TABLE 88.3 GENERALIZED RASHES THAT OFTEN HAVE CHARACTERISTIC CLINICAL APPEARANCES Rubeola Erythema infectiosum (fifth disease) Hand–foot–mouth disease (coxsackievirus A16) Molluscum contagiosum Scarlet fever Pityriasis versicolor Pityriasis rosea Roseola infantum Insect bites Erythema multiforme Stevens–Johnson syndrome Drug reaction with eosinophilia and systemic symptoms For patients with widespread rash who appear ill, consider drug hypersensitivity reaction, or severe viral or bacterial infection Figure 88.12 may help with an approach to morbilliform/mixed macular and papular eruptions For patients who not appear ill, certain exanthems will have distinctive patterns that make the diagnosis readily apparent Erythema multiforme, rubella, coxsackievirus infections ( Fig 88.14 ), erythema infectiosum ( Fig 88.15A,B ), scarlet fever, varicella, MC ( Fig 88.16 ), tinea versicolor ( Fig 88.17 ), pityriasis rosea ( Fig 88.18 ), and roseola all have recognizable clinical appearances Many of these illnesses have characteristic distributions or associated signs and symptoms that aid in their diagnoses If the pattern of the rash does not evoke immediate recognition from the examiner, a more methodical approach is indicated, as outlined in Figure 88.19