The patient with an acute maculopapular rash presents a diagnostic challenge to the clinician. The term "maculopapular" is nonspecific, as many eruptions have a primary morphology of macules or papules, and the term may be misused to indicate any rash. The term "rash" is also nonspecific and is sometimes incorrectly applied to any skin finding; eruption may be preferred for a cutaneous reaction of acute onset. However, the term "maculopapular rash" is in common clinical use and will be retained here for simplicity. Synonyms for maculopapular rash include exanthematous eruption (exanthem) and morbilliform eruption.
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Summary
Definitions
The term maculopapular rash typically implies an acute and generalized eruption.
Morphologic terms
- Macule: a flat, circumscribed skin lesion ≤1 cm in greatest diameter. When macules are >1 cm, the appropriate term is patch.
- Papule: an elevated, circumscribed skin lesion ≤1 cm in diameter. When papules are >1 cm in size, the appropriate term is plaque (palpable lesions elevated above the skin surface) or nodule (a larger, firm papule with a significant vertical dimension).
Other morphologic terms encountered in this clinical setting include:
- Pustule: a papule containing purulent fluid
- Vesicle: a papule containing clear serous fluid
- Bulla: a larger vesicle >1 cm
- Urticaria: a wheal or hive.
The term maculopapular rash, therefore, implies a skin eruption of flat and raised lesions.
Last updated
Library
Hypersensitivity rash due to penicillin
Drug eruption due to phenytoin
Stevens-Johnson Syndrome: epidermal loss on soles of feet
Toxic epidermal necrolysis with epidermal loss, ocular involvement, and ecthyma gangrenosum
Stevens-Johnson Syndrome: targetoid lesions and epidermal loss
Viral exanthem presenting as a maculopapular eruption. Note urticarial appearance of nonscaling erythematous macules and papules on the trunk of this older child
Viral exanthem presenting as a maculopapular eruption. Note the erythematous papules are larger than macules on the leg of a young adult
Rubella presenting as a generalized abdominal rash
Koplik spots
Koplik spots
Erythema infectiosum (Fifth disease) in a 10-year-old girl
Syphilis presenting with a generalized rash
Morbilliform rash (resembling measles) resulting from toxic shock syndrome
Scarlet fever rash on the forearm due to group A Streptococcus bacteria
Erythema multiforme with target lesions
Erythema multiforme with perioral ulceration
Acute graft-versus-host disease of the skin (grade I)
Characteristic spotted rash of Rocky Mountain spotted fever
During a punch biopsy, local anesthetic is instilled by injection into the surrounding skin. With the skin stretched perpendicular to normal relaxation lines, a disposable skin biopsy punch with a round stainless steel blade (at least 3 mm or 4 mm in diameter is recommended) is applied perpendicular to the skin. Pressure is applied with a rotating action until a "give" is felt as the blade pierces through the subcutaneous tissue. The cylindrical core of tissue is removed and placed in a labeled sample pot containing a suitable fixative solution
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