Updated: 1/9/2022

Microbiology of Rashes

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 Bugs Causing Rashes
Disease Rash Progression
Other Symptoms
Streptococcus pyogenes Scarlet fever Erythematous, sandpaper-like with numerous papules
Groin/axilla → trunk and extremities, sparing palms and soles. Rash is folllowed by desquamation.
Fever, sore throat, nausea
Staphylococcus aureus Toxic Shock Syndrome Sunburn-like (diffuse, erythematous, macular) with desquamation on palms and soles Trunk and neck → extremities High fever and severe systemic illness
Rickettsia rickettsii RMSF Blanching, erythematous macules Petechial Wrists/ankles → trunk. Rash then appears in later stage disease on the palms and soles Fever, headache
Treponema pallidum Secondary syphilis Copper-colored maculopapular, including palms and soles

Condylomata lata
Alopecia (patchy)
Constitutional symptoms

Borrelia burgdorferi Lyme disease Erythema chronicum migrans (expanding target-shaped red rash) Expanding circle Flu-like symptoms
Coxsackievirus type A Hand, foot, and mouth Vesicular Palms and soles only Ulcers in mouth
Rubella virus German measles (Rubella) Maculopapular Head → body. Lasts 3 days. Postauricular lymphadenopathy. Congenital rubella in fetus.
Rubeola virus Measles Maculopapular Head → entire body. Becomes confluent as it spreads downward. 3 C's, Koplik spots
Mumps virus Mumps None None Parotitis, orchitis
VZV Chickenpox Asynchronous Trunk → face/extremities Fever, pharyngitis, malaise
HHV-6 Roseola infantum
Blanching, maculopapular, occurs after fever Neck/trunk → face/extremities
High fever followed by rash (separatd temporally).  Affects infants
Parvovirus B19 Erythema infectiosum "Slapped cheek" Face → body Hydrops fetalis in pregnant women
  • Other possible causes of palm and sole rash include:
    • Graft Versus Host Disease
    • Contact dermatitis
    • Endocarditis
    • Kawasaki's Disease
    • Rubella
    • Neisseria meningitidis (disseminated meningococcemia)
    • Parovirus B19 (papular-purpuric gloves and socks syndrome) 
    • Scabies
    • Toxic Shock Syndrome
    • Stevens-Johnson syndrome and Toxic epidermal necrolysis
    • Staphylococcal scalded skin syndrome
    • Tinea corporis

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