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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Purpura is a condition of red or purple discolored spots on the skin that do not blanch on applying pressure. The spots are caused by bleeding underneath the skin usually secondary to vasculitis or dietary deficiency of vitamin C (scurvy). They measure 0.3–1 cm (3–10 mm), whereas petechiae measure less than 3 mm, and ecchymoses greater than 1 cm.
Purpura is common with typhus and can be present with meningitis caused by meningococci or septicaemia. In particular, meningococcus ("Neisseria meningitidis"), a Gram-negative diplococcus organism, releases endotoxin when it lyses. Endotoxin activates the Hageman factor (clotting factor XII), which causes disseminated intravascular coagulation (DIC). The DIC is what appears as a rash on the affected individual.
Purpura are a common and nonspecific medical sign; however, the underlying mechanism commonly involves one of:
- Platelet disorders (thrombocytopenic purpura)
- Primary thrombocytopenic purpura
- Secondary thrombocytopenic purpura
- Post-transfusion purpura
- Vascular disorders (nonthrombocytopenic purpura)
- Microvascular injury, as seen in senile (old age) purpura, when blood vessels are more easily damaged
- Hypertensive states
- Deficient vascular support
- Vasculitis, as in the case of Henoch–Schönlein purpura
- Coagulation disorders
- Disseminated intravascular coagulation (DIC)
- Scurvy (vitamin C deficiency) - defect in collagen synthesis due to lack of hydroxylation of procollagen results in weakened capillary walls and cells
- Meningococcemia
- Cocaine use with concomitant use of the one-time chemotherapy drug and now veterinary deworming agent levamisole can cause purpura of the ears, face, trunk, or extremities, sometimes needing reconstructive surgery. Levamisole is purportedly a common cutting agent.
- Decomposition of blood vessels including purpura is a symptom of acute radiation poisoning in excess of 2 Grays of radiation exposure. This is an uncommon cause in general, but is commonly seen in victims of nuclear disaster.
Cases of psychogenic purpura are also described in the medical literature, some claimed to be due to "autoerythrocyte sensitization". Other studies suggest the local (cutaneous) activity of tissue plasminogen activator can be increased in psychogenic purpura, leading to substantial amounts of localized plasmin activity, rapid degradation of fibrin clots, and resultant bleeding. Petechial rash is also characteristic of a rickettsial infection.
Warfarin-induced skin necrosis (or, more generally, Anticoagulant-induced skin necrosis) is a condition in which skin and subcutaneous tissue necrosis (tissue death) occurs due to acquired protein C deficiency following treatment with anti-vitamin K anticoagulants (4-hydroxycoumarins, such as warfarin).
Warfarin necrosis is a rare but severe complication of treatment with warfarin or related anticoagulants. The typical patient appears to be an obese, middle aged woman (median age 54 years, male to female ratio 1:3). This drug eruption usually occurs between the third and tenth days of therapy with warfarin derivatives. The first symptoms are pain and redness in the affected area. As they progress, lesions develop a sharp border and become petechial, then hard and purpuric. They may then resolve or progress to form large, irregular, bloody bullae with eventual necrosis and slow-healing eschar formation. Favored sites are breasts, thighs, buttocks and penis, all areas with subcutaneous fat. In rare cases, the fascia and muscle are involved.
Development of the syndrome is associated with the use of large loading doses at the start of treatment.
The rash is composed of small papular lesions, each on a separate reddened base.
Erythema toxicum neonatorum (also known as erythema toxicum, urticaria neonatorum and toxic erythema of the newborn) is a common rash in neonates. It appears in up to half of newborns carried to term, usually between day 2–5 after birth; it does not occur outside the neonatal period.
Erythema toxicum is characterized by blotchy red spots on the skin with overlying white or yellow papules or pustules. These lesions may be few or numerous. The eruption typically resolves within first two weeks of life, and frequently individual lesions will appear and disappear within minutes or hours. It is a benign condition thought to cause no discomfort to the baby.
Non-blanching rash (NBR) is a medical term used to describe a skin rash that does not fade when pressed with, and viewed through, a glass.
It is a characteristic of both purpuric and petechial rashes. Individual purpura measure 3–10 mm (0.3–1 cm, - in), whereas petechiae measure less than 3 mm.
A non-blanching rash can be a symptom of bacterial meningitis, but this is not the exclusive cause.
Many conditions mimic or may be mistaken for warfarin necrosis, including pyoderma gangrenosum or necrotizing fasciitis. Warfarin necrosis is also different from another drug eruption associated with warfarin, purple toe syndrome, which usually occurs three to eight weeks after the start of anticoagulation therapy. No report has described this disorder in the immediate postpartum period in patients with protein S deficiency.
The typical rash commonly appears on buttocks. This then resembles the colour of a baboon’s buttocks. Other areas like upper inner thigh and armpits, may be affected by the rash. The rashes are red and well-defined. The presentation is typically symmetrical and not associated with systemic symptoms.
A maculopapular rash is a type of rash characterized by a flat, red area on the skin that is covered with small confluent bumps. It may only appear red in lighter-skinned people. The term "maculopapular" is a compound: "macules" are small, flat discolored spots on the surface of the skin; and "papules" are small, raised bumps. It is also described as erythematous, or red.
This type of rash is common in several diseases and medical conditions, including scarlet fever, measles, Ebola virus disease, rubella, secondary syphilis (Congenital syphilis, which is asymptomatic, the newborn may present this type of rash), erythrovirus (parvovirus B19), chikungunya (alphavirus), zika, and heat rash. It is also a common manifestation of a skin reaction to the antibiotic amoxicillin or chemotherapy drugs. Cutaneous infiltration of leukemic cells may also have this appearance. Maculopapular rash is seen in graft-versus-host disease (GVHD) developed after a hematopoietic stem cell transplant (bone marrow transplant), which can be seen within one week or several weeks after the transplant. In the case of GVHD, the maculopapular rash may progress to a condition similar to toxic epidermal necrolysis. In addition, this is the type of rash that some patients presenting with Ebola virus hemorrhagic (EBO-Z) fever will reveal but can be hard to see on dark skin people. It is also seen in patients with Marburg hemorrhagic fever, a filovirus not unlike Ebola.
This type of rash can be as a result of large doses of niacin or no-flush niacin (2000 – 2500 mg), used for the management of low HDL cholesterol.
This type of rash can also be a symptom of Sea bather's eruption. This stinging, pruritic, maculopapular rash affects swimmers in some Atlantic locales (e.g., Florida, Caribbean, Long Island). It is caused by hypersensitivity to stings from the larvae of the sea anemone (e.g., "Edwardsiella lineate") or the thimble jellyfish ("Linuche unguiculata"). The rash appears where the bathing suit contacts the skin.
This type of rash can also be a symptom of acute arsenic intoxication, appearing 2 weeks later.
Gianotti–Crosti syndrome mainly affects infants and young children. Children as young as 1.5 months and up to 12 years of age are reported to be affected. It is generally recognized as a papular or papulovesicular skin rash occurring mainly on the face and distal aspects of the four limbs. Purpura is generally not seen but may develop upon tourniquet test. However, extensive purpura without any hemorrhagic disorder has been reported. The presence of less lesions on the trunk does not exclude the diagnosis. Lymphadenopathy and hepatomegaly are sometimes noted. Raised AST and ALT levels with no rise in conjugated and unconjugated bilirubin levels are sometimes detectable, although the absence of such does not exclude the diagnosis. Spontaneous disappearance of the rash usually occurs after 15 to 60 days.
"Rickettsia aeschlimannii" infection is a condition characterized by a rash of maculopapules.
Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), more popularly known as Baboon syndrome because of its resemblance to the distinctive red buttocks displayed by female baboons, is a systemic contact dermatitis characterized by well-demarcated patches of erythema distributed symmetrically on the buttocks.
The cause of the syndrome may be drug-related, i.e. induced by systemic administration of hydroxyzine penicillin, iodinated radio contrast media and others.
Erythema (redness) multiforme (EM) is usually a reaction of the skin and mucous membranes that occurs suddenly. It appears as a symmetrical rash and may include the mucous membrane lesions. This means that the body is sensitive to something that causes the skin and mucous membranes to react. The more common mild form is refer to as EM minor. It consists of a skin rash that involve no more than one mucosal surface. The sudden onset will progress rapidly as symmetrical lesions with circular color changes in some or all of the lesions. Rash will spread towards center or trunk of the body. Evenly distributed bumps on the skin become classic iris or target lesions. They have bright red borders and small white bumps in the center.
The cause of EM appears to be a highly sensitive reaction that can be triggered by a variety of causes. The causes can include bacterial, viral or chemical products, such as antibiotics – specifically penicillins or cephalosporins. This reaction is an allergic reaction and is in no way contagious.
Erythema multiforme minus is sometimes divided into papular and vesiulobullous forms.
The term morbilliform refers to a rash that looks like measles. The rash consists of macular lesions that are red and usually 2–10 mm in diameter but may be confluent in places.
Patients with measles will have the rash but there are other syndromes and infections that will display the same symptom such as patients with Kawasaki disease, meningococcal petechiae or Waterhouse-Friderichsen syndrome, Dengue, congenital syphilis, rubella, Echovirus 9, drug hypersensitivity reactions (in particular with certain classes of antiretroviral drugs, such as abacavir and nevirapine, and also the antiepileptic drug phenytoin), or other conditions may also have a morbilliform rash.
One cause of morbilliform rash is an allergic reaction to transfused blood/blood components. In such a case, the skin lesions would develop within a few hours (Approx. 4hours) of transfusion along with pruritus. The condition may even present with other symptoms, such as conjunctival oedema, oedema in the lips and tongue, and even localised angioedema. On rare occasions, the condition may even escalate to anaphylactic shock where pulmonary restrictions are seen. The associated cause for this is a reaction against an allergen that is seldom identified during testing. Transfusing products with anti-IgA antibodies to IgA-deficient patients has also been a suspected cause for such reactions. Management usually relates to the stoppage of transfusion for around 30minutes, until given antihistamines take effect. Transfusion may even be continued after, if no further progression is seen.
A rash is a change of the human skin which affects its color, appearance, or .
A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell, and may be painful.
The causes, and therefore treatments for rashes, vary widely. Diagnosis must take into account such things as the appearance of the rash, other symptoms, what the patient may have been exposed to, occupation, and occurrence in family members. Rash can last 5 to 20 days, the diagnosis may confirm any number of conditions.
The presence of a rash may aid diagnosis; associated signs and symptoms are diagnostic of certain diseases. For example, the rash in measles is an erythematous, morbilliform, maculopapular rash that begins a few days after the fever starts. It classically starts at the head, and spreads downwards.
Acute cutaneous lupus erythematosus is a cutaneous condition characterized by a bilateral malar rash (also known as a "butterfly rash") and lesions that tend to be transient, and that follow sun exposure.
The symptoms of this condition include:
- An upper respiratory tract infection may precede all other symptoms in as many as 69% of patients.
- A single, 2- to (rarely) 10-cm oval red "herald" patch appears, classically on the abdomen. Occasionally, the "herald" patch may occur in a 'hidden' position (in the armpit, for example) and not be noticed immediately. The "herald" patch may also appear as a cluster of smaller oval spots, and be mistaken for acne. Rarely, it does not become present at all.
- 7–14 days after the herald patch, many small (5–10 mm) patches of pink or red, flaky, oval-shaped rash appear on the torso. The more numerous oval patches generally spread widely across the chest first, following the rib-line in a characteristic "christmas-tree" distribution. Small, circular patches may appear on the back and neck several days later.
- In 6% of cases an "inverse" distribution may occur, with rash mostly on the extremities. In children, presentation can be atypical or inverse, and the course is typically milder.
- About one in four people with PR have mild to severe symptomatic itching. (Moderate itching due to skin over-dryness is much more common, especially if soap is used to cleanse the affected areas.) The itching is often non-specific, and worsens if scratched. This tends to fade as the rash develops and does not usually last through the entire course of the disease.
- The rash may be accompanied by low-grade fever, headache, nausea and fatigue.
The differential diagnoses are: acrodermatitis enteropathica, erythema infectiosum, erythema multiforme, hand-foot-and-mouth disease, Henoch–Schönlein purpura, Kawasaki disease, lichen planus, papular urticaria, papular purpuric gloves and socks syndrome, and scabies.
The erythema migrans rash is classically 5 to 6.8 cm in diameter, appearing as an annular homogenous erythema (59%), central erythema (30%), central clearing (9%), or central purpura (2%). Because of the "bull's-eye" description to describe the Lyme disease rash, the condition commonly called ringworm is sometimes confused with Lyme disease. Uncommonly, EM may be less than 5 cm in diameter. Multiple painless EM rashes may occur, indicating disseminated infection.
The EM rash occurs in 80% to 90% of those infected with "Borrelia". A systematic review of the medical literature showed 80% of patients have an expanding EM rash, at the site of the tick bite, although some patients with EM do not recall a tick bite. In endemic areas of the United States, homogeneously red rashes are more frequent.
Advocates of a diagnosis called "chronic lyme disease" dispute the generally accepted incidence of the rash, claiming it occurs in less than 50% of infections.
Eosinophilic cellulitis, also known as Wells' syndrome, is a skin disease that presents with painful, red, raised, and warm patches of skin. The rash comes on suddenly, lasts for a few weeks, and often repeatedly comes back. Scar formation does not typically occur.
Eosinophilic cellulitis is of unknown cause. It is suspected to be an autoimmune disorder. It may be triggered by bites from insects such as spiders, fleas, or ticks, or from medications or surgery. Diagnosis is made after other potential cases are ruled out. Skin biopsy of the affected areas may show an increased number of eosinophils. Other conditions that may appear similar include cellulitis, contact dermatitis, and severe allergic reactions such as anaphylaxis.
Treatment is often with a corticosteroids. Steroids applied as a cream is generally recommended over the use of steroids by mouth. Antihistamines may be used to help with itchiness. Many times the condition goes away after a few weeks without treatment. The condition is uncommon with about 200 described cases. It affects both sexes with the same frequency. It was first described by George Crichton Wells in 1971.
"Erythema migrans is the only manifestation of Lyme disease in the United States that is sufficiently distinctive to allow clinical diagnosis in the absence of laboratory confirmation." It is a pathognomonic sign: a physician-identified rash warrants an instant diagnosis of Lyme disease and immediate treatment without further testing, even by the strict criteria of the Centers for Disease Control and Prevention. Such target lesions (bull's-eye rashes) are characteristic of "Borrelia" infections, and no other pathogens are known that cause this form of rash. It is also true, though, that the rash in Lyme disease may also be solid rather than bullseye-shaped, so self-diagnosis cannot rule out Lyme disease, and a doctor visit is advisable.
Pityriasis rosea is a type of skin rash. Classically, it begins with a single red and slightly scaly area known as a "herald patch". This is then followed, days to weeks later, by a pink whole body rash. It typically lasts less than three months and goes away without treatment. Sometime a fever may occur before the start of the rash or itchiness may be present, but often there are few other symptoms.
While the cause is not entirely clear, it is believed to be related to human herpesvirus 6 (HHV6) or human herpesvirus 7 (HHV7). It does not appear to be contagious. Certain medications may result in a similar rash. Diagnosis is based on the symptoms.
Evidence for specific treatment is limited. About 1.3% of people are affected at some point in time. It most often occurs in those between the ages of 10 and 35. The condition was described at least as early as 1798.
Tick-borne lymphadenopathy is a condition characterized by lymphadenopathy and a rash.
American tick bite fever (also known as ""Rickettsia parkeri" infection") is a condition that may be characterized by a rash of maculopapules.
The most common type of eruption is a morbilliform (resembling measles) or erythematous rash (approximately 90% of cases). Less commonly, the appearance may also be urticarial, papulosquamous, pustular, purpuric, bullous (with blisters) or lichenoid. Angioedema can also be drug-induced (most notably, by angiotensin converting enzyme inhibitors).