Causes of Acne

List of causes of Acne

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Acne) that could possibly cause Acne includes:

• Excess androgen hormones
• Puberty

More causes: see full list of causes for Acne

Causes of Acne: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Acne.

Acne: Differential Diagnosis
(In a Page: Signs and Symptoms)

• Acne vulgaris
  –Common in adolescents, especially boys
  –Most common on face, chest, and upper back
  –Due to hormones, P. acnes, and comedogenic cosmetics
  –May be secondary to or exacerbated by medications (e.g., corticosteroids, phenytoin, lithium, isoniazid) and polycystic ovarian syndrome
• Rosacea
  –Middle-aged to older adults
  –Papules and pustules in middle third of face, telangiectasia, flushing, erythema
  –No comedones
  –Often associated with ingestion of hot beverages, alcohol, or vasodilating medications

• Miliaria (“heat rash”)
  –Burning, pruritic vesicles, papules, or pustules on covered areas, usually trunk and intertriginous areas

• Gram-negative folliculitis
  –Klebsiella, Enterobacter, E. coli –May develop during antibiotic treatment of
  acne

• Acne conglobata
  –Most severe form of acne
  –Deep nodules, cysts, ulcers, abscesses,
  sinus tracks, scars
  –Causes severe scarring and keloid formation if untreated

• Hidradenitis suppurativa
  –Pustules and cysts, often draining and very
  painful
  –Especially in axilla, groin

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Papular rash: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Acne vulgaris

With acne vulgaris, rupture of enlarged comedones produces inflamed — and perhaps, painful and pruritic — papules, pustules, nodules, or cysts on the face and sometimes the shoulders, chest, and back.

Anthrax (cutaneous)

Anthrax is an acute infectious disease caused by the gram-positive, spore-forming bacterium Bacillus anthracis. The disease can occur in humans exposed to infected animals, tissue from infected animals, or biological warfare. Cutaneous anthrax occurs when the bacterium enters a cut or abrasion on the skin. The infection begins as a small, painless, or pruritic macular or papular lesion resembling an insect bite. Within 1 to 2 days, it develops into a vesicle and then a painless ulcer with a characteristic black, necrotic center. Lymphadenopathy, malaise, a headache, or a fever may develop.

Dermatomyositis

Gottron’s papules — flat, violet-colored lesions on the dorsa of the finger joints and the nape of the neck and shoulders — are pathognomonic of dermatomyositis, as is the dusky lilac discoloration of periorbital tissue and lid margins (heliotrope edema). These signs may be accompanied by a transient, erythematous, macular rash in a malar distribution on the face and sometimes on the scalp, forehead, neck, upper torso, and arms. This rash may be preceded by symmetrical muscle soreness and weakness in the pelvis, upper extremities, shoulders, neck and, possibly, the face (polymyositis).

Follicular mucinosis

With follicular mucinosis, perifollicular papules or plaques are accompanied by prominent alopecia.

Fox-Fordyce disease

Fox-Fordyce disease is a chronic disorder that’s marked by pruritic papules on the axillae, pubic area, and areolae associated with apocrine sweat gland inflammation. Sparse hair growth in these areas is also common.

Granuloma annulare

Granuloma annulare is a benign, chronic disorder that produces papules that usually coalesce to form plaques. The papules spread peripherally to form a ring with a normal or slightly depressed center. They usually appear on the feet, legs, hands, or fingers and may be pruritic or asymptomatic.

Human immunodeficiency virus (HIV) infection

Acute infection with the HIV retrovirus typically causes a generalized maculopapular rash. Other signs and symptoms include a fever, malaise, a sore throat, and a headache. Lymphadenopathy and hepatosplenomegaly may also occur. Most patients don’t recall these symptoms of acute infection.

Kaposi’s sarcoma

Kaposi’s sarcoma is characterized by purple or blue papules or macules of vascular origin on the skin, mucous membranes, and viscera. These lesions decrease in size with firm pressure and then return to their original size within 10 to 15 seconds. They may become scaly and ulcerate with bleeding.

Multiple variants of Kaposi’s sarcoma are known; most individuals are immunocompromised in some way, especially those with HIV or acquired immunodeficiency syndrome. Human herpes virus-8 has been strongly implicated as a cofactor in the development of Kaposi’s sarcoma.

Lichen planus

Discrete, flat, angular or polygonal, violet papules, commonly marked with white lines or spots, are characteristic of lichen planus. The papules may be linear or coalesce into plaques and usually appear on the lumbar region, genitalia, ankles, anterior tibiae, and wrists. Lesions usually develop first on the buccal mucosa as a lacy network of white or gray threadlike papules or plaques. Pruritus, distorted fingernails, and atrophic alopecia commonly occur.

Mononucleosis (infectious)

A maculopapular rash that resembles rubella is an early sign of mononucleosis in 10% of patients. The rash is typically preceded by a headache, malaise, and fatigue. It may be accompanied by a sore throat, cervical lymphadenopathy, and fluctuating temperature with an evening peak of 101° to 102° F (38.3° to 38.9° C). Splenomegaly and hepatomegaly may also develop.

Necrotizing vasculitis

With necrotizing vasculitis, crops of purpuric, but otherwise asymptomatic, papules are typical. Some patients also develop a low-grade fever, a headache, myalgia, arthralgia, and abdominal pain.

Pityriasis rosea

Pityriasis rosea begins with an erythematous “herald patch” — a slightly raised, oval lesion about 2 to 6 cm in diameter that may appear anywhere on the body. A few days to weeks later, yellow to tan or erythematous patches with scaly edges appear on the trunk, arms, and legs, commonly erupting along body cleavage lines in a characteristic “pine tree” pattern. These patches may be asymptomatic or slightly pruritic, are 0.5 to 1 cm in diameter, and typically improve with skin exposure.

Polymorphic light eruption

Abnormal reactions to light may produce papular, vesicular, or nodular rashes on sun-exposed areas. Other symptoms include pruritus, a headache, and malaise.

Psoriasis

Psoriasis is a common chronic disorder that begins with small, erythematous papules on the scalp, chest, elbows, knees, back, buttocks, and genitalia. These papules are sometimes pruritic and painful. Eventually they enlarge and coalesce, forming elevated, red, scaly plaques covered by characteristic silver scales, except in moist areas such as the genitalia. These scales may flake off easily or thicken, covering the plaque. Associated features include pitted fingernails and arthralgia.

Rosacea

Rosacea is a hyperemic disorder characterized by persistent erythema, telangiectasia, and recurrent eruption of papules and pustules on the forehead, malar areas, nose, and chin. Eventually, eruptions occur more frequently and erythema deepens. Rhinophyma may occur in severe cases.

Seborrheic keratosis

With seborrheic keratosis, a cutaneous disorder, benign skin tumors begin as small, yellow-brown papules on the chest, back, or abdomen, eventually enlarging and becoming deeply pigmented. However, in blacks, these papules may remain small and affect only the malar part of the face (dermatosis papulosa nigra).

Smallpox

(variola major). Initial signs and symptoms of smallpox include a high fever, malaise, prostration, a severe headache, a backache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face, and forearms and then spreads to the trunk and legs. Within 2 days, the rash becomes vesicular and later pustular. The lesions develop at the same time, appear identical, and are more prominent on the face and extremities. The pustules are round, firm, and deeply embedded in the skin. After 8 to 9 days, the pustules form a crust, and later the scab separates from the skin, leaving a pitted scar. In fatal cases, death results from encephalitis, extensive bleeding, or secondary infection.

Syringoma

With syringoma, adenoma of the sweat glands produces a yellowish or erythematous papular rash on the face (especially the eyelids), neck, and upper chest.

Systemic lupus erythematosus (SLE)

SLE is characterized by a “butterfly rash” of erythematous maculopapules or discoid plaques that appears in a malar distribution across the nose and cheeks. Similar rashes may appear elsewhere, especially on exposed body areas. Other cardinal features include photosensitivity and nondeforming arthritis, especially in the hands, feet, and large joints. Common effects are patchy alopecia, mucous membrane ulceration, a low-grade or spiking fever, chills, lymphadenopathy, anorexia, weight loss, abdominal pain, diarrhea
or constipation, dyspnea, tachycardia, hematuria, a headache, and irritability.

Typhus

Typhus is a rickettsial disease transmitted to humans by fleas, mites, or body lice. Initial symptoms include
a headache, myalgia, arthralgia, and malaise, followed by an abrupt onset of chills, a fever, nausea, and vomiting. A maculopapular rash may be present in some cases.

Other causes

Drugs

Transient maculopapular rashes, usually on the trunk, may accompany reactions to many drugs, including antibiotics, such as tetracycline, ampicillin, cephalosporins, and sulfonamides; benzodiazepines, such as diazepam; lithium; phenylbutazone; gold salts; allopurinol; isoniazid; and salicylates.

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Pustular rash: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Acne vulgaris

Pustules typify inflammatory lesions of acne vulgaris, which is accompanied by papules, nodules, cysts, open comedones (blackheads), and closed (whiteheads) comedones. Lesions commonly appear on the face, shoulders, back, and chest. Other findings include pain on pressure, pruritus, and burning. Chronic recurrent lesions produce scars.

Blastomycosis

Blastomycosis is a fungal infection that produces small, painless, nonpruritic macules or papules that can enlarge to well-circumscribed, verrucous, crusted, or ulcerated lesions edged by pustules. Localized infection may cause only one lesion; systemic infection may cause many lesions on the hands, feet, face, and wrists. Blastomycosis also produces signs of pulmonary infection, such as pleuritic chest pain and a dry, hacking or productive cough with occasional hemoptysis.

Folliculitis

Folliculitis is a bacterial infection of hair follicles that produces individual pustules, each pierced by a hair and possibly accompanied by pruritus. “Hot tub” folliculitis produces pustules on areas covered by a bathing suit.

Furunculosis

A furuncle is an acute, deep-seated, red, hot, tender abscess that evolves from a staphylococcal folliculitis. Furuncles usually begin as small, tender red pustules at the base of hair follicles. They’re likely to occur on the face, neck, forearm, groin, axillae, buttocks, and legs or areas that are prone to repeated friction. The pustules usually remain tense for 2 to 4 days and then become fluctuant. Rupture discharges pus and necrotic material. Then pain subsides, but erythema and edema may persist.

Impetigo contagiosa

Impetigo contagiosa, a vesiculopustular eruptive disorder that occurs in nonbullous and bullous forms, is usually caused by streptococci or staphylococci. Vesicles form and break, and a crust forms from the exudate: a thick, yellow crust in streptococcal impetigo and a thin, clear crust in staphylococcal impetigo. Both forms usually produce painless itching.

Pustular miliaria

Pustular miliaria is an anhidrotic disorder that causes pustular lesions that begin as tiny erythematous papulovesicles located at sweat pores. Diffuse erythema may radiate from the lesion. The rash and associated burning and pruritus worsen with sweating.

Pustular psoriasis

Small vesicles form and eventually become pustules in pustular psoriasis. The patient may report pruritus, burning, and pain. Localized pustular psoriasis usually affects the hands and feet. Generalized pustular psoriasis may erupt suddenly in a patient with psoriasis, psoriatic arthritis, or exfoliative psoriasis; although rare, this form of psoriasis can occasionally be fatal.

Rosacea

Rosacea is a chronic hyperemic disorder that commonly produces telangiectasia with acute episodes of pustules, papules, and edema. Characterized by persistent erythema, rosacea may begin as a flush covering the forehead, malar region, nose, and chin. Intermittent episodes gradually become more persistent, and the skin — instead of returning to its normal color — develops varying degrees of erythema.

Scabies

Threadlike channels or burrows under the skin characterize scabies, which can also produce pustules, vesicles, and excoriations. The lesions are a few millimeters long, with a swollen nodule or red papule that contains the itch mite.

Gender Cue: In men, crusted lesions commonly develop on the glans, shaft, and scrotum. In women, lesions may form on the nipples. In both genders, these lesions have a predilection for skin folds. Crusty excoriated lesions also develop on wrists, elbows, axillae, waistline, behind the knees, and ankles. Related pruritus worsens with inactivity and warmth.

Smallpox

(variola major). Initial signs and symptoms include a high fever, malaise, prostration, a severe headache, a backache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face, and forearms and then spreads to the trunk and legs. Within 2 days, the rash becomes vesicular and later pustular. The lesions develop at the same time, appear identical, and are more prominent on the face and extremities. The pustules are round, firm, and deeply embedded in the skin. After 8 to 9 days, the pustules form a crust and, later, the scab separates from the skin, leaving a pitted scar. In fatal cases, death results from encephalitis, extensive bleeding, or secondary infection.

Varicella zoster

When immunity to varicella declines, the virus reactivates along a dermatome, producing extremely painful and pruritic vesicles and pustules (herpes zoster, or shingles). Even with resolution of the rash, patients may experience chronic pain (postherpetic neuralgia) that may persist for months.

Other causes

Drugs

Bromides and iodides commonly cause a pustular rash. Other drug causes include corticotropin, corticosteroids, dactinomycin, trimethadione, lithium, phenytoin, phenobarbital, isoniazid, hormonal contraceptives, androgens, and anabolic steroids.

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Acne vulgaris: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

The cause of acne is multifactorial, but theories regarding dietary influences appear to be groundless. Predisposing factors include heredity; hormonal contraceptives (many females experience an acne flare-up during their first few menstrual cycles after starting or discontinuing hormonal contraceptives); androgen stimulation; certain drugs, including corticosteroids, corticotropin, androgens, iodides, bromides, trimethadione, phenytoin, isoniazid, lithium, and halothane; cobalt irradiation; and hyperalimentation. Other possible factors are exposure to heavy oils, greases, or tars; trauma or rubbing from tight clothing; cosmetics; emotional stress; and unfavorable climate.

More is known about the pathogenesis of acne. (See What happens in acne.) Androgens stimulate sebaceous gland growth and production of sebum, which is secreted into dilated hair follicles that contain bacteria. The bacteria, usually Propionibacterium acnes and Staphylococcus epidermidis (which are normal skin flora), secrete lipase. This enzyme interacts with sebum to produce free fatty acids, which provoke inflammation. Also, the hair follicles produce more keratin, which joins with the sebum to form a plug in the dilated follicle.

Acne vulgaris primarily affects adolescents (usually between ages 15 and 18), although lesions can appear as early as age 8. Although acne strikes boys more often and more severely than girls, it usually occurs in girls at an earlier age and tends to last longer, sometimes into adulthood.

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Papular rash: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Acne vulgaris

With this disorder, rupture of enlarged comedones produces inflamed—and perhaps, painful and pruritic—papules, pustules, nodules, or cysts on the face and sometimes the shoulders, chest, and back.

Anthrax (cutaneous)

Anthrax is an acute infectious disease caused by the gram-positive, spore-forming bacterium Bacillus anthracis. The disease can occur in humans exposed to infected animals, tissue from infected animals, or biological warfare. Cutaneous anthrax occurs when the bacterium enters a cut or abrasion on the skin. The infection begins as a small, painless, or pruritic macular or papular lesion resembling an insect bite. Within 1 to 2 days it develops into a vesicle and then a painless ulcer with a characteristic black, necrotic center. Lymphadenopathy, malaise, headache, or fever may develop.

Dermatitis (perioral)

This inflammatory disorder causes an erythematous eruption of discrete, tiny papules and pustules on the nasolabial fold, chin, and upper lip area. The lesions may be pruritic and painful.

Dermatomyositis

Gottron’s papules—flat, violet-colored lesions on the dorsa of the finger joints and the nape of the neck and shoulders—are pathognomonic of this disorder, as is the dusky lilac discoloration of periorbital tissue and lid margins (heliotrope edema). These signs may be accompanied by a transient, erythematous, macular rash in a malar distribution on the face and sometimes on the scalp, forehead, neck, upper torso, and arms. This rash may be preceded by symmetrical muscle soreness and weakness in the pelvis, upper extremities, shoulders, neck and, possibly, the face (polymyositis).

Erythema migrans

Transmitted through a tick bite, this systemic disorder is characterized by a papular or macular rash starting from a single lesion (usually on the leg) that spreads at the margins while clearing centrally. The rash commonly appears on the thighs, trunk, or upper arms and is the classic early sign of Lyme disease, but about 25% of patients don’t develop this skin manifestation. It may be accompanied by fever, chills, headache, malaise, nausea, vomiting, fatigue, backache, knee pain, and stiff neck.

Follicular mucinosis

With this cutaneous disorder, perifollicular papules or plaques are accompanied by prominent alopecia.

Fox-Fordyce disease

This chronic disorder is marked by pruritic papules on the axillae, pubic area, and areolae associated with apocrine sweat gland inflammation. Sparse hair growth in these areas is also common.

Gonococcemia

With this chronic STD, sporadic eruption of an erythematous macular rash is characteristic, although fistulas and petechiae may appear. The rash typically affects the distal extremities (palms and soles) and rapidly becomes maculopapular, vesiculopustular and, commonly, hemorrhagic. Bullae may form. The mature lesion is raised; has a gray, necrotic center; and is surrounded by erythema. Typically, it heals in 3 to 4 days. Eruptions are commonly accompanied by fever and joint pain.

Granuloma annulare

This benign, chronic disorder produces papules that usually coalesce to form plaques. The papules spread peripherally to form a ring with a normal or slightly depressed center. They usually appear on the feet, legs, hands, or fingers, and may be pruritic or asymptomatic.

Human immunodeficiency virus (HIV) infection

Acute infection with the HIV retrovirus typically causes a generalized maculopapular rash. Other signs and symptoms include fever, malaise, sore throat, and headache. Lymphadenopathy and hepatosplenomegaly may also occur. Most patients don’t recall these symptoms of acute infection.

Insect bites

Salivary secretions from insect bites—especially ticks, lice, flies, and mosquitoes—may produce an allergic reaction associated with a papular, macular, or petechial rash. The rash is usually accompanied by nonspecific signs and symptoms, such as fever, myalgia, headache, lymphadenopathy, nausea, and vomiting.

Kaposi’s sarcoma

This neoplastic disorder is characterized by purple or blue papules or macules of vascular origin on the skin, mucous membranes, and viscera. These lesions decrease in size with firm pressure and then return to their original size within 10 to 15 seconds. They may become scaly and ulcerate with bleeding.

Multiple variants of Kaposi’s sarcoma are known; most individuals are immunocompromised in some way, especially those with HIV/AIDS (acquired immunodeficiency syndrome). Human herpes virus-8 (HHV-8) has been strongly implicated as a cofactor in the development of Kaposi’s sarcoma.

Leprosy

This chronic infectious disorder produces various skin lesions. Early papular or macular lesions are erythematous, hypopigmented, and symmetrical (with lepromatous leprosy) or asymmetrical (with tuberculoid leprosy). The lesions may spread over the entire skin surface. Later, plaques and nodules form, especially on the ear lobes, nose, eyebrows, and forehead. Associated findings include hypoesthesia or anesthesia, anhidrosis, and dry, scaly skin in affected areas; enlarged, palpable peripheral nerves with severe neuralgia; and muscle atrophy and contractures.

Lichen amyloidosis

This idiopathic cutaneous disorder produces discrete, firm, hemispherical, pruritic papules on the anterior tibiae. Papules may be brown or yellow, smooth or scaly.

Lichen planus

Discrete, flat, angular or polygonal, violet papules, commonly marked with white lines or spots, are characteristic of this disorder. The papules may be linear or coalesce into plaques and usually appear on the lumbar region, genitalia, ankles, anterior tibiae, and wrists. Lesions usually develop first on the buccal mucosa as a lacy network of white or gray threadlike papules or plaques. Pruritus, distorted fingernails, and atrophic alopecia commonly occur.

Monkeypox

Usually preceded 1 to 3 days by a fever, a papular rash is a characteristic sign of monkeypox. The rash is often blisterlike and can follow these stages: vesiculation, postulation, umbilication, and crusting. Frequently beginning on the face and spreading to the trunk and extremities, the rash may be either localized or generalized. Other accompanying symptoms in humans include lymphadenopathy, chills, throat pain, and muscle aches. Most humans recover within 2 to 4 weeks.

Mononucleosis (infectious)

A maculopapular rash that resembles rubella is an early sign of this infection in 10% of patients. The rash is typically preceded by headache, malaise, and fatigue. It may be accompanied by sore throat, cervical lymphadenopathy, and fluctuating temperature with an evening peak of 101° to 102° F (38.3° to 38.9° C). Splenomegaly and hepatomegaly may also develop.

Mycosis fungoides

Stage I (premycotic stage) of this rare, cutaneous T-cell lymphoma is marked by the eruption of erythematous, pruritic macules on the trunk and extremities. In stage II, these lesions coalesce into pruritic papules and plaques, and nodes become irregular. Stage III is evidenced by large, irregular, brown to red tumors that ulcerate and are painful and itchy.

Necrotizing vasculitis

With this systemic disorder, crops of purpuric, but otherwise asymptomatic, papules are typical. Some patients also develop low-grade fever, headache, myalgia, arthralgia, and abdominal pain.

Parapsoriasis (chronic)

This disorder mimics psoriasis, producing small to moderately sized asymptomatic papules with a thin, adherent scale, primarily on the trunk, hands, and feet.

Pityriasis rosea

This disorder begins with an erythematous “herald patch”—a slightly raised, oval lesion about 2 to 6 cm in diameter that may appear anywhere on the body. A few days to weeks later, yellow to tan or erythematous patches with scaly edges appear on the trunk, arms, and legs, commonly erupting along body cleavage lines in a characteristic “pine tree” pattern. These patches may be asymptomatic or slightly pruritic, are 0.5 to 1 cm in diameter, and typically improve with moderate skin exposure to sunlight. This treatment should be used cautiously, however, to avoid sunburn.

Pityriasis rubra pilaris

This rare chronic disorder initially produces scaling seborrhea on the scalp that spreads to the face and ears. Scaly red patches then develop on the palms and soles; these patches thicken, become keratotic, and may develop painful fissures. Later, follicular papules erupt on the hands and forearms and then spread over wide areas of the trunk, neck, and extremities. These papules coalesce into large, scaly, erythematous plaques. Striated fingernails may appear.

Polymorphic light eruption

Abnormal reactions to light may produce papular, vesicular, or nodular rashes on sun-exposed areas. Other symptoms include pruritus, headache, and malaise.

Psoriasis

This common chronic disorder begins with small, erythematous papules on the scalp, chest, elbows, knees, back, buttocks, and genitalia. These papules are sometimes pruritic and painful. Eventually they enlarge and coalesce, forming elevated, red, scaly plaques covered by characteristic silver scales, except in moist areas such as the genitalia. These scales may flake off easily or thicken, covering the plaque. Associated features include pitted fingernails and arthralgia.

Rat bite fever

A maculopapular or petechial rash develops on the palms and soles several weeks after a bite from an infected rodent. Other findings typically include pain, redness, and swelling at the bite site; tender regional lymph nodes; fever with chills; malaise; headache; and myalgia.

Rosacea

This hyperemic disorder is characterized by persistent erythema, telangiectasia, and recurrent eruption of papules and pustules on the forehead, malar areas, nose, and chin. Eventually, eruptions occur more frequently and erythema deepens. Rhinophyma may occur in severe cases.

Sarcoidosis

This multisystem granulomatous disorder may produce crops of small, erythematous or yellow-brown papules around the eyes and mouth and on the nose, nasal mucosa, and upper back. Associated findings include dyspnea with a nonproductive cough, fatigue, arthralgia, weight loss, lymphadenopathy, vision loss, and dysphagia.

Seborrheic keratosis

With this cutaneous disorder, benign skin tumors begin as small, yellow-brown papules on the chest, back, or abdomen, eventually enlarging and becoming deeply pigmented. However, in blacks, these papules may remain small and affect only the malar part of the face (dermatosis papulosa nigra).

Smallpox (variola major)

Initial signs and symptoms include high fever, malaise, prostration, severe headache, backache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face, and forearms and then spreads to the trunk and legs. Within 2 days the rash becomes vesicular and later pustular. The lesions develop at the same time, appear identical, and are more prominent on the face and extremities. The pustules are round, firm, and deeply embedded in the skin. After 8 to 9 days the pustules form a crust, and later the scab separates from the skin leaving a pitted scar. In fatal cases, death results from encephalitis, extensive bleeding, or secondary infection.

Syphilis

A discrete, reddish brown, mucocutaneous rash and general lymphadenopathy herald the onset of secondary syphilis. The rash may be papular, macular, pustular, or nodular. It typically erupts between rolls of fat on the trunk and proximally on the arms, palms, soles, face, and scalp. Lesions in warm, moist areas enlarge and erode, producing highly contagious, pink or grayish white condylomata lata. The patient may also experience mild headache, malaise, anorexia, weight loss, nausea and vomiting, sore throat, low-grade fever, temporary alopecia, and brittle, pitted nails.

Syringoma

With this disorder, adenoma of the sweat glands produces a yellowish or erythematous papular rash on the face (especially the eyelids), neck, and upper chest.

Systemic lupus erythematosus (SLE)

SLE is characterized by a “butterfly rash” of erythematous maculopapules or discoid plaques that appears in a malar distribution across the nose and cheeks. Similar rashes may appear elsewhere, especially on exposed body areas. Other cardinal features include photosensitivity and nondeforming arthritis, especially in the hands, feet, and large joints. Common effects are patchy alopecia, mucous membrane ulceration, low-grade or spiking fever, chills, lymphadenopathy, anorexia, weight loss, abdominal pain, diarrhea or constipation, dyspnea, tachycardia, hematuria, headache, and irritability.

Typhus

Typhus is a rickettsial disease transmitted to humans by fleas, mites, or body louse. Initial symptoms include headache, myalgia, arthralgia, and malaise, followed by an abrupt onset of chills, fever, nausea, and vomiting. A maculopapular rash may be present in some cases.

Other causes

Drugs

Transient maculopapular rashes, usually on the trunk, may accompany reactions to many drugs, including antibiotics, such as tetracycline, ampicillin, cephalosporins, and sulfonamides; benzodiazepines such as diazepam; lithium; gold salts; allopurinol; isoniazid; and salicylates.

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Pustular rash: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Acne vulgaris

Pustules typify inflammatory lesions of this disorder, which is accompanied by papules, nodules, cysts, open comedones (blackheads) and closed (whiteheads) comedones. Lesions commonly appear on the face, shoulders, back, and chest. Other findings include pain on pressure, pruritus, and burning. Chronic recurrent lesions produce scars.

Blastomycosis

This fungal infection produces small, painless, nonpruritic macules or papules that can enlarge to well-circumscribed, verrucous, crusted, or ulcerated lesions edged by pustules. Localized infection may cause only one lesion; systemic infection may cause many lesions on the hands, feet, face, and wrists. Blastomycosis also produces signs of pulmonary infection, such as pleuritic chest pain and a dry, hacking or productive cough with occasional hemoptysis.

Folliculitis

This bacterial infection of hair follicles produces individual pustules, each pierced by a hair and possibly accompanied by pruritus. “Hot tub” folliculitis produces pustules on areas covered by a bathing suit.

Furunculosis

A furnicle is an acute, deep-seated, red, hot, tender abscess that evolves from a staphylococcus folliculitis. Furuncles usually begin as small, tender red pustules at the base of hair follicles. They’re likely to occur on the face, neck, forearm, groin, axillae, buttocks, and legs; areas that are prone to repeated friction. The pustules usually remain tense for 2 to 4 days and then become fluctuant. Rupture discharges pus and necrotic material. Then pain subsides, but erythema and edema may persist.

Gonococcemia

This disorder produces a rash of scanty, pinpoint erythematous macules that rapidly become vesiculopustular, maculopapular and, frequently, hemorrhagic. Bullae may form. Mature lesions are elevated, with dirty gray necrotic centers and surrounding erythema. The rash appears on the distal part of the arms and legs, usually during the 1st day that other findings, such as fever and joint pain, occur. The rash disappears after 3 to 4 days but may recur with each episode of fever.

Impetigo contagiosa

This vesiculopustular eruptive disorder, which occurs in nonbullous and bullous forms, is usually caused by streptococci or staphylococci. Vesicles form and break, and a crust forms from the exudate: a thick, yellow crust in streptococcal impetigo and a thin, clear crust in staphylococcal impetigo. Both forms usually produce painless itching.

Nummular or annular dermatitis

With this disorder, numerous coinlike (nummular) or ringed (annular) pustular lesions appear, usually on the extensor surfaces of the extremities, posterior trunk, buttocks, and lower legs; a few lesions may appear on the hands. The lesions commonly ooze a purulent exudate, itch severely, and rapidly become crusted and scaly. A few small, scaling patches may remain for some time.

Pustular miliaria

This anhidrotic disorder causes pustular lesions that begin as tiny erythematous papulovesicles located at sweat pores. Diffuse erythema may radiate from the lesion. The rash and associated burning and pruritus worsen with sweating.

Pustular psoriasis

Small vesicles form and eventually become pustules in this disorder. The patient may report pruritus, burning, and pain. Localized pustular psoriasis usually affects the hands and feet. Generalized pustular psoriasis may erupt suddenly in patients with psoriasis, psoriatic arthritis, or exfoliative psoriasis; although rare, this form of psoriasis can occasionally be fatal.

Rosacea

This chronic hyperemic disorder commonly produces telangiectasia with acute episodes of pustules, papules, and edema. Characterized by persistent erythema, rosacea may begin as a flush covering the forehead, malar region, nose, and chin. Intermittent episodes gradually become more persistent, and the skin—instead of returning to its normal color—develops varying degrees of erythema.

Scabies

Threadlike channels or burrows under the skin characterize this disorder, which can also produce pustules, vesicles, and excoriations. The lesions are a few millimeters long, with a swollen nodule or red papule that contains the itch mite.

Gender Cue: In men, crusted lesions commonly develop on the glans, shaft, and scrotum. In women, lesions may form on the nipples. In both sexes these lesions have a predilection for skin folds. Crusty excoriated lesions also develop on wrists, elbows, axillae, waistline, behind the knees and ankles. Related pruritus worsens with inactivity and warmth.

Smallpox (variola major)

Initial signs and symptoms include high fever, malaise, prostration, severe headache, backache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face and forearms and then spreads to the trunk and legs. Within 2 days the rash becomes vesicular and later pustular. The lesions develop at the same time, appear identical and are more prominent on the face and extremities. The pustules are round, firm, and deeply embedded in the skin. After 8 to 9 days, the pustules form a crust and later the scab separates from the skin leaving a pitted scar. In fatal cases, death results from encephalitis, extensive bleeding or secondary infection.

Varicella zoster

When immunity to varicella declines, the virus reactivates along a dermatome, producing extremely painful and pruritic vesicles and pustules (herpes zoster, or shingles). Even with resolution of the rash, patients may experience chronic pain (postherpetic neuralgia) that may persist for months.

Other causes

Drugs

Bromides and iodides commonly cause a pustular rash. Other drug causes include corticotropin, corticosteroids, dactinomycin, trimethadione, lithium, phenytoin, phenobarbital, isoniazid, hormonal contraceptives, androgens, and anabolic steroids.

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Acne vulgaris: Causes
(Handbook of Diseases)

Many factors contribute to acne, but theories regarding dietary influences appear to be groundless. Research now centers on follicular occlusion, androgen-stimulated sebum production, and Propionibacterium acnes as possible primary causes.

Certain drugs, including corticosteroids, glucocorticoids, phenobarbital, phenytoin, isoniazid, lithium, and halogens can cause acne.

Other precipitating factors include exposure to industrial compounds, trauma or rubbing from tight clothing, cosmetics, emotional stress, and unfavorable climate.

Androgens stimulate sebaceous gland growth and production of sebum, which is secreted into dilated hair follicles that contain bacteria. The bacteria — usually P. acnes and Staphylococcus epidermidis, which are normal skin flora — secrete lipase. This enzyme interacts with sebum to produce free fatty acids, which provoke inflammation. Also, the hair follicles produce more keratin, which joins with the sebum to form a plug in the dilated follicle.

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Papular rash: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Acne vulgaris

With acne vulgaris, rupture of enlarged comedones produces inflamed — and possibly painful and pruritic — papules, pustules, nodules, or cysts on the face and sometimes the shoulders, chest, and back.

Anthrax (cutaneous)

Cutaneous anthrax begins as a small, painless, or pruritic macular or papular lesion resembling an insect bite. Within 2 days, it develops into a vesicle and then a painless ulcer with a characteristic black, necrotic center. Lymphadenopathy, malaise, headache, or fever may develop.

Dermatitis (perioral)

Perioral dermatitis is an inflammatory disorder that causes an erythematous eruption of discrete, tiny papules and pustules on the nasolabial fold, chin, and upper lip area. The lesions may be pruritic and painful.

Erythema migrans

Transmitted through a tick bite, erythema migrans is a systemic disorder characterized by a papular or macular rash starting from a single lesion (usually on the leg) that spreads at the margins while clearing centrally. The rash commonly appears on the thighs, trunk, or upper arms and is the classic early sign of Lyme disease, but about 25% of patients don’t develop this skin manifestation. It may be accompanied by fever, chills, headache, malaise, nausea, vomiting, fatigue, backache, knee pain, and stiff neck.

Gonococcemia

In gonococcemia — a chronic STD — sporadic eruption of an erythematous macular rash is characteristic, although fistulas and petechiae may appear. The rash typically affects the distal extremities (palms and soles) and rapidly becomes maculopapular, vesiculopustular and, commonly, hemorrhagic. Bullae may form. The mature lesion is raised; has a gray, necrotic center; and is surrounded by erythema. Typically, it heals in 3 to 4 days. Eruptions are commonly accompanied by fever and joint pain.

Human immunodeficiency virus infection

Acute infection with human immunodeficiency virus (HIV) typically causes a generalized maculopapular rash. Other signs and symptoms include fever, malaise, sore throat, and headache. Lymphadenopathy and hepatosplenomegaly may also occur. Most patients don’t recall these symptoms of acute infection.

Insect bites

Salivary secretions from insect bites — especially ticks, lice, flies, and mosquitoes — may produce an allergic reaction associated with a papular, macular, or petechial rash. The rash is usually accompanied by such nonspecific signs and symptoms as fever, myalgia, headache, lymphadenopathy, nausea, and vomiting.

Kaposi’s sarcoma

Kaposi’s sarcoma is characterized by purple or blue papules or macules of vascular origin on the skin, mucous membranes, and viscera. These lesions decrease in size with firm pressure and then return to their original size within 10 to 15 seconds. They may become scaly and ulcerate with bleeding.

Lichen amyloidosis

Lichen amyloidosis, an idiopathic cutaneous disorder, produces discrete, firm, hemispherical, pruritic papules on the anterior tibiae, feet, and thighs. Papules may be brown or yellow and smooth or scaly.

Lichen planus

Discrete, flat, angular or polygonal, violet papules, commonly marked with white lines or spots, are characteristic of lichen planus. The papules may be linear or may coalesce into plaques and usually appear on the lumbar region, genitalia, ankles, anterior tibiae, and wrists. Lesions usually develop first on the buccal mucosa as a lacy network of white or gray threadlike papules or plaques. Pruritus, distorted fingernails, and atrophic alopecia commonly occur.

Mononucleosis (infectious)

A maculopapular rash that resembles rubella is an early sign of infectious mononucleosis in 10% of patients. The rash is typically preceded by headache, malaise, and fatigue. It may be accompanied by sore throat, cervical lymphadenopathy, and fluctuating temperature with an evening peak of 101° to 102° F (38.3° to 38.9° C). Splenomegaly and hepatomegaly may also develop.

Pityriasis rosea

Pityriasis rosea begins with an erythematous “herald patch” — a slightly raised, oval lesion about 2 to 6 cm in diameter that may appear anywhere on the body. A few days to weeks later, yellow to tan or erythematous patches with scaly edges appear on the trunk, arms, and legs, commonly erupting along body cleavage lines in a characteristic “pine tree” pattern. These patches may be asymptomatic or slightly pruritic, are 0.5 to 1 cm in diameter, and typically improve with skin exposure.

Polymorphic light eruption

Abnormal reactions to light may produce papular, vesicular, or nodular rashes on sun-exposed areas. Other symptoms include pruritus, headache, and malaise.

Psoriasis

Psoriasis is a common chronic disorder that begins with small, erythematous papules on the scalp, chest, elbows, knees, back, buttocks, and genitalia. These papules are sometimes pruritic and painful. Eventually they enlarge and coalesce, forming elevated, red, scaly plaques covered by characteristic silver scales, except in moist areas such as the genitalia. These scales may flake off easily or thicken, covering the plaque. Associated features include pitted fingernails and arthralgia.

Rosacea

Rosacea, a hyperemic disorder, is characterized by persistent erythema, telangiectasia, and recurrent eruption of papules and pustules on the forehead, malar areas, nose, and chin. Eventually, eruptions occur more frequently and erythema deepens. Rhinophyma may occur in severe cases.

Sarcoidosis

Sarcoidosis, a multisystem granulomatous disorder, may produce crops of small, erythematous or yellow-brown papules around the eyes and mouth and on the nose, nasal mucosa, and upper back. Associated findings include dyspnea with a nonproductive cough, fatigue, arthralgia, weight loss, lymphadenopathy, vision loss, and dysphagia.

Seborrheic keratosis

With seborrheic keratosis, benign skin tumors begin as small, yellow-brown papules on the chest, back, or abdomen, eventually enlarging and becoming deeply pigmented. However, in blacks, these papules may remain small and affect only the malar part of the face (dermatosis papulosa nigra).

Smallpox

Initial signs and symptoms of smallpox (also known as variola major) include high fever, malaise, prostration, severe headache, backache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face, and forearms and then spreads to the trunk and legs. Within 2 days, the rash becomes vesicular and, later, pustular. The lesions develop at the same time, appear identical, and are more prominent on the face and extremities. The pustules are round, firm, and deeply embedded in the skin. After 8 to 9 days, the pustules form a crust, and later the scab separates from the skin, leaving a pitted scar. In fatal cases, death results from encephalitis, extensive bleeding, or secondary infection.

Syphilis

A discrete, reddish brown, mucocutaneous rash and general lymphadenopathy herald the onset of secondary syphilis. The rash may be papular, macular, pustular, or nodular. It typically erupts between rolls of fat on the trunk and proximally on the arms, palms, soles, face, and scalp. Lesions in warm, moist areas enlarge and erode, producing highly contagious, pink or grayish white condylomata lata. The patient may also experience mild headache, malaise, anorexia, weight loss, nausea and vomiting, sore throat, low-grade fever, temporary alopecia, and brittle, pitted nails.

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is characterized by a “butterfly rash” of erythematous maculopapules or discoid plaques that appears in a malar distribution across the nose and cheeks. Similar rashes may appear elsewhere, especially on exposed body areas. Other cardinal features of SLE include photosensitivity and nondeforming arthritis, especially in the hands, feet, and large joints. Common effects are patchy alopecia, mucous membrane ulceration, low-grade or spiking fever, chills, lymphadenopathy, anorexia, weight loss, abdominal pain, diarrhea or constipation, dyspnea, tachycardia, hematuria, headache, and irritability.

Other causes

Drugs

Transient maculopapular rashes, usually on the trunk, may accompany reactions to many drugs, including antibiotics, such as tetracycline, ampicillin, cephalosporins, and sulfonamides; benzodiazepines such as diazepam; lithium; phenylbutazone; gold salts; allopurinol; isoniazid; and salicylates.

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Pustular rash: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Acne vulgaris

Pustules typify inflammatory lesions of acne vulgaris and are accompanied by papules, nodules, cysts, open comedones (blackheads) and closed comedones (whiteheads). Lesions commonly appear on the face, shoulders, back, and chest. Other findings include pain on pressure, pruritus, and burning. Chronic recurrent lesions produce scars.

Blastomycosis

Blastomycosis, a fungal infection, produces small, painless, nonpruritic macules or papules that can enlarge to well-circumscribed, verrucous, crusted, or ulcerated lesions edged by pustules. Localized infection may cause only one lesion; systemic infection may cause many lesions on the hands, feet, face, and wrists. Blastomycosis also produces signs of pulmonary infection, such as pleuritic chest pain and a dry, hacking or productive cough with occasional hemoptysis.

CULTURAL CUE:Blastomycosis is generally found in North America (where the fungus Blastomyces dermatitidis inhabits the soil) and is endemic to the southeastern United States. Sporadic cases have also been reported in Africa.

Folliculitis

This bacterial infection of hair follicles produces individual pustules, each pierced by a hair and possibly accompanied by pruritus. Folliculitis might progress to the hard painful nodules of furunculosis. “Hot tub” folliculitis produces pustules on areas covered by a bathing suit.

Furunculosis

A furuncle is an acute, deep-seated, red, hot, tender abscess that evolves from a staphylococcus folliculitis. Furuncles usually begin as small, tender red pustules at the base of hair follicles. They’re likely to occur on the face, neck, forearm, groin, axillae, buttocks, and legs — areas that are prone to repeated friction. The pustules usually remain tense for 2 to 4 days and then become fluctuant. Rupture discharges pus and necrotic material. Then pain subsides, but erythema and edema may persist.

Gonococcemia

Gonococcemia produces a rash of scanty, pinpoint erythematous macules that rapidly become vesiculopustular, maculopapular and, frequently, hemorrhagic. Bullae may form. Mature lesions are elevated, with dirty gray necrotic centers and surrounding erythema. The rash appears on the distal part of the arms and legs, usually during the 1st day that other findings, such as fever and joint pain, occur. The rash disappears after 3 to 4 days but may recur with each episode of fever.

Impetigo contagiosa

Impetigo contagiosa is a vesiculopustular eruptive disorder, which occurs in nonbullous and bullous forms, that’s usually caused by streptococci or staphylococci. Vesicles form and break, and a crust forms from the exudate: a thick, yellow crust in streptococcal impetigo and a thin, clear crust in staphylococcal impetigo. Both forms usually produce painless itching.

Nummular or annular dermatitis

With nummular or annular dermatitis, numerous coinlike (nummular) or ringed (annular) pustular lesions appear, usually on the extensor surfaces of the extremities, posterior trunk, buttocks, and lower legs; a few lesions may appear on the hands. The lesions commonly ooze a purulent exudate, itch severely, and rapidly become crusted and scaly. A few small, scaling patches may remain for some time.

Pustular miliaria

Pustular miliaria, an anhidrotic disorder, causes pustular lesions that begin as tiny erythematous papulovesicles located at sweat pores. Diffuse erythema may radiate from the lesion. The rash and associated burning and pruritus worsen with sweating.

Rosacea

Rosacea is a chronic hyperemic disorder that commonly produces telangiectasia with acute episodes of pustules, papules, and edema. Characterized by persistent erythema, rosacea may begin as a flush covering the forehead, malar region, nose, and chin. Intermittent episodes gradually become more persistent, and the skin — instead of returning to its normal color — develops varying degrees of erythema.

Scabies

Threadlike channels or burrows under the skin characterize scabies, which can also produce pustules, vesicles, and excoriations. The lesions are a few millimeters long with a swollen nodule or red papule that contains the itch mite.

Smallpox

Initial signs and symptoms of smallpox (variola major) include high fever, malaise, prostration, severe headache, backache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face and forearms and then spreads to the trunk and legs. Within 2 days, the rash becomes vesicular and later pustular. The lesions develop at the same time, appear identical, and are more prominent on the face and extremities. The pustules are round, firm, and deeply embedded in the skin. After 8 to 9 days, the pustules form a crust, and later the scab separates from the skin, leaving a pitted scar.

Varicella zoster

When immunity to varicella declines, the virus reactivates along a dermatome, producing extremely painful and pruritic vesicles and pustules (herpes zoster, or shingles). Even with resolution of the rash, patients may experience chronic pain (postherpetic neuralgia) that may persist for months.

Other causes

Drugs

Bromides and iodides commonly cause a pustular rash. Other drug causes include corticotropin, corticosteroids, dactinomycin, trimethadione, lithium, phenytoin, phenobarbital, isoniazid, hormonal contraceptives, androgens, and anabolic steroids.

READ BOOK EXCERPT ONLINE »

Papular rash: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Acne vulgaris.With acne vulgaris, rupture of enlarged comedones produces inflamed—and perhaps, painful and pruritic—papules, pustules, nodules, or cysts on the face and sometimes the shoulders, chest, and back.

Anthrax (cutaneous).Anthrax begins as a small, painless, or pruritic macular or papular lesion resembling an insect bite. Within 1 or 2 days, it develops into a vesicle and then a painless ulcer with a characteristic black, necrotic center. Lymphadenopathy, malaise, headache, or fever may develop.

Dermatomyositis.Gottron's papules—flat, violet-colored lesions on the dorsa of the finger joints and the nape of the neck and shoulders—are pathognomonic of dermatomyositis, as is the dusky lilac discoloration of periorbital tissue and lid margins (heliotrope edema). These signs may be accompanied by a transient, erythematous, macular rash in a malar distribution on the face and sometimes on the scalp, forehead, neck, upper torso, and arms. This rash may be preceded by symmetrical muscle soreness and weakness in the pelvis, upper extremities, shoulders, neck and, possibly, the face (polymyositis).

Follicular mucinosis.With follicular mucinosis, perifollicular papules or plaques are accompanied by prominent alopecia.

Fox-Fordyce disease.Fox-Fordyce disease is marked by pruritic papules on the axillae, pubic area, and areolae associated with apocrine sweat gland inflammation. Sparse hair growth in these areas is also common.

Granuloma annulare.Granuloma annulare produces papules that usually coalesce to form plaques. The papules spread peripherally to form a ring with a normal or slightly depressed center. They usually appear on the feet, legs, hands, or fingers and may be pruritic or asymptomatic.

Human immunodeficiency virus (HIV) infection.Acute infection with the HIV retrovirus typically causes a generalized maculopapular rash. Other signs and symptoms include fever, malaise, sore throat, and headache. Lymphadenopathy and hepatosplenomegaly may also occur.

Kaposi's sarcoma.Kaposi's sarcoma is characterized by purple or blue papules or macules of vascular origin on the skin, mucous membranes, and viscera. These lesions decrease in size with firm pressure and then return to their original size within 10 to 15 seconds. They may become scaly and ulcerate with bleeding.

Lichen planus.Discrete, flat, angular or polygonal, violet papules, commonly marked with white lines or spots, are characteristic of lichen planus. The papules may be linear or coalesce into plaques and usually appear on the lumbar region, genitalia, ankles, anterior tibiae, and wrists. Lesions usually develop first on the buccal mucosa as a lacy network of white or gray threadlike papules or plaques. Pruritus, distorted fingernails, and atrophic alopecia commonly occur.

Monkeypox.Usually preceded 1 to 3 days by a fever, a papular rash is a characteristic sign of monkeypox. The rash is commonly blisterlike and can follow these stages: vesiculation, postulation, umbilication, and crusting. Typically beginning on the face and spreading to the trunk and extremities, the rash may be either localized or generalized. Other accompanying symptoms in humans include lymphadenopathy, chills, throat pain, and muscle aches.

Mononucleosis (infectious).A maculopapular rash that resembles rubella is an early sign of mononucleosis in 10% of patients. The rash is typically preceded by headache, malaise, and fatigue. It may be accompanied by sore throat, cervical lymphadenopathy, and fluctuating temperature with an evening peak of 101° to 102° F (38.3° to 38.9° C). Splenomegaly and hepatomegaly may also develop.

Necrotizing vasculitis.With necrotizing vasculitis, crops of purpuric, but otherwise asymptomatic, papules are typical. Some patients also develop low-grade fever, headache, myalgia, arthralgia, and abdominal pain.

Pityriasis rosea.Pityriasis rosea begins with an erythematous “herald patch”—a slightly raised, oval lesion about 2 to 6 cm in diameter that may appear anywhere on the body. A few days to weeks later, yellow to tan or erythematous patches with scaly edges appear on the trunk, arms, and legs, commonly erupting along body cleavage lines in a characteristic “pine tree” pattern. These patches may be asymptomatic or slightly pruritic, are 0.5 to 1 cm in diameter, and typically improve with skin exposure.

Polymorphic light eruption.Abnormal reactions to light may produce papular, vesicular, or nodular rashes on sun-exposed areas. Other symptoms include pruritus, headache, and malaise.

Psoriasis.Psoriasis begins with small, erythematous papules on the scalp, chest, elbows, knees, back, buttocks, and genitalia. These papules are sometimes pruritic and painful. Eventually they enlarge and coalesce, forming elevated, red, scaly plaques covered by characteristic silver scales, except in moist areas such as the genitalia. These scales may flake off easily or thicken, covering the plaque. Associated features include pitted fingernails and arthralgia.

Rosacea.Rosacea is characterized by persistent erythema, telangiectasia, and recurrent eruption of papules and pustules on the forehead, malar areas, nose, and chin. Eventually, eruptions occur more frequently and erythema deepens. Rhinophyma may occur in severe cases.

Seborrheic keratosis.With seborrheic keratosis, benign skin tumors begin as small, yellow-brown papules on the chest, back, or abdomen, eventually enlarging and becoming deeply pigmented. However, in blacks, these papules may remain small and affect only the malar part of the face (dermatosis papulosa nigra).

Smallpox (variola major).Initial signs and symptoms of smallpox include a high fever, malaise, prostration, severe headache, a backache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face, and forearms and then spreads to the trunk and legs. Within 2 days, the rash becomes vesicular and later pustular. The lesions develop at the same time, appear identical, and are more prominent on the face and extremities. The pustules are round, firm, and deeply embedded in the skin. After 8 or 9 days, the pustules form a crust, and later the scab separates from the skin, leaving a pitted scar. In fatal cases, death results from encephalitis, extensive bleeding, or secondary infection.

Syringoma.With syringoma, adenoma of the sweat glands produces a yellowish or erythematous papular rash on the face (especially the eyelids), neck, and upper chest.

Systemic lupus erythematosus (SLE).SLE is characterized by a “butterfly rash” of erythematous maculopapules or discoid plaques that appears in a malar distribution across the nose and cheeks. Similar rashes may appear elsewhere, especially on exposed body areas. Other cardinal features include photosensitivity and nondeforming arthritis, especially in the hands, feet, and large joints. Common effects are patchy alopecia, mucous membrane ulceration, low-grade or spiking fever, chills, lymphadenopathy, anorexia, weight loss, abdominal pain, diarrhea or constipation, dyspnea, tachycardia, hematuria, headache, and irritability.

Typhus.Initial symptoms of typhus include headache, myalgia, arthralgia, and malaise, followed by an abrupt onset of chills, fever, nausea, and vomiting. A maculopapular rash may be present in some cases.

Other causes

Drugs.Transient maculopapular rashes, usually on the trunk, may accompany reactions to many drugs, including antibiotics, such as tetracycline, ampicillin, cephalosporins, and sulfonamides; benzodiazepines, such as diazepam; lithium; phenylbutazone; gold salts; allopurinol; isoniazid; and salicylates.

READ BOOK EXCERPT ONLINE »

Pustular rash: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Acne vulgaris.Pustules typify inflammatory lesions of acne vulgaris, which is accompanied by papules, nodules, cysts, open comedones (blackheads), and closed comedones (whiteheads). Lesions commonly appear on the face, shoulders, back, and chest. Other findings include pain on pressure, pruritus, and burning. Chronic recurrent lesions produce scars.

Blastomycosis.Blastomycosis is a fungal infection that produces small, painless, nonpruritic macules or papules that can enlarge to well-circumscribed, verrucous, crusted, or ulcerated lesions edged by pustules. Localized infection may cause only one lesion; systemic infection may cause many lesions on the hands, feet, face, and wrists. Blastomycosis also produces signs of pulmonary infection, such as pleuritic chest pain and a dry, hacking or productive cough with occasional hemoptysis.

Folliculitis.Folliculitis is a bacterial infection of hair follicles that produces individual pustules, each pierced by a hair and possibly accompanied by pruritus. “Hot tub” folliculitis produces pustules on areas covered by a bathing suit.

Furunculosis.A furuncle is an acute, deep-seated, red, hot, tender abscess that evolves from a staphylococcal folliculitis. Furuncles usually begin as small, tender red pustules at the base of hair follicles. They're likely to occur on the face, neck, forearm, groin, axillae, buttocks, and legs or areas that are prone to repeated friction. The pustules usually remain tense for 2 to 4 days and then become fluctuant. Rupture discharges pus and necrotic material. Then pain subsides, but erythema and edema may persist.

Impetigo contagiosa.Impetigo contagiosa, a vesiculopustular eruptive disorder that occurs in nonbullous and bullous forms, is usually caused by streptococci or staphylococci. Vesicles form and break, and a crust forms from the exudate: a thick, yellow crust in streptococcal impetigo and a thin, clear crust in staphylococcal impetigo. Both forms usually produce painless itching.

Pustular miliaria.Pustular miliaria causes pustular lesions that begin as tiny erythematous papulovesicles located at sweat pores. Diffuse erythema may radiate from the lesion. The rash and associated burning and pruritus worsen with sweating.

Pustular psoriasis.Small vesicles form and eventually become pustules with pustular psoriasis. The patient may report pruritus, burning, and pain. Localized pustular psoriasis usually affects the hands and feet. Generalized pustular psoriasis may erupt suddenly in a patient with psoriasis, psoriatic arthritis, or exfoliative psoriasis; although rare, this form of psoriasis can occasionally be fatal.

Rosacea.Rosacea commonly produces telangiectasia with acute episodes of pustules, papules, and edema. Characterized by persistent erythema, rosacea may begin as a flush covering the forehead, malar region, nose, and chin. Intermittent episodes gradually become more persistent, and the skin—instead of returning to its normal color—develops varying degrees of erythema.

Scabies.Threadlike channels or burrows under the skin characterize scabies, which can also produce pustules, vesicles, and excoriations. The lesions are a few millimeters long, with a swollen nodule or red papule that contains the itch mite.

Smallpox (variola major).Initial signs and symptoms of smallpox include high fever, malaise, prostration, severe headache, backache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face, and forearms and then spreads to the trunk and legs. Within 2 days, the rash becomes vesicular and later pustular. The lesions develop at the same time, appear identical, and are more prominent on the face and extremities. The pustules are round, firm, and deeply embedded in the skin. After 8 or 9 days, the pustules form a crust and, later, the scab separates from the skin, leaving a pitted scar. In fatal cases, death results from encephalitis, extensive bleeding, or secondary infection.

Varicella zoster.When immunity to varicella declines, the virus reactivates along a dermatome, producing extremely painful and pruritic vesicles and pustules (herpes zoster, or shingles). Even with resolution of the rash, patients may experience chronic pain (postherpetic neuralgia) that may persist for months.

Other causes

Drugs.Bromides and iodides commonly cause a pustular rash. Other drug causes include corticotropin, corticosteroids, dactinomycin, trimethadione, lithium, phenytoin, phenobarbital, isoniazid, hormonal contraceptives, androgens, and anabolic steroids.

READ BOOK EXCERPT ONLINE »

Acne as a complication of other conditions:

Other conditions that might have Acne as a complication may, potentially, be an underlying cause of Acne. Our database lists the following as having Acne as a complication of that condition:

• Jacobs syndrome
• Puberty

Acne as a symptom:

Conditions listing Acne as a symptom may also be potential underlying causes of Acne. Our database lists the following as having Acne as a symptom of that condition:

• 3?-hydroxysteroid dehydrogenase deficiency
• Adolescent conditions
• Adrenal hyperplasia, congenital type 3
• Bearn-Kunkel syndrome
• Congenital adrenal hyperplasia
• Congenital adrenal hyperplasia - simple virilizing form in males
• Copper deficiency, familial benign
• Cushing's syndrome
• Dermato-cardio-skeletal syndrome Borrone type
• Dermatocardioskeletal syndrome, Boronne type
• Diabetes
• Fowler-Christmas-Chapple syndrome
• Garret-Tripp syndrome
• Gonadotropin-dependent precocious puberty
• HAIR-AN Syndrome
• Hyperandrogenism
• Polycystic ovary syndrome
• Puberty
• Pyogenic arthritis, pyoderma gangrenosum, and acne
• Rhizomelic syndrome
• Sertoli-leydig cell tumors
• Type 2 diabetes
• Virilizing ovarian tumor

Medications or substances causing Acne:

The following drugs, medications, substances or toxins are some of the possible causes of Acne as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

• Dactinomycin
• Cosmegen
• Corticotropin
• ACTH
• Acthar

See full list of 424 medications causing Acne

Drug interactions causing Acne:

When combined, certain drugs, medications, substances or toxins may react causing Acne as a symptom.

The list below is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

• Flunisolide and Stanozolol interaction
• AeroBid and Stanozolol interaction
• AeroBid-M and Stanozolol interaction
• Bronalide and Stanozolol interaction
• Nasalide and Stanozolol interaction

See full list of 16 drug interactions causing Acne

What causes Acne?

Causes: Acne: Bacterial infection of clogged hair follicles
The exact cause of acne is unknown, but doctors believe it results from several related factors. One important factor is an increase in hormones called androgens (male sex hormones). These increase in both boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne.

Another factor is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from parents. For example, studies have shown that many school-age boys with acne have a family history of the disorder. Certain drugs, including androgens and lithium, are known to cause acne. Greasy cosmetics may alter the cells of the follicles and make them stick together, producing a plug. (Source: excerpt from Health Topics Questions and Answers About Acne: NIDDK)
Article excerpts about the causes of Acne:

Health Topics Questions and Answers About Acne: NIDDK (Excerpt)

Doctors describe acne as a disease of the pilosebaceous units (PSUs). Found over most of the body, PSUs consist of a sebaceous gland connected to a canal, called a follicle, that contains a fine hair (see "Normal Pilosebaceous Unit" diagram, below). These units are most numerous on the face, upper back, and chest. The sebaceous glands make an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle, commonly called a pore. Cells called keratinocytes line the follicle.

The hair, sebum, and keratinocytes that fill the narrow follicle may produce a plug, which is an early sign of acne. The plug prevents sebum from reaching the surface of the skin through a pore. The mixture of oil and cells allows bacteria Propionibacterium acnes (P. acnes) that normally live on the skin to grow in the plugged follicles. These bacteria produce chemicals and enzymes and attract white blood cells that cause inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and is marked by four signs: swelling, redness, heat, and pain.) When the wall of the plugged follicle breaks down, it spills everything into the nearby skin--sebum, shed skin cells, and bacteria--leading to lesions or pimples.

People with acne frequently have a variety of lesions, some of which are shown in the diagrams below. The basic acne lesion, called the comedo (KOM-e-do), is simply an enlarged and plugged hair follicle. If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produces a white bump called a whitehead. A comedo that reaches the surface of the skin and opens up is called a blackhead because it looks black on the skin's surface. This black discoloration is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.

Other troublesome acne lesions can develop, including the following:

• Papules--inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch
• Pustules (pimples)--papules topped by pus-filled lesions that may be red at the base
• Nodules--large, painful, solid lesions that are lodged deep within the skin
• Cysts--deep, painful, pus-filled lesions that can cause scarring.

Questions and Answers About Acne: NIAMS (Excerpt)

Doctors describe acne as a disease of the pilosebaceous units (PSUs). Found over most of the body, PSUs consist of a sebaceous gland connected to a canal, called a follicle, that contains a fine hair (see "Normal Pilosebaceous Unit" diagram, below). These units are most numerous on the face, upper back, and chest. The sebaceous glands make an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle, commonly called a pore. Cells called keratinocytes line the follicle.

The hair, sebum, and keratinocytes that fill the narrow follicle may produce a plug, which is an early sign of acne. The plug prevents sebum from reaching the surface of the skin through a pore. The mixture of oil and cells allows bacteria Propionibacterium acnes (P. acnes) that normally live on the skin to grow in the plugged follicles. These bacteria produce chemicals and enzymes and attract white blood cells that cause inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and is marked by four signs: swelling, redness, heat, and pain.) When the wall of the plugged follicle breaks down, it spills everything into the nearby skin--sebum, shed skin cells, and bacteria--leading to lesions or pimples. (Source: excerpt from Questions and Answers About Acne: NIAMS)

Questions and Answers About Acne: NIAMS (Excerpt)

The exact cause of acne is unknown, but doctors believe it results from several related factors. One important factor is an increase in hormones called androgens (male sex hormones). These increase in both boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne.

Another factor is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from parents. For example, studies have shown that many school-age boys with acne have a family history of the disorder. Certain drugs, including androgens and lithium, are known to cause acne. Greasy cosmetics may alter the cells of the follicles and make them stick together, producing a plug. (Source: excerpt from Questions and Answers About Acne: NIAMS)

Acne: NWHIC (Excerpt)

Acne pimples form when oil glands make too much sebum, an oily substance. Sebum is made in much larger amounts during and right after puberty than at other times in a woman's life. Sebum then blocks pores to form whiteheads, which form under the skin, and blackheads, which are open to the air. Blackheads are black because the air causes a chemical reaction with the oily debris inside, not because they are dirty. Yeast and bacteria in the skin cause whiteheads to become inflamed, making red, sometimes pus-filled pimples. (Source: excerpt from Acne: NWHIC)

Acne: NWHIC (Excerpt)

Hormonal changes can cause acne after adolescence. For instance, many women experience acne during pregnancy. This usually gets better after the baby is delivered and hormonal levels go back to normal. (Source: excerpt from Acne: NWHIC)

What triggers Acne?

The following conditions are listed as possible triggers for Acne:

• Skin rubbing
• Skin picking or squeezing
• Pollution
• High humidity
• Skin scrubbing
• Menstrual periods - usually 2-7 days before it starts.
• Stress (Note that stress does not cause acne, but stress may lead to an outbreak/flare)

Medical news summaries relating to Acne:

The following medical news items are relevant to causes of Acne:

• Acne medication may have contributed to suicide
• FDA fails to approve testosterone patch for women
• GI diet to assist cystic ovary disease
• New topical oil therapy for rosacea and acne developed
• PCOS may be improved by the diet drug Xenical
• Soy allergy sufferers need to be wary of many foods

Related information on causes of Acne:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Acne may be found in:

• Risk factors for Acne
• Medications that may cause Acne
• Contagiousness for Acne
• Hidden causes of Acne