If the patient has “febrile neutropenia”, red nodules or plaques on the skin may be an extremely dangerous sign. Schematic diagram, the characters in the picture have nothing to do with the news. (Picture taken from shutterstock)
[Health Channel/Comprehensive Report]Many people are very nervous when they see unknown rashes on their bodies. Wu Weixin, a dermatologist at National Taiwan University, talked about 5 types of rashes that may seem harmless but may cause serious health hazards on the Facebook fan page “Dermatology Specialist Wu Weixin”.
Wu Weixin said that when a rash appears on the body, our intuition always tells us that it is mosquito bites or allergies, and most of the time it is true. However, sometimes a seemingly ordinary rash turns out to be a life-threatening warning sign. The skin is not only a barrier against the outside world, but also a mirror that reflects the health of the body. Let us learn to interpret the danger signals it sends out, which is the key to self-rescue that you must master. This article will reveal five skin symptoms that require you to be highly vigilant based on the insights of Dr. Wu Weixin from the Department of Dermatology at National Taiwan University.
Not Just Mosquito Bites: The “Three Mosquito-borne Brothers” Behind High Fever and Joint Pain
Table of Contents
- Not Just Mosquito Bites: The “Three Mosquito-borne Brothers” Behind High Fever and Joint Pain
- The Pimple Pretender: Why is it so important to accurately identify monkey pox? “Deep” alerts that appear simultaneously
- Severe pain beyond the surface, disproportionate pain: redness, swelling, heat and pain are not simply cellulitis
- “Painless marks” after outdoor activities, a mysterious black scab: an invisible threat in Taiwan’s mountains
- Three treasures: infection, Sweet’s syndrome and blood cancer; a nightmare for people with low immunity when rash is the tip of the iceberg of systemic infection
“Similar beginnings, very different clues.” Uweixin said that during the mosquito breeding season, if there is a sudden high fever, body muscle and joint pain, accompanied by skin rash, this may be the typical beginning of three diseases transmitted by mosquitoes: dengue fever, schizophrenia and Zika virus. Their initial symptoms are very similar, which is a typical differential diagnosis pitfall, but it is important to remember the following key differences, which are important clues to the physician’s diagnosis.
• Dengue Fever: In addition to high fever and muscle pain, a rather unique symptom of dengue fever is “pain behind the eye socket”. Its rash is also very distinctive. The red rashes often merge over large areas, but leave some unaffected areas of normal skin color, forming a scene like “islands in a sea of red”. In addition, doctors can use the “Tourniquet test” to use a blood pressure monitor to pressurize the arm to observe whether there is spot bleeding. The test works on the principle that the dengue virus attacks the capillaries, making them fragile, so slight pressure can cause spotting under the skin, which provides important clues to diagnosis.
• Chikungunya:The joint pain of TCM may be more severe than that of dengue fever. Although the rash itself is not specific, it has a unique sequelae: after the rash subsides, it may leave obvious “post-rash pigmentation” on the face, especially in the center of the nose. In Taiwan, most cases of this disease are imported cases.
• Zika Virus:Its symptoms are usually milder than the first two, but it may be accompanied by “conjunctivitis”. The most worrying feature of Zika virus is that it can be transmitted vertically from mother to fetus, causing the serious consequences of “microcephaly in newborns”.
If you develop high fever and rash during the season when mosquitoes are abundant, do not take it lightly. You should be alert to these possibilities and seek medical treatment as soon as possible. Provide detailed symptoms and travel history to help doctors make correct judgments.
The Pimple Pretender: Why is it so important to accurately identify monkey pox? “Deep” alerts that appear simultaneously
When an acne-like rash appears on the body, combined with fever and swollen lymph nodes, one must be wary of an emerging infectious disease called “monkeypox” (Mpox). The rash of monkeypox tends to occur on the face, soles of hands and feet, and around the genitals. Its evolution and appearance are sometimes difficult to distinguish from common chickenpox.
In the clinic, our biggest concern is misdiagnosis. Please remember a few key characteristics of monkeypox rash:
• Depth of rash:The lesions “will be a little bit deeper” and feel more solid to the touch.
• Special appearance:The rash evolves from blisters to umbilicated pustules with a sunken center. The most special thing is that when scabs form, they will have a unique appearance of “a black scab in the middle with a ring of pus on the outside.”
• Distribution location:It has the characteristics of “centrifugal distribution”, that is to say, the end of the limbs such as the palms and soles of the feet are the main prone areas.
• Development stages:This is the most important identification point. The development of monkeypox rash all over the body is “synchronous”, which means that all lesions are at roughly the same stage. This is in sharp contrast to the “asynchronous” nature of the chickenpox rash in which all stages (red rash, blisters, and scabs) coexist at the same time.
• Pain:The rash itself may be accompanied by significant pain.
Although smallpox virus has been eradicated, monkeypox virus of the same genus has become a new public health challenge. Accurate identification of its unique rash characteristics is the key to early diagnosis, avoiding misdiagnosis and preventing the spread of the epidemic.
Severe pain beyond the surface, disproportionate pain: redness, swelling, heat and pain are not simply cellulitis
When there is redness, swelling, heat and pain in the calf, most people think of cellulitis. But please remember an extremely critical warning: If the patient’s subjective pain is “out of proportion to the clinical manifestations”, for example, the skin seems to be only slightly red and swollen, but the patient is in unbearable pain, this may be a warning of a fatal emergency “necrotizing fasciitis.”
Characteristics of necrotizing fasciitis include:
• Symptoms “rapidly worsen” within hours.
• The skin condition progresses rapidly, with “blisters, blood blisters, or tissue necrosis and blackening” appearing.
• Often accompanied by high fever, chills, and may quickly enter a state of “shock”.
When a patient presents with extreme pain, especially if the pain is disproportionate to the clinical picture…you have to consider this serious disease, necrotizing fasciitis. This is an emergency requiring immediate surgical debridement.
When physicians are faced with red and swollen legs, in addition to cellulitis, deep vein thrombosis (DVT) must be ruled out. The erythema of DVT is usually less obvious, the skin temperature is normal, and the main manifestations are edema and deep tenderness. However, the alarm for necrotizing fasciitis must immediately sound as soon as there is severe pain that is disproportionate to the appearance. This severe pain is the most urgent distress signal sent by the body, and any delay may lead to amputation or even life-threatening.
“Painless marks” after outdoor activities, a mysterious black scab: an invisible threat in Taiwan’s mountains
Imagine a scenario: A patient comes to the doctor with persistent fever and rash all over his body, but various tests cannot find the cause. At this time, if he mentions that he has recently been to a place with lush grass such as “mountainous areas, Huadong or outlying islands”, an experienced doctor will immediately do one thing: carefully examine the patient’s skin all over the body, especially the armpits, groin, waist and other warm, moist and hard-to-notice secret places, looking for a painless “black scab (eschar)”.
This inconspicuous black scab is the most important “pathognomonic sign” of Scrub Typhus. Because other symptoms of scrub typhus (such as fever, headache, rash) are very non-specific, it is easy to be misdiagnosed. The formation of this scab is due to the fact that after being bitten by chiggers carrying rickettsiae, the pathogen multiplies in large numbers at the bite site, causing local blood vessel destruction and tissue ischemia and necrosis. In Taiwan, when unexplained fever and black scabs are seen, scrub typhus should be given priority. This clue requires doctors and patients to be vigilant together and proactively provide travel history in order to make an early diagnosis.
Three treasures: infection, Sweet’s syndrome and blood cancer; a nightmare for people with low immunity when rash is the tip of the iceberg of systemic infection
For patients who are undergoing chemotherapy or have hematological cancer diseases, their immune systems are in an extremely vulnerable state. In this case of “febrile neutropenia”, any new red nodule or patch on the skin may be an extremely dangerous sign.
In the hematology and oncology ward, when doctors face this kind of rash, a joke often pops up in their minds – they must identify the “three treasures”. The clinical manifestations of these three possibilities are very similar, but the meanings behind them are very different:
• Disseminated fungal infection: This is the most dangerous and can be quickly fatal. Fungi such as Candida, Aspergillus, and Mucor may spread throughout the body through the blood, invade blood vessels, and cause skin tissue necrosis.
• Sweet’s syndrome: This is a benign “neutrophilic skin disease” that is often related to cancer itself or drugs. Although it is not fatal, its appearance can easily be confused with infection.
• Leukemia cutis: refers to the metastasis and infiltration of blood cancer cells into the skin.
The appearance of all three rashes may be red, infiltrated nodules, which are almost indistinguishable to the naked eye. Ultimately, urgent “skin biopsies” for pathological testing are often required to obtain a correct diagnosis. For people with low immunity, the skin is an important window for monitoring serious systemic infections, and any small changes must not be taken lightly.
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