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Diseases » Warts » Causes

Causes of Warts

Contents

List of causes of Warts

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

Human papilloma virus
Molluscum Contagiosum
Immune deficiency - may cause widespread development of warts.
See also underlying causes of genital warts
Warts - dark brown warts
Incontinentia Pigmenti - warty skin growths
Plantar wart
Buschke-Lowenstein giant condyloma
Eczema - warts
Tuberous sclerosis - warts
Keratosis - small raised warts
Genital warts - penile warts
Condylomata accuminata
Cancer - Wart changes
Syphilis - wart-like lumps
Secondary Lymphatic Obstruction - warts
Lymphatic Obstruction - warts
Epidermodysplasia verruciformis of Lewandowsky-Lutz
Primary Lymphatic Obstruction - warts
Fucosidosis type II - warty skin growths
Seborrheic keratosis - small raised warts
WHIM syndrome - Warts
Sun spots - small raised warts
Sexually Transmitted Diseases - genital warts
Condyloma - anal warts
Basal cell papilloma

More causes: see full list of causes for Warts

Causes of Warts (Diseases Database):

The follow list shows some of the possible medical causes of Warts that are listed by the Diseases Database:

Source: Diseases Database

Warts Causes: Book Excerpts

Warts as a complication of other conditions:

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

Eczema

Warts as a symptom:

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

Related information on causes of Warts:

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

Causes of Warts: Online Medical Books

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

Dry Skin (Xerosis): Differential Diagnosis
(In a Page: Signs and Symptoms)

Dry skin is a very common problem
–Low humidity and cold temperatures make winter xerosis and “winter itch” common complaints
–Mild xerosis can cause impaired skin barrier function and allow irritants and allergens to more easily affect the skin
–Most common on the legs, but often affecting the entire skin surface
–Can present with severe pruritus without much evidence of a rash
Severe xerosis is common in the elderly, and can cause eczema craquelé
–Patient's legs often have scale that resembles cracked porcelain
–Secondary erythema and excoriations occur because of the persistent itch
Ichthyoses vulgaris
–Very common cause of dry skin
–A genetic defect in skin barrier function, leading to a higher risk of atopic dermatitis
–Patients often have hyperlinearity of their palmar skin and xerotic fish scale on their legs
Many genetic conditions, such as the large family of ichthyoses (including X-linked ichthyoses, Netherton's disease), lead to severely dry skin in association with other systemic manifestations
Hypothyroidism and hyperthyroidism can also cause marked xerosis and/or itch
Anemia
There is an uncommon association between lymphoma and marked xerosis
HIV
Sarcoidosis
Liver and biliary disease, and renal insufficiency, are commonly associated with xerosis and marked pruritus
Diabetes mellitus
Medications (e.g., niacinamide)
Atopic dermatitis

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Genital Skin Lesions: Differential Diagnosis
(In a Page: Signs and Symptoms)

Herpes simplex virus (HSV-1 and HSV-2) is the most common cause of genital lesions in the U.S.
–Presents with prodromal tingling and genital discomfort before lesions
–Lesions are always painful and appear as grouped vesicles on an erythematous base
Condyloma acuminatum (“warts,” HPV)
–Etiologic agent is human papilloma virus
–Lesions usually painless and pearly with a smooth surface but may be filiform, fungating, and lobulated

Tinea cruris
–Inguinal erythema with itch or tenderness
–Always spares the scrotum

Candida intertrigo
–Inguinal erythema with itch or tenderness
–Often very red with satellite lesions
–Frequently involves the labia or scrotum

Syphilis
–Primary stage: Painless solitary ulcer (chancre) on labia, penis, or oral mucosa that heals in 2–3 weeks
–Secondary stage: Condyloma lata (moist hypertrophic papules on genital and oral regions)
–Tertiary stage: Cardiac, neurologic, and other systemic effects

Molluscum contagiosum
–Multiple, very small, painless, flesh-colored nodules with umbilicated centers

Chancroid
–Etiologic agent is Haemophilus ducreyi
–Painful, solitary, and erythematous lesions
–May present with dyspareunia and/or dysuria

Erythrasma

Lymphogranuloma venereum

Granuloma inguinale

Behçet syndrome
–Oral and genital ulcers, retinitis, uveitis

Lichen planus

Scabies

Zoon's plasma cell balanitis

Less common etiologies (“zebras”) include inverse psoriasis, seborrheic dermatitis, genital squamous cell carcinoma, extramammary Paget's disease, plaque psoriasis, and fixed drug eruptions

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Skin Pigmentation (Decreased): Differential Diagnosis
(In a Page: Signs and Symptoms)

Vitiligo
–Affects 1% of the population
–Begins as a focal or diffuse (more common) hypopigmented patch that progresses to total loss of pigmentation of the affected skin (chalk white)
–Usually symmetric; often tops of hands, perioral, periorbital skin, knees, elbows

Pityriasis alba
–Very common, especially in black children
–Less distinct borders than in vitiligo, does not result in complete depigmentation
–Plaques may appear lighter than surrounding skin and may be scaly
–Often secondary to mild inflammation, such as tinea versicolor or atopic eczema
–Completely reversible and does not cause permanent hypopigmentation

Piebaldism
–Congenital, permanent, and irreversible
–Newborns often have a patch of white scalp hair and depigmented patches on the trunk with normally pigmented patches within these larger depigmented areas
Chemical leukoderma (depigmentation)
–May be caused by phenols, germicides, and many other caustic chemicals
–Results in confetti-like macules of depigmentation in exposed skin
- Albinism
  –Congenital
  –Disorder of melanin synthesis with several phenotypes, ranging from complete lack of pigmentation (white hair and translucent or “red” iris) to the more common diffuse hypopigmentation or “yellow” albinism that is prevalent in the black population
  –Affects the skin, hair, and eyes
  –Photophobia, decreased visual acuity, strabismus, and risk of skin cancer are the main problems faced by these patients
- Congenital birthmarks (e.g., nevus anemicus, nevus depigmentosis) are isolated patches of hypo- or depigmentation that remain unchanged over time
- Tuberous sclerosis is an inherited systemic disorder that results in hypopigmented macules in the shape of an “ash leaf ” on the trunk, and confetti-type depigmented macules on the arms/legs

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Papulosquamous Lesions: Differential Diagnosis
(In a Page: Signs and Symptoms)

Allergic and irritant contact reactions and drug-induced rashes are included in the papulosquamous diseases

Psoriasis
–Affects 2% of the U.S. population
–May acutely present as guttate (drop-like), round plaques with minimal scale
–More common is the variant called psoriasis vulgaris: Presents as thick plaques of silvery adherent scale on an erythematous base on the extensor joints
Seborrheic dermatitis
–An inflammatory “dandruff” that manifests as light scale on a greasy and/or erythematous background around the hairline, upper lip, nasolabial creases, chin, external ears, eyebrow areas, scalp
–Due to overgrowth of Pityrosporum ovale
Pityriasis rosea
–A common exanthem that is self-limited; the etiology is unclear
–Presents with initial “herald patch,” with subsequent scaly pink papules/plaques over the trunk in a “Christmas tree” distribution
–May be very itchy and is often confused with guttate psoriasis
Atopic dermatitis
–Common among children with a history of asthma, hay fever, or seasonal allergies
–Manifests as itchy eczematous plaques on the antecubital and popliteal fossae; often becomes secondarily lichenified (i.e., thickened with chronic rubbing changes)
–60% of patients have initial symptoms before 1 year of age
–The disease often lasts 15–20 years

Fungal infections of the skin caused by dermatophytes often present as itchy, scaly papulosquamous rashes that can mimic nummular eczema
Nummular eczema
–An idiopathic disease that affects many patients mostly in the winter months
Lichen planus
–Present with flat topped, polygonal, and purplish papules that may have white streaks or “Wickham's striae”

Eczematous diseases (e.g., eczema craquelé, lichen simplex chronicus)

Infection (e.g., secondary syphilis meningococcemia, RMSF)

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Vesicular & Bullous Lesions: Differential Diagnosis
(In a Page: Signs and Symptoms)

Localized

Allergic contact dermatitis (e.g. rhus)
–Localized vesicular and bullous eruptions

Herpes-zoster or shingles
–Due to reactivation of latent virus
–More common in adults
–Presents as painful vesicles on an erythematous base in a dermatomal distribution, beginning with fever, dysesthesia, and/or malaise
Herpes simplex virus
–Herpetic lesions present as painful, recurrent vesicles on an erythematous base
–Type 1 usually affects oral mucosa and vermilion border
–Genital HSV (most commonly HSV-2) may manifest as nonspecific symptoms (e.g., dysuria, urethritis)

Bullous impetigo
–Most common in children
–Presents as flaccid vesicles and bullae with honey-colored crust

Bites from many insects
Many viral infections of childhood can present with focal vesicles, especially hand-foot-andmouth disease

Burns and friction blisters
–Common causes of bullae, especially on hands

Diabetics can develop bullae on the legs
Dyshidrotic eczema (pompholyx)
–Causes itching, scaling, and erythema, and minute vesicles and painful fissures
Diffuse
Polymorphous light eruption
–Common reaction to ultraviolet light
–Presents as itchy vesicles or erythematous papules on sun-exposed areas

Varicella or “chicken pox”
–Presents with vesicles in crops, and in many stages of evolution

Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN)
–Most commonly caused by medications
–TEN is life threatening
Blistering diseases like bullous pemphigoid, pemphigus vulgaris, and porphyria cutanea tarda present with coalescing vesicles and bullae

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

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.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Skin turgor, decreased: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Cholera

Cholera is characterized by abrupt watery diarrhea and vomiting, which leads to severe water and electrolyte loss. These imbalances cause the following symptoms: decreased skin turgor, thirst, weakness, muscle cramps, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

Dehydration

Decreased skin turgor commonly occurs with moderate to severe dehydration. Associated findings include dry oral mucosa, decreased perspiration, resting tachycardia, orthostatic hypotension, a dry and furrowed tongue, increased thirst, weight loss, oliguria, a fever, and fatigue. As dehydration worsens, other findings include enophthalmos, lethargy, weakness, confusion, delirium or obtundation, anuria, and shock. Hypotension persists even when the patient lies down.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Skin, clammy: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Anxiety

An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, a dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, a headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.

Arrhythmias

Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.

Cardiogenic shock

Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.

Heat exhaustion

In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, a headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.

Hypoglycemia (acute)

Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, a headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.

Hypovolemic shock

With hypovolemic shock, generalized pale, cold, clammy skin accompanies a subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and a rapid, thready pulse. Other findings are flat neck veins, an increased capillary refill time, decreased urine output, confusion, and a decreased level of consciousness.

Septic shock

The cold shock stage causes generalized cold, clammy skin. Associated findings include a rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Skin, mottled: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Acrocyanosis

With the rare disorder acrocyanosis, anxiety or exposure to cold can cause vasospasm in small cutaneous arterioles. This results in persistent symmetrical blue and red mottling of the affected hands, feet, and nose.

Arterial occlusion (acute)

Initial signs of acute arterial occlusion include temperature and color changes. Pallor may change to blotchy cyanosis and livedo reticularis. Color and temperature demarcation develop at the level of obstruction. Other effects include sudden onset of pain in the extremity and, possibly, paresthesia, paresis, and a sensation of cold in the affected area. Examination reveals diminished or absent pulses, cool extremities, an increased capillary refill time, pallor, and diminished reflexes.

Arteriosclerosis obliterans

Atherosclerotic buildup narrows intra-arterial lumina, resulting in reduced blood flow through the affected artery. Obstructed blood flow to the extremities (most commonly the legs) produces such peripheral signs and symptoms as leg pallor, cyanosis, blotchy erythema, and livedo reticularis. Related findings include intermittent claudication (most common symptom), diminished or absent pedal pulses, and leg coolness. Other symptoms include coldness and paresthesia.

Buerger’s disease

Buerger’s disease, a form of vasculitis, produces unilateral or asymmetrical color changes and mottling, particularly livedo networking in the lower extremities. It also typically causes intermittent claudication and erythema along extremity blood vessels. During exposure to cold, the feet are cold, cyanotic, and numb; later they’re hot, red, and tingling. Other findings include impaired peripheral pulses and peripheral neuropathy. Buerger’s disease is typically exacerbated by smoking.

Cryoglobulinemia

Cryoglobulinemia is a necrotizing disorder that causes patchy livedo reticularis, petechiae, and ecchymoses. Other findings include a fever, chills, urticaria, melena, skin ulcers, epistaxis, Raynaud’s phenomenon, eye hemorrhages, hematuria, and gangrene.

Hypovolemic shock

Vasoconstriction from shock commonly produces skin mottling, initially in the knees and elbows. As shock worsens, mottling becomes generalized. Early signs include a sudden onset of pallor, cool skin, restlessness, thirst, tachypnea, and slight tachycardia. As shock progresses, associated findings include cool, clammy skin; a rapid, thready pulse; hypotension; narrowed pulse pressure; decreased urine output; subnormal temperature; confusion; and a decreased level of consciousness.

Livedo reticularis (idiopathic or primary)

Symmetrical, diffuse mottling can involve the hands, feet, arms, legs, buttocks, and trunk. Initially, networking is intermittent and most pronounced on exposure to cold or stress; eventually, mottling persists even with warming.

Periarteritis nodosa

Skin findings in periarteritis nodosa include asymmetrical, patchy livedo reticularis, palpable nodules along the path of medium-sized arteries, erythema, purpura, muscle wasting, ulcers, gangrene, peripheral neuropathy, a fever, weight loss, and malaise.

Polycythemia vera

Polycythemia vera is a hematologic disorder that produces livedo reticularis, hemangiomas, purpura, rubor, ulcerative nodules, and scleroderma-like lesions. Other symptoms include a headache, a vague feeling of fullness in the head, dizziness, vertigo, vision disturbances, dyspnea, and aquagenic pruritus.

Systemic lupus erythematosus (SLE)

SLE is a connective tissue disorder that can cause livedo reticularis, most commonly on the outer arms. Other signs and symptoms include a butterfly rash, nondeforming joint pain and stiffness, photosensitivity, Raynaud’s phenomenon, patchy alopecia, seizures, a fever, anorexia, weight loss, lymphadenopathy, and emotional lability.

Other causes

Immobility

Prolonged immobility may cause bluish mottling, most noticeably in dependent extremities.

Thermal exposure

Prolonged thermal exposure, as from a heating pad or hot water bottle, may cause erythema Ab Igne — a localized, reticulated, brown-to-red mottling.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Skin, scaly: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Bowen’s disease

Bowen’s disease is a common form of intraepidermal carcinoma that causes painless, erythematous plaques that are raised and indurated with a thick, hyperkeratotic scale and, possibly, ulcerated centers.

Dermatitis

Exfoliative dermatitis begins with rapidly developing generalized erythema. Desquamation with fine scales or thick sheets of all or most of the skin surface may cause life-threatening hypothermia. Other possible complications include cardiac output failure and septicemia. Systemic signs and symptoms include a low-grade fever, chills, malaise, lymphadenopathy, and gynecomastia.

With nummular dermatitis, round, pustular lesions commonly ooze purulent exudate, itch severely, and rapidly become encrusted and scaly. Lesions appear on the extensor surfaces of the limbs, posterior trunk, and buttocks.

Seborrheic dermatitis begins with erythematous, scaly papules that progress to larger, dry or moist, greasy scales with yellowish crusts. This disorder primarily involves the center of the face, the chest and scalp and, possibly, the genitalia, axillae, and perianal regions. Pruritus occurs with scaling.

Dermatophytosis

Tinea capitis produces lesions with reddened, slightly elevated borders and a central area of dense scaling; these lesions may become inflamed and pus-filled (kerions). Patchy alopecia and itching may also occur. Tinea pedis causes scaling and blisters between the toes. The squamous type produces diffuse, fine, branlike scales. Adherent and silvery white, they’re most prominent in skin creases and may affect the entire dorsum of the foot. Tinea corporis produces crusty lesions. As they enlarge, their centers heal, causing the classic ringworm shape.

Lymphoma

Hodgkin’s disease and non-Hodgkin’s lymphoma commonly cause scaly rashes. Hodgkin’s disease may cause pruritic scaling dermatitis that begins in the legs and spreads to the entire body. Remissions and recurrences are common. Small nodules and diffuse pigmentation are related signs. This disease typically produces painless enlargement of the peripheral lymph nodes. Other signs and symptoms include a fever, fatigue, weight loss, malaise, and hepatosplenomegaly.

Non-Hodgkin’s lymphoma initially produces erythematous patches with some scaling that later become interspersed with nodules. Pruritus and discomfort are common; later, tumors and ulcers form. Progression produces nontender lymphadenopathy.

Parapsoriasis (chronic)

Parapsoriasis produces small or moderate-sized maculopapular, erythematous eruptions, with a thin, adherent scale on the trunk, hands, and feet. Removal of the scale reveals a shiny brown surface.

Pityriasis

Pityriasis rosea, an acute, benign, and self-limiting disorder, produces widespread scales. It begins with an erythematous, raised, oval herald patch anywhere on the body. A few days or weeks later, yellow-tan or erythematous patches with scaly edges erupt on the trunk and limbs and sometimes on the face, hands, and feet. Pruritus also occurs.

Pityriasis rubra pilaris, an uncommon disorder, initially produces seborrheic scaling on the scalp, progressing to the face and ears. Later, scaly red patches develop on the palms and soles, becoming diffuse, thick, fissured, hyperkeratotic, and painful. Lesions also appear on the hands, fingers, wrists, and forearms and then on wide areas of the trunk, neck, and limbs.

Psoriasis

Silvery white, micaceous scales cover erythematous plaques that have sharply defined borders. Psoriasis usually appears on the scalp, chest, elbows, knees, back, buttocks, and genitalia. Associated signs and symptoms include nail pitting, pruritus, arthritis, and sometimes pain from dry, cracked, encrusted lesions.

Systemic lupus erythematosus (SLE)

SLE produces a bright-red maculopapular eruption, sometimes with scaling. Patches are sharply defined and involve the nose and malar regions of the face in a butterfly pattern — a primary sign. Similar characteristic rashes appear on other body surfaces; scaling occurs along the lower lip or anterior hair line. Other primary signs and symptoms include photosensitivity and joint pain and stiffness. Vasculitis (leading to infarctive lesions, necrotic leg ulcers, or digital gangrene), Raynaud’s phenomenon, patchy alopecia, and mucous membrane ulcers can also occur.

Tinea versicolor

Tinea versicolor is a benign fungal skin infection that typically produces macular hypopigmented, fawn-colored, or brown patches of varying sizes and shapes. All are slightly scaly. Lesions commonly affect the upper trunk, arms, and lower abdomen; sometimes the neck; and, rarely, the face.

Other causes

Drugs

Many drugs — including penicillins, sulfonamides, barbiturates, quinidine, diazepam, phenytoin, and isoniazid — can produce scaling patches.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

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

Warts are caused by infection with the human papillomavirus, a group of ether-resistant, deoxyribonucleic acid-containing papovaviruses. Mode of transmission is probably through direct contact, but autoinoculation is possible.

Although their incidence is highest in children and young adults, warts may occur at any age.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Genital warts: Causes
(Professional Guide to Diseases (Eighth Edition))

Infection with one of the more than 70 known strains of HPV causes genital warts, which are transmitted through sexual contact. The warts grow rapidly in the presence of heavy perspiration, poor hygiene, or pregnancy and commonly accompany other genital infections.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Staphylococcal scalded skin syndrome: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

The causative organism in SSSS is group 2 Staphylococcus aureus, primarily phage type 71, which produces exotoxins that cause detachment of the epidermis. Predisposing factors may include impaired immunity and renal insufficiency — present to some extent in the normal neonate because of immature development of these systems.

SSSS is most prevalent in infants age 1 to 3 months but may develop in children. It’s uncommon in adults.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

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

Other causes

Drugs

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Skin turgor, decreased: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Cholera

This infection is characterized by abrupt watery diarrhea and vomiting, which leads to severe water and electrolyte loss. These imbalances cause the following symptoms: decreased skin turgor, thirst, weakness, muscle cramps, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

Dehydration

Decreased skin turgor commonly occurs with moderate to severe dehydration. Associated findings include dry oral mucosa, decreased perspiration, resting tachycardia, orthostatic hypotension, dry and furrowed tongue, increased thirst, weight loss, oliguria, fever, and fatigue. As dehydration worsens, other findings include enophthalmos, lethargy, weakness, confusion, delirium or obtundation, anuria, and shock. Hypotension persists even when the patient lies down.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Skin, bronze: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Adrenal hyperplasia

The skin assumes a dark bronze tone within a few months. Other findings include visual field deficits and headache (from an expanding pituitary lesion), and signs of masculinization in females.

Biliary cirrhosis

This disorder causes bronze skin from melanosis of exposed areas of jaundiced skin: eyelids, palms, neck, and chest or back. The patient may also experience generalized pruritus, weakness, fatigue, jaundice, dark urine, pale stools with steatorrhea, decreased appetite with weight loss, and hepatomegaly.

Chronic renal failure

The skin becomes pallid, yellowish bronze, dry, and scaly. Other findings include ammonia breath odor, oliguria, fatigue, decreased mental acuity, seizures, muscle cramps, peripheral neuropathy, bleeding tendencies, pruritus and, occasionally, uremic frost and hypertension.

Hemochromatosis

An early sign is progressive, generalized bronzing accentuated by metallic gray-bronze skin on sun-exposed areas, genitalia, and scars. Mucous membranes are affected less often. Early associated effects include weakness, lethargy, weight loss, abdominal pain, loss of libido, polydipsia, and polyuria.

Malnutrition

As weight loss depletes body nutrients, bronzing develops along with apathy, lethargy, anorexia, weakness, and slow pulse and respiratory rates. Patients may develop paresthesia in the extremities; dull, sparse, dry hair; brittle nails; dark, swollen cheeks; dry, flaky skin; red, swollen lips; muscle wasting; and gonadal atrophy in males.

Primary adrenal insufficiency

Bronze skin is a classic sign. Other findings include axillary and pubic hair loss, vitiligo, progressive fatigue, weakness, anorexia, nausea and vomiting, weight loss, orthostatic hypotension, weak and irregular pulse, abdominal pain, irritability, diarrhea or constipation, amenorrhea, and syncope.

Wilson’s disease

Kayser-Fleischer rings—rusty brown rings of pigment around the corneas—characterize this disease, which may cause skin bronzing. Other effects include incoordination, dysarthria, chorea, ataxia, muscle spasms and rigidity, abdominal distress, fatigue, personality changes, hypotension, syncope, and seizures.

Other causes

Drugs

Prolonged therapy with high doses of a phenothiazine may cause gradual bronzing of the skin.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Skin, clammy: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Anxiety

An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.

Arrhythmias

Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.

Cardiogenic shock

Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.

Heat exhaustion

In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.

Hypoglycemia (acute)

Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.

Hypovolemic shock

With this common form of shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and decreased level of consciousness.

Septic shock

The cold shock stage causes generalized cold, clammy skin. Associated findings include rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Skin, mottled: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Acrocyanosis

With this rare disorder, anxiety or exposure to cold can cause vasospasm in small cutaneous arterioles. This results in persistent symmetrical blue and red mottling of the affected hands, feet, and nose.

Arterial occlusion (acute)

Initial signs include temperature and color changes. Pallor may change to blotchy cyanosis and livedo reticularis. Color and temperature demarcation develop at the level of obstruction. Other effects include sudden onset of pain in the extremity and possibly paresthesia, paresis, and a sensation of cold in the affected area. Examination reveals diminished or absent pulses, cool extremities, increased capillary refill time, pallor, and diminished reflexes.

Arteriosclerosis obliterans

Atherosclerotic buildup narrows intra-arterial lumina, resulting in reduced blood flow through the affected artery. Obstructed blood flow to the extremities (most commonly the lower) produces such peripheral signs and symptoms as leg pallor, cyanosis, blotchy erythema, and livedo reticularis. Related findings include intermittent claudication (most common symptom), diminished or absent pedal pulses, and leg coolness. Other symptoms include coldness and paresthesia.

Buerger’s disease

This form of vasculitis produces unilateral or asymmetrical color changes and mottling, particularly livedo networking in the lower extremities. It also typically causes intermittent claudication and erythema along extremity blood vessels. During exposure to cold, the feet are cold, cyanotic, and numb; later they’re hot, red, and tingling. Other findings include impaired peripheral pulses and peripheral neuropathy. Buerger’s disease is typically exacerbated by smoking.

Cryoglobulinemia

This necrotizing disorder causes patchy livedo reticularis, petechiae, and ecchymoses. Other findings include fever, chills, urticaria, melena, skin ulcers, epistaxis, Raynaud’s phenomenon, eye hemorrhages, hematuria, and gangrene.

Hypovolemic shock

Vasoconstriction from shock commonly produces skin mottling, initially in the knees and elbows. As shock worsens, mottling becomes generalized. Early signs include sudden onset of pallor, cool skin, restlessness, thirst, tachypnea, and slight tachycardia. As shock progresses, associated findings include cool, clammy skin; rapid, thready pulse; hypotension; narrowed pulse pressure; decreased urine output; subnormal temperature; confusion; and decreased level of consciousness.

Livedo reticularis (idiopathic or primary)

Periarteritis nodosa

Skin findings include asymmetrical, patchy livedo reticularis, palpable nodules along the path of medium-sized arteries, erythema, purpura, muscle wasting, ulcers, gangrene, peripheral neuropathy, fever, weight loss, and malaise.

Polycythemia vera

This hematologic disorder produces livedo reticularis, hemangiomas, purpura, rubor, ulcerative nodules, and scleroderma-like lesions. Other symptoms include headache, a vague feeling of fullness in the head, dizziness, vertigo, vision disturbances, dyspnea, and aquagenic pruritus.

Rheumatoid arthritis

This disorder may cause skin mottling. Early nonspecific signs and symptoms progress to joint pain and stiffness with subcutaneous nodules, usually on the elbows.

Systemic lupus erythematosus

This connective tissue disorder can cause livedo reticularis, most commonly on the outer arms. Other signs and symptoms include a butterfly rash, nondeforming joint pain and stiffness, photosensitivity, Raynaud’s phenomenon, patchy alopecia, seizures, fever, anorexia, weight loss, lymphadenopathy, and emotional lability.

Other causes

Immobility

Prolonged immobility may cause bluish mottling, most noticeably in dependent extremities.

Thermal exposure

Prolonged thermal exposure, as from a heating pad or hot water bottle, may cause erythema Ab Igne—a localized, reticulated, brown-to-red mottling.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Skin, scaly: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Bowen’s disease

This common form of intraepidermal carcinoma causes painless, erythematous plaques that are raised and indurated with a thick, hyperkeratotic scale and, possibly, ulcerated centers.

Dermatitis

Exfoliative dermatitis begins with rapidly developing generalized erythema. Desquamation with fine scales or thick sheets of all or most of the skin surface may cause life-threatening hypothermia. Other possible complications include cardiac output failure and septicemia. Systemic signs and symptoms include low-grade fever, chills, malaise, lymphadenopathy, and gynecomastia.

Dermatophytosis

Discoid lupus erythematosus

This cutaneous form of lupus may occur without systemic signs and symptoms. Separate or coalescing lesions (macules, papules, or plaques), ranging from pink to purple, are covered with a yellow or brown crust. Enlarged hair follicles are filled with scales, and telangiectasia may be present. After this inflammatory stage, the lesions heal and hypopigmentation or hyperpigmentation and noncontractile scarring and atrophy may occur. Discoid lupus commonly involves the face or sun-exposed areas of the neck, ears, scalp, lips, and oral mucosa. Alopecia may also occur.

Lichen planus

With this disorder, small, flat, violet lesions with a fine scale and gray lines on the surface usually affect the lumbar region, genitalia, wrists, ankles, and anterior lower legs.

Lymphoma

Hodgkin’s disease and non-Hodgkin’s lymphoma commonly cause scaly rashes. Hodgkin’s disease may cause pruritic scaling dermatitis that begins in the legs and spreads to the entire body. Remissions and recurrences are common. Small nodules and diffuse pigmentation are related signs. This disease typically produces painless enlargement of the peripheral lymph nodes. Other signs and symptoms include fever, fatigue, weight loss, malaise, and hepatosplenomegaly.

Parapsoriasis (chronic)

This disorder produces small or moderate-sized maculopapular, erythematous eruption, with a thin, adherent scale on the trunk, hands, and feet. Removal of the scale reveals a shiny brown surface.

Pityriasis

Psoriasis

Syphilis (secondary)

Papulosquamous, slightly scaly eruptions characterize this disorder. A ring-shaped pattern of copper-red papules usually forms on the face, arms, palms, soles, chest, back, and abdomen. Annular papules may occur. Systemic findings include lymphadenopathy, malaise, weight loss, anorexia, nausea, vomiting, headache, sore throat, and low-grade fever.

Systemic lupus erythematosus

This disorder produces a bright-red maculopapular eruption, sometimes with scaling. Patches are sharply defined and involve the nose and malar regions of the face in a butterfly pattern—a primary sign. Similar characteristic rashes appear on other body surfaces; scaling occurs along the lower lip or anterior hair line. Other primary signs and symptoms include photosensitivity and joint pain and stiffness. Vasculitis (leading to infarctive lesions, necrotic leg ulcers, or digital gangrene), Raynaud’s phenomenon, patchy alopecia, and mucous membrane ulcers also can occur.

Tinea versicolor

This benign fungal skin infection typically produces macular hypopigmented, fawn-colored, or brown patches of varying sizes and shapes. All are slightly scaly. Lesions commonly affect the upper trunk, arms, and lower abdomen, sometimes the neck and, rarely, the face.

Other causes

Drugs

Many drugs—including penicillins, sulfonamides, barbiturates, quinidine, diazepam, phenytoin, and isoniazid—can produce scaling patches.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Staphylococcal scalded skin syndrome: Causes
(Handbook of Diseases)

The causative organism in SSSS is Group 2 Staphylococcus aureus, primarily phage type 71. Predisposing factors may include impaired immunity and renal insufficiency — present to some extent in the normal neonate because of immature development of these systems.

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Source: Handbook of Diseases, 2003

Skin, clammy: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Anxiety

Arrhythmias

Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.

Cardiogenic shock

Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.

Heat exhaustion

Hypoglycemia (acute)

Hypovolemic shock

With this common form of shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and a rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and a decreased level of consciousness.

Septic shock

The cold shock stage causes generalized cold, clammy skin. Associated findings include a rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Skin, mottled: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Acrocyanosis

. With acrocyanosis, a rare disorder, anxiety or exposure to cold can cause vasospasm in small cutaneous arterioles. This results in persistent symmetrical blue and red mottling of the affected hands, feet, and nose.

Arterial occlusion (acute)

Initial signs include temperature and color changes. Pallor may change to blotchy cyanosis and livedo reticularis. Color and temperature demarcation develop at the level of the obstruction. Other effects include a sudden onset of pain in the extremity and possibly paresthesia, paresis, and a sensation of cold in the affected area. Examination reveals diminished or absent pulses, cool extremities, increased capillary refill time, pallor, and diminished reflexes.

Arteriosclerosis obliterans

Atherosclerotic buildup narrows intra-arterial lumina, resulting in reduced blood flow through the affected artery. Obstructed blood flow to the extremities (most commonly the lower) produces such peripheral signs and symptoms as leg pallor, cyanosis, blotchy erythema, and livedo reticularis. Related findings include intermittent claudication (most common symptom), diminished or absent pedal pulses, and leg coolness. Other symptoms include coldness and paresthesia.

Buerger’s disease

A form of vasculitis, Buerger’s disease produces unilateral or asymmetrical color changes and mottling, particularly livedo networking in the lower extremities. It also typically causes intermittent claudication and erythema along extremity blood vessels. During exposure to cold, the feet are cold, cyanotic, and numb; later, they’re hot, red, and tingling. Other findings include impaired peripheral pulses and peripheral neuropathy. Buerger’s disease is typically exacerbated by smoking.

Cryoglobulinemia

A necrotizing disorder, cryoglobulinemia causes patchy livedo reticularis, petechiae, and ecchymoses. Other findings include fever, chills, urticaria, melena, skin ulcers, epistaxis, Raynaud’s phenomenon, eye hemorrhage, hematuria, and gangrene.

Hypovolemic shock

Vasoconstriction from shock commonly produces skin mottling, initially in the knees and elbows. As shock worsens, mottling becomes generalized. Early signs include a sudden onset of pallor, cool skin, restlessness, thirst, tachypnea, and slight tachycardia. As shock progresses, associated findings include cool, clammy skin as well as a rapid, thready pulse accompanied by hypotension, narrowed pulse pressure, decreased urine output, subnormal temperature, confusion, and a decreased level of consciousness.

Livedo reticularis (idiopathic or primary)

Periarteritis nodosa

Polycythemia vera

A hematologic disorder, polycythemia vera produces livedo reticularis, hemangiomas, purpura, rubor, ulcerative nodules, and scleroderma-like lesions. Other symptoms include headache, a vague feeling of fullness in the head, dizziness, vertigo, vision disturbances, dyspnea, aquagenic pruritus, and night sweats.

Rheumatoid arthritis (RA)

RA may cause skin mottling. Early nonspecific signs and symptoms progress to joint pain and stiffness with subcutaneous nodules, usually on the elbows.

Systemic lupus erythematosus (SLE)

A connective tissue disorder, SLE can cause livedo reticularis, most commonly on the outer arms. Other signs and symptoms include a butterfly rash, nondeforming joint pain and stiffness, photosensitivity, Raynaud’s phenomenon, patchy alopecia, seizures, fever, anorexia, weight loss, lymphadenopathy, and emotional lability.

Other causes

Immobility

Prolonged immobility may cause bluish mottling, most noticeably in dependent extremities.

Thermal exposure

Prolonged thermal exposure, such as from a heating pad or hot water bottle, may cause erythema ab igne —a localized, reticulated, brown-to-red mottling.

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

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

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

Other causes

Drugs

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Skin, bronze: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Adrenal hyperplasia

With adrenal hyperplasia, the skin assumes a dark bronze tone within a few months. Other findings include visual field deficits and headache (from an expanding pituitary lesion), and signs of masculinization in females such as clitoral enlargement, and male distribution of hair, fat, and muscle mass.

Biliary cirrhosis

Biliary cirrhosis causes bronze skin from melanosis of exposed areas of jaundiced skin: eyelids, palms, neck, and chest or back. The patient may also experience generalized pruritus, weakness, fatigue, jaundice, dark urine, pale stools with steatorrhea, decreased appetite with weight loss, and hepatomegaly.

Hemochromatosis

An early sign of hemochromatosis is progressive, generalized bronzing accentuated by metallic gray-bronze skin on sun-exposed areas, genitalia, and scars. Mucous membranes are affected less often. Early associated effects include weakness, lethargy, weight loss, abdominal pain, loss of libido, polydipsia, and polyuria.

CULTURAL CUE:Hereditary hemochromatosis is the most common genetic disorder in whites, affecting 1 in 200 to 300 people of Northern European descent.

Malnutrition

As weight loss, which occurs from malnutrition, depletes body nutrients, bronzing develops along with apathy, lethargy, anorexia, weakness, and slow pulse and respiratory rates. Patients may develop paresthesia in the extremities; dull, sparse, dry hair; brittle nails; dark, swollen cheeks; dry, flaky skin; red, swollen lips; muscle wasting; and gonadal atrophy in males.

Primary adrenal insufficiency

Bronze skin is a classic sign of primary adrenal insufficiency. Other findings include axillary and pubic hair loss, vitiligo, progressive fatigue, weakness, anorexia, nausea and vomiting, weight loss, orthostatic hypotension, weak and irregular pulse, abdominal pain, irritability, diarrhea or constipation, amenorrhea, and syncope.

Renal failure (chronic)

With chronic renal failure, the skin becomes pallid, yellowish bronze, dry, and scaly. Other findings include ammonia breath odor, oliguria, fatigue, decreased mental acuity, seizures, muscle cramps, peripheral neuropathy, bleeding tendencies, pruritus and, occasionally, uremic frost and hypertension.

Other causes

Drugs

Prolonged therapy with high doses of a phenothiazine may cause gradual bronzing of the skin.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Skin, clammy: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Anxiety

Cardiac arrhythmias

Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension. The pulse rate may be rapid, slow, or irregular. The patient may report palpitations, chest pain, diaphoresis, light-headedness, and weakness.

Cardiogenic shock

With cardiogenic shock, generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria. Associated signs and symptoms include anginal pain, dyspnea, jugular vein distention, ventricular gallop, and a weak, rapid pulse.

Heat exhaustion

Hypoglycemia (acute)

With acute hypoglycemia, generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.

Hypovolemic shock

With hypovolemic shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and decreased level of consciousness.

Septic shock

The cold shock stage of septic shock causes generalized cold, clammy skin. Associated findings include rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Skin, mottled: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Arterial occlusion (acute)

Initial signs of acute arterial occlusion include temperature and color changes. Pallor may change to blotchy cyanosis and livedo reticularis. Color and temperature demarcation develop at the level of obstruction. Other effects include sudden onset of pain in the extremity and possibly paresthesia, paresis, and a sensation of cold in the affected area. Examination reveals diminished or absent pulses, cool extremities, increased capillary refill time, pallor, and diminished reflexes.

Arteriosclerosis obliterans

Atherosclerotic buildup narrows intra-arterial lumina, resulting in reduced blood flow through the affected artery. Obstructed blood flow to the extremities (most commonly the lower) produces such peripheral signs and symptoms as leg pallor, cyanosis, blotchy erythema, and livedo reticularis. Related findings include intermittent claudication (most common symptom), diminished or absent pedal pulses, and leg coolness. Other symptoms include coldness and paresthesia.

Buerger’s disease

Buerger’s disease is a form of vasculitis that produces unilateral or asymmetrical color changes and mottling, particularly livedo networking in the lower extremities. It also typically causes intermittent claudication and erythema along extremity blood vessels. During exposure to cold, the feet are cold, cyanotic, and numb; later they’re hot, red, and tingling. Other findings include impaired peripheral pulses and peripheral neuropathy. Buerger’s disease is typically exacerbated by smoking.

Hypovolemic shock

Vasoconstriction from hypovolemic shock commonly produces skin mottling, initially in the knees and elbows. As shock worsens, mottling becomes generalized. Early signs include sudden onset of pallor, cool skin, restlessness, thirst, tachypnea, and slight tachycardia. As shock progresses, associated findings include cool, clammy skin; rapid, thready pulse; hypotension; narrowed pulse pressure; decreased urine output; subnormal temperature; confusion; and decreased level of consciousness.

Livedo reticularis (idiopathic or primary)

With livedo reticularis, symmetrical, diffuse mottling can involve the hands, feet, arms, legs, buttocks, and trunk. Initially, networking is intermittent and most pronounced on exposure to cold or stress; eventually, mottling persists even with warming.

Polycythemia vera

Polycythemia vera, a hematologic disorder, produces livedo reticularis, hemangiomas, purpura, rubor, ulcerative nodules, and scleroderma-like lesions. Other symptoms include headache, a vague feeling of fullness in the head, dizziness, vertigo, vision disturbances, dyspnea, and aquagenic pruritus.

Rheumatoid arthritis

Rheumatoid arthritis may cause skin mottling. Early nonspecific signs and symptoms progress to joint pain and stiffness with subcutaneous nodules, usually on the elbows. The patient may report morning stiffness.

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a connective tissue disorder that can cause livedo reticularis, most commonly on the outer arms. Other signs and symptoms include a butterfly rash, nondeforming joint pain and stiffness, photosensitivity, Raynaud’s phenomenon, patchy alopecia, seizures, fever, anorexia, weight loss, lymphadenopathy, and emotional lability.

Other causes

Immobility

Prolonged immobility may cause bluish mottling, most noticeably in dependent extremities.

Thermal exposure

Prolonged thermal exposure, such as from a heating pad or hot water bottle, may cause erythema Ab Igne — a localized, reticulated, brown-to-red mottling.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Skin, scaly: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Bowen’s disease

Bowen’s disease, a common form of intraepidermal carcinoma, causes painless, erythematous plaques that are raised and indurated with a thick, hyperkeratotic scale and, possibly, ulcerated centers. The head and neck are the most commonly affected sites.

Dermatitis

Exfoliative dermatitis begins with rapidly developing generalized erythema. Desquamation with fine scales or thick sheets of all or most of the skin surface may cause life-threatening hypothermia. Other possible complications include cardiac output failure and septicemia. Systemic signs and symptoms include low-grade fever, chills, malaise, lymphadenopathy, and gynecomastia.

Dermatophytosis

Discoid lupus erythematosus

Discoid lupus erythematosus is a cutaneous form of lupus that may occur without systemic signs and symptoms. Separate or coalescing lesions (macules, papules, or plaques), ranging from pink to purple, are covered with a yellow or brown crust. Enlarged hair follicles are filled with scales, and telangiectasia may be present. After this inflammatory stage, the lesions heal and hypopigmentation or hyperpigmentation and noncontractile scarring and atrophy may occur. Discoid lupus commonly involves the face or sun-exposed areas of the neck, ears, scalp, lips, and oral mucosa. Alopecia may also occur.

Lymphoma

Hodgkin’s disease and non-Hodgkin’s lymphoma commonly cause scaly rashes. Hodgkin’s disease may cause pruritic scaling dermatitis that begins in the legs and spreads to the entire body. Remissions and recurrences are common. Small nodules and diffuse pigmentation are related signs. This disease typically produces painless enlargement of the peripheral lymph nodes. Other signs and symptoms include fever, fatigue, weight loss, malaise, and hepatosplenomegaly.

Pityriasis rosea

Psoriasis

Syphilis (secondary)

Papulosquamous, slightly scaly eruptions characterize secondary syphilis. A ring-shaped pattern of copper-red papules usually forms on the face, arms, palms, soles, chest, back, and abdomen. Annular papules may occur. Systemic findings include lymphadenopathy, malaise, weight loss, anorexia, nausea, vomiting, headache, sore throat, and low-grade fever.

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) produces a bright-red maculopapular eruption, sometimes with scaling. Patches are sharply defined and involve the nose and malar regions of the face in a butterfly pattern — a primary sign. Similar characteristic rashes appear on other body surfaces; scaling occurs along the lower lip or anterior hair line. Other primary signs and symptoms include photosensitivity and joint pain and stiffness. Vasculitis (leading to infarctive lesions, necrotic leg ulcers, or digital gangrene), Raynaud’s phenomenon, patchy alopecia, and mucous membrane ulcers also can occur.

Tinea versicolor

Tinea versicolor, a benign fungal skin infection, typically produces macular hypopigmented, fawn-colored, or brown patches of varying sizes and shapes. All are slightly scaly. Lesions commonly affect the upper trunk, arms, and lower abdomen, sometimes the neck and, rarely, the face.

Other causes

Drugs

Many drugs — including penicillins, sulfonamides, barbiturates, quinidine, diazepam, phenytoin, and isoniazid — can produce scaling patches.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Skin Lesions and Rashes: Principal Causes of Skin Lesions and Rashes
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

Blistering(vesiculobullous) lesions
1. Miliaria
2. Allergic contact dermatitis
3. Chemical and thermal burns
4. Friction blisters
5. Frostbite
6. Bullous impetigo
7. Papular urticaria (insect bites)
8. Hand-foot-mouth disease
9. Varicella-zoster virus infections
10. Herpes simplex virus infections
11. Erythema multiforme
12. Staphylococcal scalded skin syndrome
13. Epidermolysis bullosa
14. Chronic bullous dermatitis of childhood(linear immunoglobulin A dermatosis)
15. Dermatitis herpetiformis
16. Bullous pemphigoid
17. Incontinentia pigmenti
Pustular lesions
1. Erythematoxicum
2. Transient neonatal pustular melanosis
3. Acne
4. Folliculitis
5. Eosinophilic pustular folliculitis
6. Infantile acropustulosis
7. Miliaria
8. Candidiasis
9. Herpes simplex virus infections
10. Local bacterial infections (Staphylococcusaureus)
11. Scabies
Skin-colored papules and nodules
1. Smoothsurface
  1. Milia
  2. Molluscum contagiosum
  3. Acne
  4. Epidermal cyst
  5. Granuloma annulare
  6. Lipoma
  7. Juvenile xanthogranuloma
  8. Xanthoma
  9. Neurofibroma
2. Rough surface
  1. Epidermal nevi
  2. Warts
  3. Corns and calluses
  4. Keratosis pilaris
White lesions
1. Flat lesions
  1. Postinflammatory hypopigmentation
  2. Pityriasis alba
  3. Tinea versicolor
  4. Vitiligo
  5. Piebaldism
  6. Ash-leaf macules
  7. Hypomelanosis of Ito
  8. Chediak-Higashi syndrome
  9. Waardenburg syndrome
2. Raised lesions
  1. Milia
  2. Acne
  3. Keratosis pilaris
  4. Molluscum contagiosum
Brown, blue-black, or black lesions
1. Flat lesions
  1. Freckles(ephelides)
  2. Mongolian spots (dermal melanosis)
  3. Café au lait spots
  4. Lentigines
  5. Nevi of Ota and of Ito
  6. Congenital nevocellular nevi
  7. Acquired nevocellular nevi
  8. Nevus spilus (speckled lentiginousnevus)
  9. Spitz nevi (spindle epithelioid nevi)
  10. Epidermal nevi
2. Raised lesions
  1. Postinflammatoryhyperpigmentation
  2. Mastocytoma and urticaria pigmentosa
  3. Pyogenic granuloma
  4. Dysplastic melanocytic nevi
  5. Melanoma
Yellow lesions
1. Jaundice
2. Carotenemia
3. Sebaceous gland hyperplasia
4. Nevus sebaceous of Jadassohn
Inflammatory papules and nodules
1. Insectbites
2. Acne
3. Roseola (exanthem subitum)
4. Enteroviruses (coxsackie A and B viruses,echoviruses)
5. Epstein-Barr virus
6. Parvovirus B19 (fifth disease)
7. Postnatal rubella
8. Measles (rubeola)
9. Scarlet fever
10. Cellulitis
11. Furuncle
12. Candidiasis
13. Kawasaki disease
14. Mycoplasma infections
15. Erythema marginatum
16. Panniculitis
17. Erythema chronicum migrans
18. Cutaneous larva migrans
19. Urticaria (hives)
Vascular reactions
1. Blanching
  1. Mottling(cutis marmorata)
  2. Salmon patch
  3. Spider angioma
  4. Port-wine stains
  5. Hemangiomas
  6. Drug hypersensitivity reactions
  7. Erythema toxicum
  8. Urticaria
  9. Viral infections (exanthems)
  10. Scarlet fever
  11. Erythema multiforme
  12. Kawasaki disease
  13. Toxic shock syndrome
  14. Erythema chronicum migrans
  15. Syphilis
  16. Pyogenic granuloma
  17. Pityriasis rosea (early lesions)
  18. Guttate psoriasis (early lesions)
2. Nonblanching (purpuric rashes)
  1. Meningococcemia
  2. Toxic shock syndrome
  3. Rocky Mountain spotted fever
  4. Other
Papulosquamous disorders
1. Diaperdermatitis (irritant dermatitis)
2. Atopic dermatitis
3. Nummular eczematous dermatitis
4. Juvenile plantar dermatosis (foot eczema)
5. Seborrheic dermatitis (infantile)
6. Contact dermatitis
7. Tinea corporis
8. Tinea pedis
9. Candidiasis
10. Sunburn
11. Pityriasis rosea
12. Drug eruptions
13. Scabies
14. Polymorphous light eruption
15. Psoriasis
16. Parapsoriasis
17. Lichen nitidis
18. Lichen striatus
19. Lichen planus
20. Lupus erythematosus
21. Dermatomyositis
22. Langerhans cell histiocytosis
23. Acrodermatitis enteropathica
24. Human immunodeficiency virus infection
25. Secondary syphilis
26. Ichthyoses
  1. Ichthyosis vulgaris
  2. X-linked ichthyosis
  3. Classic lamellar ichthyosis and congenitalnonbullous ichthyosiform erythroderma
  4. Congenital bullous ichthyosiform erythroderma(epidermolytic hyperkeratosis)

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

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 »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Skin turgor, decreased: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Cholera.Cholera is characterized by abrupt watery diarrhea and vomiting, which leads to severe water and electrolyte loss. These imbalances cause the following symptoms: decreased skin turgor, thirst, weakness, muscle cramps, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

Dehydration.Decreased skin turgor commonly occurs with moderate to severe dehydration. Associated findings include dry oral mucosa, decreased perspiration, resting tachycardia, orthostatic hypotension, a dry and furrowed tongue, increased thirst, weight loss, oliguria, fever, and fatigue. As dehydration worsens, other findings include enophthalmos, lethargy, weakness, confusion, delirium or obtundation, anuria, and shock. Hypotension persists even when the patient lies down.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Skin, clammy: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Anxiety.An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, a dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.

Arrhythmias.Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.

Cardiogenic shock.Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.

Heat exhaustion.In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.

Hypoglycemia (acute).Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.

Hypovolemic shock.With hypovolemic shock, generalized pale, cold, clammy skin accompanies a subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and a rapid, thready pulse. Other findings are flat neck veins, an increased capillary refill time, decreased urine output, confusion, and decreased level of consciousness.

Septic shock.The cold shock stage causes generalized cold, clammy skin. Associated findings include a rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Skin, mottled: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Acrocyanosis.With acrocyanosis, anxiety or exposure to cold can cause vasospasm in small cutaneous arterioles. This results in persistent symmetrical blue and red mottling of the affected hands, feet, and nose.

Arterial occlusion (acute).Initial signs of acute arterial occlusion include skin temperature and color changes. Pallor may change to blotchy cyanosis and livedo reticularis. Color and temperature demarcation develop at the level of obstruction. Other effects include sudden onset of pain in the extremity and, possibly, paresthesia, paresis, and a sensation of cold in the affected area. Examination reveals diminished or absent pulses, cool extremities, an increased capillary refill time, pallor, and diminished reflexes.

Arteriosclerosis obliterans.Atherosclerotic buildup narrows intra-arterial lumina, resulting in reduced blood flow through the affected artery. Obstructed blood flow to the extremities (most commonly the legs) produces such peripheral signs and symptoms as leg pallor, cyanosis, blotchy erythema, and livedo reticularis. Related findings include intermittent claudication (most common symptom), diminished or absent pedal pulses, and leg coolness. Other symptoms include coldness and paresthesia.

Buerger's disease.Buerger's disease produces unilateral or asymmetrical color changes and mottling, particularly livedo networking in the lower extremities. It also typically causes intermittent claudication and erythema along extremity blood vessels. During exposure to cold, the feet are cold, cyanotic, and numb; later they're hot, red, and tingling. Other findings include impaired peripheral pulses and peripheral neuropathy. Buerger's disease is typically exacerbated by smoking.

Cryoglobulinemia.Cryoglobulinemia causes patchy livedo reticularis, petechiae, and ecchymoses. Other findings include fever, chills, urticaria, melena, skin ulcers, epistaxis, Raynaud's phenomenon, eye hemorrhages, hematuria, and gangrene.

Hypovolemic shock.Vasoconstriction from hypovolemic shock commonly produces skin mottling, initially in the knees and elbows. As shock worsens, mottling becomes generalized. Early signs include a sudden onset of pallor, cool skin, restlessness, thirst, tachypnea, and slight tachycardia. As shock progresses, associated findings include cool, clammy skin; a rapid, thready pulse; hypotension; narrowed pulse pressure; decreased urine output; subnormal temperature; confusion; and decreased level of consciousness.

Livedo reticularis (idiopathic or primary).With livedo reticularis, symmetrical, diffuse mottling can involve the hands, feet, arms, legs, buttocks, and trunk. Initially, networking is intermittent and most pronounced on exposure to cold or stress; eventually, mottling persists even with warming.

Periarteritis nodosa.Skin findings in periarteritis nodosa include asymmetrical, patchy livedo reticularis, palpable nodules along the path of medium-sized arteries, erythema, purpura, muscle wasting, ulcers, gangrene, peripheral neuropathy, fever, weight loss, and malaise.

Polycythemia vera.Polycythemia vera produces livedo reticularis, hemangiomas, purpura, rubor, ulcerative nodules, and scleroderma-like lesions. Other symptoms include headache, a vague feeling of fullness in the head, dizziness, vertigo, vision disturbances, dyspnea, and aquagenic pruritus.

Systemic lupus erythematosus (SLE).SLE can cause livedo reticularis, most commonly on the outer arms. Other signs and symptoms include a butterfly rash, nondeforming joint pain and stiffness, photosensitivity, Raynaud's phenomenon, patchy alopecia, seizures, fever, anorexia, weight loss, lymphadenopathy, and emotional lability.

Other causes

Drugs.Vasoconstrictors administered at a high dose can cause mottling of the extremities.

Immobility.Prolonged immobility may cause bluish mottling, most noticeably in dependent extremities.

Thermal exposure.Prolonged thermal exposure, as from a heating pad or hot water bottle, may cause erythema ab igne—a localized, reticulated, brown-to-red mottling.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Skin, scaly: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Bowen's disease.Bowen's disease causes painless, erythematous plaques that are raised and indurated with a thick, hyperkeratotic scale and, possibly, ulcerated centers.

Dermatitis.Exfoliative dermatitis begins with rapidly developing generalized erythema. Desquamation with fine scales or thick sheets of all or most of the skin surface may cause life-threatening hypothermia. Other possible complications include cardiac output failure and septicemia. Systemic signs and symptoms include a low-grade fever, chills, malaise, lymphadenopathy, and gynecomastia.

Dermatophytosis.Tinea capitis produces lesions with reddened, slightly elevated borders and a central area of dense scaling; these lesions may become inflamed and pus-filled (kerions). Patchy alopecia and itching may also occur. Tinea pedis causes scaling and blisters between the toes. The squamous type produces diffuse, fine, branlike scales. Adherent and silvery white, they're most prominent in skin creases and may affect the entire dorsum of the foot. Tinea corporis produces crusty lesions. As they enlarge, their centers heal, causing the classic ringworm shape.

Lymphoma.Hodgkin's disease and non-Hodgkin's lymphoma commonly cause scaly rashes. Hodgkin's disease may cause pruritic scaling dermatitis that begins in the legs and spreads to the entire body. Remissions and recurrences are common. Small nodules and diffuse pigmentation are related signs. This disease typically produces painless enlargement of the peripheral lymph nodes. Other signs and symptoms include fever, fatigue, weight loss, malaise, and hepatosplenomegaly.

Non-Hodgkin's lymphoma initially produces erythematous patches with some scaling that later become interspersed with nodules. Pruritus and discomfort are common; later, tumors and ulcers form. Progression produces nontender lymphadenopathy.

Parapsoriasis (chronic).Parapsoriasisproduces small or moderate-sized maculopapular, erythematous eruptions, with a thin, adherent scale on the trunk, hands, and feet. Removal of the scale reveals a shiny brown surface.

Pityriasis.Pityriasis rosea, an acute, benign, and self-limiting disorder, produces widespread scales. It begins with an erythematous, raised, oval herald patch anywhere on the body. A few days or weeks later, yellow-tan or erythematous patches with scaly edges erupt on the trunk and limbs and sometimes on the face, hands, and feet. Pruritus also occurs.

Psoriasis.Silvery white, micaceous scales cover erythematous plaques that have sharply defined borders. Psoriasis usually appears on the scalp, chest, elbows, knees, back, buttocks, and genitalia. Associated signs and symptoms include nail pitting, pruritus, arthritis, and sometimes pain from dry, cracked, encrusted lesions.

Systemic lupus erythematosus (SLE).SLE produces a bright-red maculopapular eruption, sometimes with scaling. Patches are sharply defined and involve the nose and malar regions of the face in a butterfly pattern—a primary sign. Similar characteristic rashes appear on other body surfaces; scaling occurs along the lower lip or anterior hair line. Other primary signs and symptoms include photosensitivity and joint pain and stiffness. Vasculitis (leading to infarctive lesions, necrotic leg ulcers, or digital gangrene), Raynaud's phenomenon, patchy alopecia, and mucous membrane ulcers can also occur.

Tinea versicolor.Tinea versicolor typically produces macular hypopigmented, fawn-colored, or brown patches of varying sizes and shapes. All are slightly scaly. Lesions commonly affect the upper trunk, arms, and lower abdomen; sometimes the neck; and, rarely, the face.

Other causes

Drugs.Many drugs—including penicillins, sulfonamides, barbiturates, quinidine, diazepam, phenytoin, and isoniazid—can produce scaling patches.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Warts: Warts - pathophysiology
(The 5-Minute Pediatric Consult)

The viruses have specific affinity for epidermal cells and cannot replicate in dermal connective tissue cells or other types of nonepithelial tissues.
After implantation in the epidermis, the viruses enter the nuclei of lower and midepidermal cells. The viruses then take over the machinery of cell production. While replicating themselves, they induce a rapid proliferation of epithelial cells.
The quantity of the virus, location of the warts, pre-existing skin injury, and cell-mediated immunity all play a role in the transmission of the virus.

Warts - etiology

Warts are caused by HPV, which is a subgroup of papovaviruses, small double-stranded DNA viruses.
There are >200 types of HPV.

» READ BOOK EXCERPT ONLINE »

Source: The 5-Minute Pediatric Consult, 2008

» Next page: Risk Factors for Warts

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Dry Skin (Xerosis): Differential Diagnosis (In a Page: Signs and Symptoms)

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Papulosquamous Lesions: Differential Diagnosis (In a Page: Signs and Symptoms)

Vesicular & Bullous Lesions: Differential Diagnosis (In a Page: Signs and Symptoms)

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

Acne vulgaris

Blastomycosis

Folliculitis

Furunculosis

Impetigo contagiosa

Pustular miliaria

Pustular psoriasis

Rosacea

Scabies

Smallpox

Varicella zoster

Other causes

Drugs

Skin turgor, decreased: Medical causes (Handbook of Signs & Symptoms (Third Edition))

Cholera

Dehydration

Skin, clammy: Medical causes (Handbook of Signs & Symptoms (Third Edition))

Anxiety

Arrhythmias

Cardiogenic shock

Heat exhaustion

Hypoglycemia (acute)

Hypovolemic shock

Septic shock

Skin, mottled: Medical causes (Handbook of Signs & Symptoms (Third Edition))

Acrocyanosis

Arterial occlusion (acute)

Arteriosclerosis obliterans

Buerger’s disease

Cryoglobulinemia

Hypovolemic shock

Livedo reticularis (idiopathic or primary)

Periarteritis nodosa

Polycythemia vera

Systemic lupus erythematosus (SLE)

Other causes

Immobility

Thermal exposure

Skin, scaly: Medical causes (Handbook of Signs & Symptoms (Third Edition))

Bowen’s disease

Dermatitis

Dermatophytosis

Lymphoma

Parapsoriasis (chronic)

Pityriasis

Psoriasis

Systemic lupus erythematosus (SLE)

Tinea versicolor

Other causes

Drugs

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

Genital warts: Causes (Professional Guide to Diseases (Eighth Edition))

Staphylococcal scalded skin syndrome: Causes and incidence (Professional Guide to Diseases (Eighth Edition))

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

Acne vulgaris

Blastomycosis

Folliculitis

Furunculosis

Gonococcemia

Impetigo contagiosa

Nummular or annular dermatitis

Pustular miliaria

Pustular psoriasis

Rosacea

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Checklist

Dry Skin (Xerosis): Differential Diagnosis
(In a Page: Signs and Symptoms)

Genital Skin Lesions: Differential Diagnosis
(In a Page: Signs and Symptoms)

Skin Pigmentation (Decreased): Differential Diagnosis
(In a Page: Signs and Symptoms)

Papulosquamous Lesions: Differential Diagnosis
(In a Page: Signs and Symptoms)

Vesicular & Bullous Lesions: Differential Diagnosis
(In a Page: Signs and Symptoms)

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

Skin turgor, decreased: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Skin, clammy: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Skin, mottled: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Skin, scaly: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

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

Genital warts: Causes
(Professional Guide to Diseases (Eighth Edition))

Staphylococcal scalded skin syndrome: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

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

Skin turgor, decreased: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Skin, bronze: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Skin, clammy: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Skin, mottled: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Skin, scaly: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Staphylococcal scalded skin syndrome: Causes
(Handbook of Diseases)

Skin, clammy: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Skin, mottled: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)