Morbiliform rash
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Understanding Morbilliform Rash: Causes, Manifestations, and Implications
Introduction to Morbilliform Rash
A morbilliform rash, characterized by a widespread erythematous maculopapular eruption, can be triggered by various factors including viral infections, drug reactions, and underlying systemic conditions. This article synthesizes recent research to provide a comprehensive overview of the causes, clinical presentations, and implications of morbilliform rashes.
Viral Infections and Morbilliform Rash
Respiratory Viral Infections
Morbilliform rashes have been observed in the terminal stages of viral respiratory infections. For instance, during an epidemic of respiratory infections in 1967-1968, several children developed morbilliform rashes as their respiratory symptoms subsided, indicating a possible link between viral infections and the rash .
COVID-19 and Skin Manifestations
The COVID-19 pandemic has also highlighted morbilliform rashes as a common skin manifestation. Patients with severe COVID-19 have presented with these rashes, typically appearing on the trunk and arms, often accompanied by itching. The exact mechanism remains unclear but is thought to involve immune-mediated vasodilation or micro thrombosis .
Other Viral Causes
In highly immunized populations, morbilliform rashes have been linked to various viral infections such as parvovirus B19, human herpesvirus type 6, enterovirus, and adenovirus. These findings underscore the importance of considering a broad range of viral etiologies in patients presenting with morbilliform rashes .
Drug-Induced Morbilliform Rash
Common Drug Triggers
Several medications are known to cause morbilliform rashes. Notably, aromatic anticonvulsants and allopurinol have been implicated in drug reaction with eosinophilia and systemic symptoms (DRESS), a severe hypersensitivity reaction . Additionally, febuxostat, used for gout treatment, has been associated with morbilliform rashes, necessitating careful management and desensitization protocols in sensitive patients .
Rare Drug Reactions
Baclofen, a GABA-B receptor agonist used for spasticity and alcohol dependence, has also been reported to cause morbilliform rashes, although such cases are exceedingly rare . Similarly, diethylstilbestrol, used in prostate cancer treatment, has been documented to cause morbilliform eruptions, which resolve upon drug withdrawal .
Morbilliform Rash in Systemic Conditions
Lymphomas and Skin Involvement
Morbilliform rashes can sometimes be a manifestation of underlying malignancies such as lymphomas. Angioimmunoblastic T-cell lymphoma (AITL) and mantle cell lymphoma have both been reported to present with morbilliform rashes, highlighting the need for thorough diagnostic workups in cases of unexplained rashes 89.
Conclusion
Morbilliform rashes are a common dermatological presentation with a wide array of potential causes, including viral infections, drug reactions, and systemic conditions. Recognizing the diverse etiologies and clinical contexts of these rashes is crucial for accurate diagnosis and effective management. Clinicians should maintain a high index of suspicion and consider comprehensive diagnostic evaluations to identify the underlying cause and guide appropriate treatment.
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