountain spotted fever (RMSF)
- Scarlet fever
- Toxic Epidermal Necrolysis (TEN)
- Stevens-Johnson Syndrome (SJS)
- Henoch-Schonlein Purpura (HSP)
- Kawasaki disease
- Lyme disease
- Endocarditis
- Disseminated gonococcal infection
- Autoimmune vasculitis
Systemic lupus erythematosus (SLE)
Rheumatoid arthritis
Sjogrens syndrome
- Systemic lupus erythematosus (SLE)
- Rheumatoid arthritis
- Sjogrens syndrome
- Varicella
- Necrotizing fasciitis
- Hand foot and mouth (HFM) disease
- Anaphylaxis
- Shingles
- Rubella
- Measles

# Diagnosis
Shown below are 04 algorithms summarizing the diagnosis of Rash with fever in a patient:
Abbreviations: BP: Blood pressure, RR=Respiratory rate, HR=Heart Rate, HIV=Human immunodeficiency Virus, EM major=Erythema Multiforme Major, EM minor=Erythema Multiforme Minor, H/O=History of, DIC=disseminated intravascular coagulation, VZV=Varicella zoster virus,SLE=Systemic lupus erythematosus, TTP=Thrombotic Thrombocytopenic Purpura ,RMSF= Rocky Mountain spotted fever, IM=Intramuscular, IVIG= Intravenous Immunoglobulin, IVDU -Intravenous Drug User
Terminolgies used to diagnose Rashes
If a patient present with fever with maculopapular rash then follow the algorithm given below:
If patient presents with Petechial/Purpuric rash:
If patient presents with Vesiculo-bullous Rash, follow the algoritm below:
Patient comes with Erythematous rash, follow the algorithm below:

# Treatment
Shown below is an algorithm summarizing the treatment of rash with fever
If patient comes it maculopapular rash and fever:
Abbreviations: HIV=Human immunodeficiency Virus, EM major=Erythema Multiforme Major, EM minor=Erythema Multiforme Minor, H/O=History of, DIC=disseminated intravascular coagulation, VZV=Varicella zoster virus,SLE=Systemic lupus erythematosus, TTP=Thrombotic Thrombocytopenic Purpura ,RMSF= Rocky Mountain spotted fever, IM=Intramuscular, IVIG= Intravenous Immunoglobulin
If patient comes with  Petechial/Purpuric rash
If patient presents with Vesiculo-bullous Rash, follow the algoritm below:
Patient comes with Erythematous rash, follow the algorithm below:

# Do's
- If patient started any new medication,immediately should stop taking it.
- If allergic to any known product/medication/food, stop taking it.

# Don'ts
- Dont use rubbing alcohol on  skin
- Don't clean open wounds with hydrogen peroxide or bleach
- Dont use a triple-antibiotic ointment