Viral exanthems: An update on laboratory testing of the adult patient

J Am Acad Dermatol. 2017 Mar;76(3):538-550. doi: 10.1016/j.jaad.2016.08.034. Epub 2016 Oct 26.

Abstract

Although classic viral exanthems of childhood are well described, they are rarely differentiated in adults. Laboratory techniques for viral identification have advanced without substantial literature to suggest how a dermatologist ought to conduct a cost-effective and diagnostic viral panel. Certain clinical features such as petechiae, vesicles, and dusky macular or morbilliform exanthems point strongly toward a viral exanthem. Differentiation of drug and viral causes of morbilliform eruptions has proven difficult. It is possible that with further diagnostic refinement that unnecessary and fruitless workups of an exanthem and unneeded discontinuation of drugs can be avoided. We review viral exanthems based on clinical features and discuss the available and optimal laboratory techniques to assist the dermatologist in a targeted workup.

Keywords: Cost-effectiveness; laboratory tests; morbilliform eruption; polymerase chain reaction; serology; viral antigen tests; viruses.

Publication types

  • Review

MeSH terms

  • Adult
  • Chikungunya Fever / complications
  • Chikungunya Fever / diagnosis
  • Clinical Laboratory Techniques*
  • Coxsackievirus Infections / complications
  • Coxsackievirus Infections / diagnosis
  • Cytomegalovirus Infections / complications
  • Cytomegalovirus Infections / diagnosis
  • Dengue / complications
  • Dengue / diagnosis
  • Echovirus Infections / complications
  • Echovirus Infections / diagnosis
  • Exanthema / virology*
  • Exanthema Subitum / diagnosis
  • HIV Infections / complications
  • HIV Infections / diagnosis
  • Humans
  • Infectious Mononucleosis / complications
  • Infectious Mononucleosis / diagnosis
  • Measles / complications
  • Measles / diagnosis
  • Parvoviridae Infections / complications
  • Parvoviridae Infections / diagnosis
  • Respiratory Tract Infections / complications
  • Respiratory Tract Infections / diagnosis
  • Roseolovirus Infections / complications
  • Roseolovirus Infections / diagnosis
  • Rubella / complications
  • Rubella / diagnosis
  • Virus Diseases / complications*
  • Virus Diseases / diagnosis*
  • Zika Virus Infection / complications
  • Zika Virus Infection / diagnosis