Browse categories and answer follow-up questions to refine your symptom profile.
History
Presenting rash overview
Rash timeline and context
Time of onset
Progression pattern
Initial site then spread pattern
Intermittent or persistent pattern
OPQRST
Onset
Sudden onset
Gradual onset
Provocation/Palliation
Triggered by new medication exposure
Triggered by infection exposure
Triggered by food exposure
Triggered by insect bite exposure
Improved with antihistamine
Improved with cool compress
Quality
Pruritic
Painful
Burning
Non pruritic
Region/Radiation
Localized
Generalized
Palms and soles involvement
Perioral involvement
Genital involvement
Flexural predominance
Extensor predominance
Severity
Sleep disruption
Functional limitation
Timing
Worse at night
Worse after heat
Worse after bathing
Associated symptoms
Fever pattern
Upper respiratory symptoms
Sore throat
Cough
Conjunctivitis
Oral lesions
Vomiting
Diarrhea
Abdominal pain
Arthralgia
Limp
Headache
Neck pain
Dyspnea
Wheeze
Exposures and triggers
New medication within 1 to 8 weeks
Recent antibiotic exposure
Recent vaccination exposure
New foods
New soaps
New detergents
New topical products
Hot tub exposure
Outdoor exposure
Tick exposure
Scabies contact exposure
Infectious contacts
Household sick contacts
Daycare exposure
School outbreak exposure
Known varicella exposure
Known measles exposure
Prior episodes and baseline
Prior similar rash
Atopic history baseline
Baseline skin disease
Impact and safety
Oral intake change
Urine output change
Itch driven excoriation
Sleep disruption
Alarm Features
Immediate escalation triggers
High risk physiology
Toxic appearance
Altered mental status
Respiratory distress
Shock features
Persistent tachycardia out of proportion to fever
High risk rash patterns
Non blanching petechiae or purpura
Rapidly progressive purpura
Bullae with skin pain
Skin sloughing
Necrosis
Crepitus
High risk mucosal involvement
Oral mucosal erosions
Eye pain
Conjunctival injection with photophobia
Dysuria with genital erosions
High risk systemic features
Neck stiffness
Severe headache
Persistent vomiting
New seizure
New focal neurologic deficit
Anaphylaxis features
Hypotension
Bronchospasm
Stridor
Angioedema
Kawasaki disease and MIS-C features
Fever at least 5 days
Conjunctival injection
Strawberry tongue
Cracked lips
Extremity swelling
Cervical lymphadenopathy
Severe abdominal pain
Chest pain
Syncope
Neonate and immunocompromised risk
Age under 28 days with fever
Immunosuppression with fever
Vesicles in neonate
Medications
Current and recent exposures
Medication history relevant to rash
New prescription medications
Recent antibiotics
Antiepileptics
NSAIDs
Acetaminophen
OTC cold remedies
Topical exposures
Topical antibiotics
Topical steroids
New emollients
New sunscreens
Allergy and intolerance history
Prior drug rash
Prior anaphylaxis
Food allergy history
High risk medication patterns
Stevens Johnson syndrome risk medications
Serum sickness like reaction risk medications
Diet
Intake and allergen exposure
Recent intake patterns
Reduced intake
Normal intake
Poor fluid intake
New foods exposure
First time exposure food
Restaurant exposure
Hidden allergen exposure risk
Hydration indicators
Dry mucous membranes
Decreased urine output
Poor tears
Review of Systems
System based symptoms
General and infectious
Fever
Chills
Fatigue
Weight loss
ENT and eyes
Sore throat
Rhinorrhea
Conjunctivitis
Eye pain
Photophobia
Respiratory
Cough
Dyspnea
Wheeze
GI
Vomiting
Diarrhea
Abdominal pain
GU
Dysuria
Genital pain
MSK
Arthralgia
Joint swelling
Limp
Neuro
Headache
Neck pain
Confusion
Seizure
Skin specific
Pruritus
Pain
Blistering
Facial swelling
Collateral History and Family History
Family and collateral context
Collateral source and reliability
Parent or guardian historian
Caregiver historian
Teen self historian
Family history relevant to rash
Atopy
Asthma
Eczema
Psoriasis (L40.9)
Household context
Sick contacts at home
Infestation risk
Bedbugs exposure risk
Supervision and access
Ability to monitor at home
Ability to return for reassessment
Risk Factors
Host and exposure risks
Host risk
Age under 3 months
Immunocompromised state
Asplenia
Chronic skin disease
Exposure risk
Daycare exposure
Travel exposure
Tick exposure
Animal exposure
Medication risk
Recent high risk medications
Polypharmacy exposure
Vaccination status risk
Incomplete measles vaccination
Incomplete varicella vaccination
Differential Diagnosis
Life threatening
Life threatening causes
Meningococcemia (A39.0)
Non blanching petechiae or purpura
Fever with toxicity
Rapid progression over hours
Sepsis with purpura fulminans (D65)
Shock features
Widespread purpura with necrosis
Stevens Johnson syndrome and toxic epidermal necrolysis (L51.1)
Skin pain out of proportion
Mucosal erosions
New medication exposure within weeks
Anaphylaxis (T78.2)
Urticaria with respiratory symptoms
Hypotension
Angioedema
Necrotizing soft tissue infection (M72.6)
Rapidly progressive erythema
Severe pain
Crepitus
Kawasaki disease shock syndrome (M30.3)
Fever
Hypotension
Mucocutaneous changes
MIS-C
Fever
GI pain
Hypotension
Elevated inflammatory markers pattern
Common
Common causes
Viral exanthem
Recent URI symptoms
Well appearing
Urticaria (L50.9)
Migratory wheals
Pruritus
Individual lesions under 24 hours
Atopic dermatitis (L20.9)
Chronic relapsing itch
Flexural distribution
Contact dermatitis (L23.9)
Pattern matching exposure
Sharp demarcation
Impetigo (L01.00)
Honey crusted lesions
Localized
Hand foot and mouth disease
Oral ulcers
Palms and soles lesions
Scabies (B86)
Night itch
Household itch
Burrows in web spaces
Scarlet fever (A38.9)
Sore throat
Sandpaper rash
Strawberry tongue
Less common
Less common and zebras
Henoch Schonlein purpura IgA vasculitis (D69.0)
Palpable purpura on legs
Abdominal pain
Arthralgia
Erythema multiforme (L51.9)
Target lesions
HSV trigger history
Varicella
Vesicles in different stages
Truncal predominance
Measles
Fever
Cough
Coryza
Conjunctivitis
Rocky Mountain spotted fever
Fever with headache
Tick exposure
Palms and soles involvement
Drug reaction with eosinophilia and systemic symptoms
Facial edema
Fever
Lymphadenopathy
Organ involvement pattern
Staphylococcal scalded skin syndrome (L00)
Tender erythema
Periorificial crusting
Desquamation
Past Medical History
Relevant prior conditions
Chronic conditions and context
Atopic dermatitis
Asthma (J45.909)
Immunodeficiency
Sickle cell disease (D57.1)
Prior severe reactions
Prior anaphylaxis
Prior drug rash
Prior SJS or TEN
Recent infections
Recent streptococcal infection
Recent varicella
Recent healthcare exposures
Recent hospitalization
Recent surgery
Baseline function
Baseline oral intake
Baseline activity level
Physical Exam
General and vitals
General assessment
Toxic appearance
Comfort level
Hydration status
Vitals interpretation
Fever pattern
Tachycardia
Hypotension
Hypoxia
Skin and mucosa
Rash characterization
Morphology
Maculopapular
Urticarial
Vesicular
Pustular
Petechial
Purpuric
Bullous
Targetoid
Distribution
Trunk
Face
Extremities
Palms
Soles
Flexural surfaces
Extensor surfaces
Blanching
Blanching
Non blanching
Tenderness
Painful
Non painful
Skin barrier
Excoriations
Crusting
Weeping
Desquamation
Secondary infection signs
Warmth
Purulence
Mucosal exam
Oral ulcers
Lip cracking
Strawberry tongue
Genital lesions
Eye exam
Conjunctival injection
Discharge pattern
Periorbital edema
Nikolsky related findings
Epidermal sloughing with shear
Skin pain out of proportion
Systems relevant to rash etiologies
ENT and lymph nodes
Cervical lymphadenopathy
Pharyngeal erythema
Tonsillar exudate
Cardiopulmonary
Work of breathing
Wheeze
Perfusion
Capillary refill
Abdomen
Tenderness
Hepatosplenomegaly
MSK and joints
Joint swelling
Range of motion limitation
Limp
Neuro
Mental status
Neck stiffness
Focal deficits
Lab Studies
Core labs by scenario
Inflammatory and hematologic evaluation
CBC with differential
Leukocytosis pattern
Neutropenia pattern
Thrombocytopenia pattern
Eosinophilia pattern
CRP
Elevated supports inflammatory syndrome
Normal does not exclude early serious infection
ESR
Elevated supports vasculitis
Slower response than CRP
Infection and sepsis evaluation
Blood culture
Prior antibiotics reduce yield
Draw before antibiotics when feasible
Lactate
Elevated supports hypoperfusion
Normal does not exclude sepsis
End organ evaluation
CMP
Transaminases elevation
Creatinine baseline
Electrolytes for dehydration
Coagulation studies
PT
INR
aPTT
Kawasaki disease and MIS-C supportive labs
BNP or NT-proBNP
Elevated supports myocardial involvement
Interpret with age norms
Troponin
Elevated supports myocarditis
Serial trend when suspected
Ferritin
Elevated supports hyperinflammation
Not specific
D-dimer
Elevated supports MIS-C pattern
Not specific
Urinalysis
Sterile pyuria supports Kawasaki pattern
Hematuria suggests vasculitis
Targeted microbiology
Rapid strep test
Supports scarlet fever when positive
Negative may need culture local protocol dependent
Throat culture
Backup when rapid strep negative local protocol dependent
Delayed results
Viral PCR panel
Supports viral exanthem
Does not exclude bacterial coinfection
Varicella or HSV PCR from lesion
Higher yield from fresh vesicle
Lower yield after crusting
Imaging
Scoring Systems
Clinical decision aids and structured criteria
Kawasaki disease classic criteria
Fever at least 5 days
Conjunctival injection
Oral mucosal changes
Peripheral extremity changes
Polymorphous rash
Cervical lymphadenopathy
Incomplete Kawasaki disease pathway
Fever at least 5 days with fewer than 4 features
CRP and ESR supportive
Echocardiography threshold local protocol dependent
MRI
MRI indications in rash presentations
Suspected osteomyelitis with overlying cellulitis
Deep space infection when ultrasound nondiagnostic
MRI limitations
Need for sedation in young children
Access and timing limitations
CT
CT indications in rash presentations
Suspected deep neck infection with rash and toxic appearance
Suspected necrotizing soft tissue infection with severe pain
CT cautions
Ionizing radiation risk
Contrast allergy risk
Contrast nephrotoxicity risk
Ultrasound
Ultrasound uses
Abscess evaluation in cellulitis
Soft tissue gas evaluation adjunct for necrotizing infection
Ultrasound limitations
Limited sensitivity for early necrotizing infection
Operator dependent findings
Special Tests
Bedside maneuvers and focused tests
Blanching and petechiae assessment
Glass test for non blanching lesions
Distribution mapping over time
Dermatologic bedside signs
Dermatographism
Nikolsky sign support for SJS and TEN
Infection focused bedside tests
Point of care glucose in toxic child
Rapid antigen testing local protocol dependent
Ophthalmic screening when mucosal involvement
Visual acuity screen if cooperative
Urgent ophthalmology trigger with eye pain
ECG
When ECG is relevant in rash presentations
Cardiac involvement triggers
Suspected MIS-C with tachycardia
Suspected myocarditis with chest pain
Kawasaki disease with shock features
ECG patterns and actions
Conduction abnormalities
ST and T wave changes suggesting myocarditis
If unstable rhythm then resuscitation pathway activation
Assessment
Problem representation and risk stratification
Working diagnosis categories
Benign self limited viral exanthem
Allergic urticaria
Bacterial skin infection
Systemic inflammatory syndrome
Severity stratification
Well appearing with stable vitals
Moderate illness with dehydration
Toxic appearance or shock
Cannot miss complications
Meningococcemia
SJS and TEN
Anaphylaxis
Kawasaki disease coronary involvement
MIS-C myocardial involvement
Diagnostic uncertainty management
Reassessment after antipyretic and fluids when indicated
Serial rash photos for evolution tracking
Lower threshold for observation in infants
Plan
First 5 minutes and stabilization
Critical rash workflow
Continuous monitoring for toxic appearance
IV or IO access if shock features
Oxygen if hypoxia or distress
Isotonic fluid bolus if shock local protocol dependent
Epinephrine IM immediately if anaphylaxis
Empiric antibiotics within 60 minutes if sepsis suspected local protocol dependent
Targeted management by likely etiology
Urticaria without anaphylaxis
Non sedating antihistamine dosing by weight local protocol dependent
Trigger avoidance when identified
Short course steroid only for severe refractory symptoms local protocol dependent
Atopic dermatitis flare
Emollient barrier therapy
Topical steroid potency by site local protocol dependent
Treat secondary infection when present
Cellulitis and impetigo
Antibiotic choice based on local resistance patterns
MRSA risk assessment
Abscess drainage pathway if fluctuance present
Suspected meningococcemia or sepsis
Ceftriaxone IV or IM local protocol dependent
Blood culture before antibiotics when feasible
Droplet precautions for suspected meningococcal disease
Suspected SJS and TEN
Immediate stop suspected trigger medications
Burn center or ICU consultation early
Ophthalmology consultation early
Avoid empiric steroids unless specialist guided local protocol dependent
Kawasaki disease
IVIG 2 g per kg single infusion local protocol dependent
Aspirin regimen local protocol dependent
Echocardiography and cardiology involvement
MIS-C
Early pediatric critical care consultation
Broad lab panel for inflammation and cardiac injury
Immunomodulation local protocol dependent
Reassessment loop
Time based reassessment
Repeat vitals every 30 to 60 minutes if moderate illness
Repeat perfusion exam after fluids
Repeat rash distribution check for progression
Repeat airway assessment if urticaria evolving
Disposition
Level of care criteria
ICU
Shock requiring vasoactive support
Respiratory failure
Suspected SJS and TEN with significant skin involvement
MIS-C with cardiac dysfunction
Inpatient admission
Non blanching rash with fever pending evaluation
Kawasaki disease suspected
Dehydration requiring IV fluids
Cellulitis requiring IV antibiotics
Immunocompromised with fever and rash
Observation pathway
Diagnostic uncertainty with stable vitals
Moderate symptoms needing serial exams
Discharge criteria
Well appearing
Stable vitals
No alarm rash pattern
Oral intake adequate
Reliable follow up and return ability
Follow up timing
Primary care within 24 to 72 hours when uncertain diagnosis
Dermatology referral if persistent rash over 1 to 2 weeks
Discharge Instructions
Copy discharge instructions
Rash summary
Today you were seen for a rash
The exam did not show signs of a dangerous rash at this time
Home care
Keep skin cool
Avoid new soaps and scented products until resolved
Use fragrance free moisturizer
Medications
Use antihistamine as directed if itchy
Use prescribed topical medication only on the areas instructed
Hydration
Encourage fluids
Watch urine output
Follow up
See your primary care clinician within the recommended timeframe
Return sooner if you cannot get follow up
Return to ED now for
Trouble breathing
Swelling of lips or tongue
Fainting
New vomiting that will not stop
New severe headache
Neck stiffness
Confusion
Purple or non blanching spots
Rash rapidly spreading over hours
Skin pain
Blistering
Mouth sores
Eye pain
References
Guidelines and high quality sources
Pediatric rash evaluation references
American Heart Association Kawasaki Disease scientific statement 2017
CDC measles clinical guidance updated regularly
CDC varicella clinical guidance updated regularly
IDSA practice guidelines for skin and soft tissue infections 2014
NICE fever in under 5s assessment and initial management updated regularly
British Association of Dermatologists SJS and TEN guidance local protocol dependent
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.