Let's start with a definition - what does "acral" actually mean?
I actually didn't learn this until #derm residency, which was shocking to me.
So let's start with one of the biggest mimickers of all....
🙏to this paper for the photo: scielo.br/scielo.php?scr…
The most important thing is that the RMSF rash comes late in the illness, so if you suspect it, don't wait/expect the rash. Just start the doxy!
Just to make it all jumble together, we are now seeing a lot more "atypical HFMS" which can have targetoid rash. Sorry....
My 1st ever #tweetorial was on SJS/TEN! Take a look!
- Acral means: hand, feet, ears, nose
- Copper pennies--> think secondary syphilis
- Petechiae--> RMSF (but just start the doxy!)
- Blisters in a kid --> HFMS
- Target-ish lesions: EM or SJS/TEN!
- History helps to differentiate too!
In darker skin types, it might cause hyperpigmentation.
Here's my scabies #tweetorial:
- Onc patients can get HFS from cytotoxic chemo, HFSR from targeted therapies
- BMT patients who get GVHD have a predilection on acral surfaces first. It's also more follicular
- If the pt is itchy, think scabes!
We didn't discuss PPKs/keratodermas since they're so rare. Next time!
Feel free to add more if you have 'em! 🙏for joining!