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E

Ecthyma

Etiology: deep erosion of impetigo into the dermis via S. aureus + S. pyogenes

Appearance: begins as a vesicle or pustule on inflamed skin, then develops a hard crust covering the blister; if crust is removed, lesion will reveal an ulcer that is erythematous, edematous, and oozing pus

Location: buttocks, thighs, legs, ankle, feet

At risk: immunocompromised, warmer climates

Tx: oral abx

Ecthyma Gangrenosum

Etiology: P. aeruginosa

Appearance:

  1. painless, annular, erythematous patches that rapidly become pustular

  2. hemorrhagic focus appears in the center + forms a blister that spreads peripherally

  3. gangrenous ulceration develops with a black/gray scab surrounded by a red halo

At risk: immunocompromised, critically ill​

Tx: piperacillin, FQ, aminoglycosides 

Eczema Herpeticum

Etiology: HSV 1 or 2 infection
Appearance: clusters of erythematous based vesicles that spread over 7–10 days + may rarely be widely disseminate
At risk: infants + children with atopic dermatitis
Location: face + neck
Tx: oral acyclovir

Enteric fever / Typhoid fever

Etiology: Salmonella typhi
Appearance: "rose spots" - grouped 5-15 pink blanching papules
Location: anterior trunk
Tx: abx
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Epidermoid Inclusion Cyst (EIC)

Etiology: occluded pilosebaceous unit
Appearance: mobile dermal nodule with overlying punctum
At risk: adults, men, acromegaly
Location: central trunk and face
Tx: excision with an intact capsule
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Epidermal Nevus Syndrome

Etiology: 

Types:

  • ILVEN

    • Location: legs​

    • Appearance: long linear, verrucous plaques

  • Ichthyosis Hysterix

    • Location: trunk​

    • Appearance: whorl-like verrucous plaques

Inheritance: sporadic

Systemic Sx = "Syndrome"

Ass. Sx:

  • CNS: developmental delay, seizure, deafness

  • skeletal: foot abnormalities, hemihypertrophy

  • eyes: coloboma, nystagmus
     

Epidermolysis Bullosa

Etiology: gene mutation (KRT5, KRT14, LAMA3, LAMB3, COL7A1) that makes the skin more fragile - AD or AR (multiple subtypes)

Appearance: blisters which burst easily and leave slow-healing wounds

Tx: gene therapy + cell based therapy

Erysipelas

Etiology: S. pyogenes
Location: lower extremities > face
Sx: systemic symptoms before onset of well demarcated erythematous plaque with burning, tenderness, and itching
At risk: immunocompromised, DM, very young + very old
Tx: oral penicillin

Erythema Induratum of Bazin

Etiology: M. tuberculosis-complex

Appearance: tender, erythematous to violaceous nodules

Location: posterior lower leg

Erythema Infectiosum / Fifth Disease / Slapped Cheek Rash

Etiology: Parvovirus B19

Appearance: classic malar rash beginning 2-5 days after onset of other sx; few days later a lacy race appears on trunk + extremities

Transmission: respiratory secretions

At risk: children + daycare workers 

Tx: self limited

Erythema Marginatum

Etiology: S. pyogenes (acute rheumatic fever)

Appearance: evanescent pink well demarcated, serpiginous macules that clear centrally

Erythema Multiforme

Etiology: HSV, TB, mycoplasma pneumonia, other chemicals or medications

Appearance: targetoid lesion - central dusky purpura with an elevated edematous pale ring; typically occurring 1-2 weeks after infection

Location: extremities and spreads centripetally

Sx: painful

Tx: self limited; topical CS can relieve symptoms

Erythema Nodosum

Etiology: delayed type HS reaction that can be triggered by infection, drugs, inflammatory disease, Hodgkin lymphoma, sarcoidosis, pregnancy

Appearance: erythematous, tender, immobile nodules 

Location: anterior lower legs

Tx: self limited, bedrest, leg elevation, compression stockings

Prog: resolve within a month

Erythema Toxicum Neonatorum (ETN)

Etiology: 
Description: erythematous macules, papules, and pustules that can erupt over several days and it is unusual for an individual lesion to persist for more than a day; appears in the first 4 days of life 
Location: spares palms + soles

Erythrasma

Etiology: Corynebacterium minutissimum

Appearance: well defined pink to brown patches with fine scale and superficial fissures

Location: folds under arms, groin (males), between toes (females)

At risk: humid environment, sweating, obesity, poor hygiene 

Erythroderma

Appearance: generalized erythema with scales covering >80% of BSA

Sx: fevers, chills, pruritus, peripheral edema

Exanthematous Drug Eruption

Appearance: erythematous macules and papules

Location: first appear on trunk and spread centrifugally to extremities in symmetric fashion

Timing: 7-10 days after drug initiation or 24-48 hours after repeat drug initiation

Sx: fever, pruritus

Tx: topical steroids, oral antihistamines

Prog: resolves in a few days to a week after med stopped

Extramammary Paget Disease

Etiology: intraepithelial adenocarcinoma
Appearance: erythematous plaque with ulcer and overlying crust
Sx: pruritus
Location: anogenital or axillary

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