Adele K. Evans

The symptom of facial or neck rash requires careful description to approach the proper treatment plan. Rashes are described clinically by the type, shape, margination, arrangement and distribution of the lesions.

Type

Rash types may be papular (consisting of fine raised lesions) or macular (consisting of wide, flat lesions). They may be restricted to an allergic-type whealand-flare. The type may be nodular (solid) or cystic. Pustular lesions consist of papule-like lesions filled with pus, whereas vesicular lesions are nonpustular and contain small volumes of liquid, and bullous lesions are blister-like and contain large volumes of liquid. The lesions may alternatively be erosive and ulcerated, scaly and hyperkeratotic, or heavily scarred and referred to as sclerotic, or the skin structures may be destroyed by the process characterized best as atrophic. The color, feel on palpation, response to heat or cold, tenderness, and tissue mobility are also used to characterize lesions.

Shape

Descriptors of shape include round, oval, polygonal, polycyclic, annular (ring-shaped), iris (target), serpiginous (snakelike), or umbilicated.

Margination

Margination describes the edges of the lesions, such as well defined versus ill defined.

Arrangement

Arrangement describes grouped lesions such as herpetiform or linear patterns versus disseminated patterns with scattered discrete appearance or diffuse involvement.

Distribution descriptors include descriptors of extent, such as isolated, localized, regional, or generalized. Pattern descriptors include symmetrical, exposed areas, pressure sites, intertriginous areas, follicular localization, or random. There are many characteristic lesion patterns that are helpful descriptors as well, such as Lyme disease or Rocky Mountain spotted fever, varicella or erythema multiforme.

For differential diagnosis, we have grouped rashes based on associated findings and location.

Rash with Fever

Rashes appearing on the face and presenting with fever include measles, rubella, and varicella