Diffuse red rashes are a common complaint. The differential diagnosis for this type of rash is wide, including minor, self-resolving illnesses that can be managed safely in the outpatient setting to life-threatening conditions that require prompt and aggressive intervention. Diffuse red rashes are most often a result of exposure to sunlight, a number of infections, or medications. In some cases, the combination of exposure to sunlight and medication is the reason for the rash.

• The timing of the rash in the setting of medication ingestion is often helpful in determining the etiology.

• Exanthematous drug eruptions usually occur within 5 to 14 days after starting medications. Medications most commonly implicated in drug eruptions include antibiotics (penicillins, sulfonamides), nonsteroidal anti-inflammatory drugs (NSAIDs), and anticonvulsants (carbamazepine, phenytoin). Pruritus is often an associated symptom.

• A severe form of drug eruption known as DRESS (drug rash with eosinophilia and systemic symptoms) usually occurs 2 to 8 weeks after a medication is initiated, most commonly after exposure to anticonvulsants.

• In the majority of cases, the onset of Red Man syndrome is within 60 minutes of initiation of vancomycin infusion.

• The typical prodrome of measles (rubeola) includes fever, malaise, cough, coryza, conjunctivitis, and Koplik spots (small red lesions on mucous membranes with a white central spot) followed on day 3 by the rash that spreads in a cephalocaudal fashion.

• The diffuse painful, sometimes painless, erythema of sunburn occurs 3 to 5 hours after exposure and usually peaks at 12 to 24 hours, after ultraviolet (UV) radiation of as little as 30 minutes duration.

• Drug- and chemical-induced photosensitivity similar in appearance to a typical sunburn results from the combination of UVA light exposure and the use of photosensitizing medications such as NSAIDs, sulfonamides, quinolones, tetracyclines, furosemide, griseofulvin, thiazides, amiodarone, and isoniazid.

• Polymorphous light eruption is a light-induced, nonscarring, pruritic eruption that tends to be most severe at the beginning of the sunny season and lessens in severity as the season progresses.

• Initial symptoms of staphylococcal scalded skin syndrome (SSSS) include fever, malaise, irritability, conjunctivitis, pharyngitis, and impetigo prior to the onset of the rash. SSSS can present at any age but preferentially affects newborns during their first week of life and children under age 5.

• In toxic shock syndrome (TSS), there is typically a focus of infection such as a tampon, soft tissue infection, abscess, or burn.

• Drug-related rashes usually manifest as generalized morbilliform eruptions, generally starting on the face and trunk, and then spreading distally.

• DRESS is a severe form of a drug reaction that is characterized by fever, erythroderma, lymphadenopathy, facial edema, transaminitis, leukocytosis with eosinophilia, and visceral involvement.

• Erythema, flushing, and pruritus of the face and upper body are typical of Red Man syndrome. Severe reactions include generalized erythema, intense pruritus, and hypotension.

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