PUO and Skin Rash:

PUO is a very common symptom and most of the time it is infective in origin. Microorganisms can directly affect the cutaneous cells and micro vessels or through immunological stimulations resulting in various types of skin rashes. Most of the time these rashes are non-specific. However, sometimes they are very specific to la particular organism or the disease process and such rashes help in clinical diagnosis of PUO.

1. Infectious Conditions
   
   

1. Bacterial infections:
   
2. Streptococcal infections: Can cause various manifestations.
   

• rythema nodosum


• Erythema marginatum


• Scarlet fever

• Staphylococcal infections- Staphylococcal scalded Skin Syndrome
  
• Hansen’s disease in reaction
  
• Urticaria
  
  

1. Viral Infections:
   

• Kawasaki’s disease
  
• Measles
  
  

1. Rickettsial disease
   
   

1. Henoch Schonlein purpura
   
   

1. Non Infectious Conditions-
   
   

• Drug rash
  
• Lupus erythematous
  
  

Examination of the Nail:

1. Beau’s lines-sign of catabolism.


2. Mee’s lines - Arsenic poisoning.
   
3. Splinter Haemorrhage – LE, SBE.
   
4. Half and half nail -CRF
   
   

Examination of Mouth:

1. Gum hypertrophy – Leukemia and dilantin.
2. Hemangioma –Internal hemangioma.
3. Pigmented spots- Peutz Jegher’s Syndrome

Pigmentation on Skin:

Neurocutaneous syndromes have got one common link i.e. melanocyte which is neuroectodermal in origin. Therefore most of the neurocutaneous syndromes have some pigmentary abnormalities.

1. Hyperpigmentation –
   
   
2. Café au lait spots-Neurofibromatosis
   
3. Melanocytic nerves – Melanoma
   
   
4. Hypopigmentation –
   
   
5. Linear marks – Hypomelanoses of lto
   
   

Vascular lesions:

1. Strawberry hemangioma
2. Nevus flemmeus –



• Sturge Weber’s Syndrome
  
• KTW Syndrome
  
  

Hair abnormalities:

Sacral hair growth –Spina bifida

2. Alopecia areata - DM, Hypothyroidism
   
3. Poliosis
   
   

Ichthyosis:

1. Congenital- Various syndromes
2. Acquired- Hypothyroidism

Adenoma sebaceum: Tuberous sclerosis

Xeroderma pigmentosus

Linear vesicular lesions

Congenital anomalies

Ehler Danlos Syndrome

Nutritional and Metabolic Diseases:

1. Phrynoderma
   
2. B12 deficiency pigmentation
   
3. Xanthomatosis
   
4. Calcinosis cutis
   
5. Lipoid proteinosis
   
6. Porphyria