Cutaneous Manifestations of Dengue Fever: An Overview

Introduction:

A flu-like illness, dengue fever can affect individuals of all age groups, including adults, children, and infants, with an incubation period varying from three to eight days. The diverse symptoms associated with dengue viral infection, such as headaches, fever, abdominal pain, and muscle pain, underscore the crucial role of the skin in exhibiting various dermatological signs essential for diagnosing and managing dengue fever. The spectrum of dengue symptoms spans from mild to severe, with the potential to escalate into a life-threatening condition referred to as severe dengue or dengue hemorrhagic fever. These skin indicators serve as key elements assisting healthcare professionals in precisely diagnosing and promptly intervening in the disease.

What Are the Cutaneous Manifestations of Dengue Fever?

The presentation of dengue fever varies significantly from person to person, rendering its clinical manifestations a unique experience for each individual. In the case of infants or young children, fever may manifest without specific indications, accompanied by the development of rashes. However, severe cases in this age group may involve prolonged high temperatures persisting for up to a week. Conversely, adults grappling with dengue fever may grapple with a spectrum of symptoms. These can include fever, abdominal pain, headache, pain behind the eyes, muscle pain, nausea, vomiting, and joint pain. Moreover, adults may exhibit diverse types of rashes, ranging from macular (flat lesions) to maculopapular (flat and small raised bumps). In certain instances, more severe hemorrhagic manifestations may emerge, featuring symptoms like fever, petechiae, gingival bleeding, or epistaxis.

It is noteworthy that cutaneous manifestations are prevalent in a substantial percentage of dengue patients, occurring in 50 to 82 percent of cases. There exist two primary phases in the manifestation of the rash:

1. Initial Rash: This is a transient skin condition causing facial redness known as transient erythema. It typically emerges shortly within one or two days of the onset of symptoms, primarily due to the widening of small blood vessels, a phenomenon referred to as capillary dilatation.

2. Subsequent Rash: Emerging between three to six days after the onset, this painless rash can exhibit characteristics of either maculopapular (featuring a combination of flat spots or raised bumps) or morbilliform (involving raised lesions that merge) eruption. In certain instances, these rashes may encompass multiple lesions, creating a widespread redness interspersed with small, unaffected areas akin to white islands in a sea of red.

These rashes typically arise as a result of the immune response to the virus. Initially appearing on the hands and feet, they spread to other areas. Although itching may be associated with these rashes in some cases, they are predominantly asymptomatic. Notably, some patients may only experience the initial rash and achieve a complete recovery, while others may develop a generalized rash.

Hemorrhagic manifestations typically arise in severe cases, notably in dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). These manifestations manifest around four to five days after the onset of fever and may encompass the following:

1. Petechiae: These are minuscule, pinpoint, round spots that emerge on the skin due to bleeding in the small capillaries.

2. Purpura: Characterized by large reddish or purplish areas on the skin, purpura results from bleeding under the skin.

3. Ecchymosis: Representing a larger bruise or accumulation of blood under the skin, ecchymosis surpasses the size of petechiae or purpura.

A tourniquet test can be conducted to assess these manifestations by inflating a blood pressure cuff on the upper arm for five minutes. A positive result is indicated when more than 20 petechiae per 2.5-centimeter square are observed.

What Are the Other Dermatological Manifestations of Dengue Fever?

Among the various dermatological signs:

1. One noteworthy manifestation is erythema, where redness appears on the face or palms, known as palmar erythema.

2. Another dermatological indication involves mucosal bleeding, which can manifest in mucosal membranes such as the nose and gums.

3. The occurrence of redness in the eyes is linked to inflammation of the conjunctiva.

4. Swollen lymph nodes represent another distinctive manifestation.

5. Pruritus, or itching of the skin, may be experienced by some individuals due to an inflammatory response.

It is important to note that these manifestations are not exclusive to dengue fever and can also be observed in other viral infections.

How to Differentiate Dengue Rash From Other Viral Rashes?

The manifestations of dengue fever include heightened fever, intense headaches, discomfort in joints and muscles, and a distinctive rash. The rash usually appears a few days after the onset of fever. Identifying this rash from those associated with other viral infections is challenging due to timing, occurring between the third and seventh day, and its widespread coverage across various body parts with different viruses.

Despite these distinctive features, it is vital to acknowledge that these characteristics are not exclusive to dengue fever. Similar rashes can arise from other viral infections, including:

1. Chikungunya Fever: Flushing erythema appears on the face and upper chest.

2. Scarlet Fever: Small raised bumps on reddish skin give a sandpaper-like texture. Linear petechiae (pastia's lines) may cause bleeding under the skin. Peeling or shedding of the skin may occur, and these rashes manifest 12 to 48 hours after the onset of fever.

3. Toxic Shock Syndrome: In these cases, the skin has widespread generalized redness, resembling or being similar to scarlet fever.

4. Erythema Infectiosum: Redness of the skin in flat areas lasting for one to four days may occur. A slapped cheek appearance and lacy rash on the outer surfaces of joints, such as elbows and knees, may be present.

5. Kawasaki Disease: A sudden reddening of the skin, known as flushing macular erythema, may occur. Red, raised areas on the skin that do not itch, called non-pruritic erythematous plaques, may be present. Skin redness with well-defined borders and peeling or shedding of the skin may also occur.

Conclusion:

The dermatological signs assume a critical role in the diagnostic journey of dengue fever. Beyond the prominent symptoms of elevated fever, intense headaches, and joint discomfort, a distinct rash contributes to the overall diagnostic framework. A comprehensive understanding of the diverse cutaneous manifestations observed in different viral diseases is indispensable for holistic patient care, actively enriching the knowledge base in infectious diseases.