Maculopapular Rashes - THE ALGORITHMIC APPROACH The term maculopapule is a portmanteau, a combination of macule and papule (Table 1, page 8). Maculopapular rashes are differentiated based on the distribution of the rash and systemic toxicity (Figure 3, page 10). Patients with centrally distributed rashes who appear toxic and febrile have a wide differential diagnosis; however, it is paramount that patients living in endemic areas be assessed for Lyme disease. Those with centrally distributed rashes but without signs of toxicity usually present with either a drug reaction or pityriasis rosea. Patients with peripherally distributed rashes have a broader differential diagnosis, which is dependent upon systemic toxicity, presence or absence of target lesions, and whether the rash is located on the flexor or extensor surfaces. Target lesions are pathognomonic for SJS or EM. Patients with peripheral lesions and systemic toxicity but without target lesions require emergent evaluation for meningococcemia, RMSF, and syphilis. Nontoxic patients with a peripherally distributed rash but without target lesions require further assessment for flexor involvement (scabies or eczema) or extensor involvement (psoriasis). #Diagnosis #Dermatology #Maculopapular #Rash #Algorithm #Central #Peripheral #Differential
