Kawasaki disease (KD) is an acute, self-limited vasculitis that primarily affects young children, and early treatment is essential to prevent coronary artery complications. Diagnosis is clinical and can be challenging in children who present atypically or receive initial evaluation in resource-limited settings. We report a case of KD in a 6-year-old girl who presented to a rural clinic with six days of fever, a progressive polymorphous rash, bilateral conjunctivitis, and mucocutaneous changes. Her evaluation showed leukopenia, marked transaminitis, elevated inflammatory markers, and an extensive negative infectious workup. These findings, along with her older age and a pruritic rash, complicated initial recognition and broadened the differential to include viral exanthems and systemic infections. KD was suspected based on her clinical course, and she was promptly transferred to a tertiary pediatric center, where she met four of the five diagnostic criteria. She received intravenous immunoglobulin and high-dose aspirin, resulting in rapid improvement. Echocardiography showed no coronary involvement. This case reinforces the importance of maintaining suspicion for KD in children with prolonged fever and mucocutaneous findings, even when laboratory abnormalities are atypical. It also highlights the value of early consultation, efficient transfer pathways, and collaboration between rural and tertiary facilities to ensure timely treatment and reduce the risk of cardiac complications.

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder characterized by high spiking fevers, arthralgia or arthritis, and a distinctive salmon-colored evanescent rash. Diagnosis is clinical but can pose a challenge for providers given its rarity and variable clinical presentation. Here, the authors present the case of a 58-year-old Caucasian male exhibiting fever, myalgias, hyperferritinemia, polyarthralgia, and diffuse pruritic rash. While a rash is part of the typical presentation for AOSD, the diffuse pruritus seen in this patient is atypical. Several differentials were considered, and infectious, neoplastic, and alternative rheumatologic etiologies were excluded. Despite the pruritic nature of the patient's rash, the Yamaguchi criteria for AOSD was fulfilled. The patient achieved symptomatic improvement after treatment with NSAIDs, antihistamines, and corticosteroids. This case emphasizes the diagnostic challenge AOSD can pose, especially when the presenting symptoms mimic more common conditions such as viral infections, allergic reactions, or autoimmune dermatologic diseases. It reinforces the importance of considering AOSD in the differential diagnosis of patients with persistent fevers, rash, and arthralgia, particularly when infectious and autoimmune workups are unrevealing. Early recognition is crucial, as prompt initiation of therapy can significantly reduce morbidity and prevent complications.

Measles is a highly contagious vaccine-preventable disease that was once controlled with measles, mumps, and rubella vaccinations but has reemerged in the United States and globally as a public health emergency. Despite availability of a safe and effective vaccine, declining vaccination rates driven by vaccine hesitancy, access issues, and clustering of unvaccinated individuals have led to measles outbreaks. Since January 2026 in the United States, both the International Vaccine Access Center (IVAC; 1,654 cases) and the Centers for Disease Control (CDC; 1,671 cases) have reported a high number of cases (IVAC, March 27, 2026; CDC, April 3, 2026) that will exceed the reported cases (2,286) in 2025 (CDC, April 3, 2026). The Pan American Health Organization (PAHO) reported an epidemiological alert on measles in the Americas Region (PAHO, February 3, 2026). Emergency Nurse Practitioners must identify, manage, and initiate control measures. This review covers clinical manifestations, vaccination guidelines, management, and complications of measles.

Measles is a highly contagious viral exanthematous disease, caused by a Morbillivirus, that continues to cause outbreaks in under-immunized populations. While neurologic complications are rare, the progression to meningoencephalitis with convulsive status epilepticus is exceptional, particularly in immunocompetent adolescents. We report a 17-year-old unvaccinated male who presented with a febrile, descending asymptomatic maculopapular rash, lacking Koplik spots, followed by rapid onset of severe headache, photophobia, vomiting, and convulsive status epilepticus. Day-7 IgM was negative, and PCR was unavailable, prompting a broad viral, bacterial, and autoimmune workup, all of which were excluded. Cerebrospinal Fluid (CSF) showed mild protein elevation without pleocytosis, and repeat serology confirmed measles (IgM 1210 IU/mL; IgG 1980 IU/mL). The patient received meningeal-dose ceftriaxone, acyclovir, antiepileptics, and high-dose vitamin A per World Health Organization (WHO) recommendations, with complete neurologic recovery. This case highlights an uncommon but severe neurologic complication of measles in an unvaccinated adolescent, emphasizing the risk of diagnostic delay due to atypical features and early seronegativity. It reinforces the need for high clinical suspicion, broad etiologic evaluation, early empiric therapy, and sustained efforts to ensure complete vaccination.

Artificial intelligence (AI) in dermatology has moved beyond the early paradigm of single-image classification. Dermatological diagnosis is achieved based on morphology, distribution, symptoms, tactile findings, temporal evolution, patient history, histopathology, and treatment response. Clinically important differentials, such as eczema versus psoriasis, cutaneous T-cell lymphoma versus chronic dermatitis, drug eruption versus viral exanthem, lupus erythematosus versus dermatomyositis, and melanoma versus atypical nevus, are rarely resolved with one photograph alone. This review therefore frames AI-assisted dermatology around a central argument: the field must progress from lesion recognition to dermatology-specific multimodal clinical reasoning. We summarize major advances in convolutional neural networks, dermoscopic benchmarks, clinical-image datasets, large language models, vision-language systems, and dermatology foundation models. We also analyze challenges that are particularly relevant to dermatology, including morphologic overlap, skin-tone bias, reduced erythema visibility on darker skin, dataset imbalance, variable smartphone imaging, imperfect reference standards, and the gap between benchmark performance and clinical deployment. Special attention is given to fairness, regulatory oversight, software as a medical device, human-AI collaboration, prognosis prediction, biologic-response modeling, longitudinal monitoring, and treatment optimization. Finally, we discuss future directions, including skin-tone-aware foundation models, lesion-level and body-site grounding, pathology-genomics integration, dermatology copilots, post-marketing surveillance, and prospective clinical trials. By prioritizing dermatological reasoning rather than generic AI architecture, this review outlines a clinically grounded pathway for building safe, interpretable, equitable, and useful AI systems for skin disease management.

Hand, foot, and mouth disease (HFMD) is a common viral illness of childhood but is increasingly recognized in adults with often atypical and severe presentations. We report a case of HFMD in an immunocompetent man in his sixties who presented with a generalized, tender vesiculopapular eruption involving the groin, trunk, extremities, palms, and soles. An extensive infectious evaluation was initially pursued, and empiric broad-spectrum antimicrobials were administered. Dermatology consultation led to the diagnosis of HFMD, and antibiotics were discontinued with subsequent clinical improvement. This case highlights the importance of considering HFMD in the differential diagnosis of vesiculopapular eruptions in adults, particularly when the palms and soles are involved, to avoid unnecessary antimicrobial exposure and invasive testing.

Drug eruptions are common mucocutaneous adverse reactions encountered across all medical specialties, occurring in approximately 0.1-1% of patients exposed to medications. However, accurate diagnosis and identification of the culprit drug remain challenging because of heterogeneous clinical presentations and a wide range of differential diagnoses, particularly viral exanthems. Comprehensive evaluation of medication history, infection status, latency period, and clinical phenotype is essential for appropriate narrowing of suspected agents. Among drug eruptions, Stevens-Johnson syndrome and toxic epidermal necrolysis represent life-threatening, rapidly progressive conditions in which early recognition is critical; mucosal erosions, skin pain, fever, and systemic organ involvement should prompt immediate suspicion. Identification of the causative drug is crucial not only for preventing recurrence but also for preserving future therapeutic options. Diagnostic modalities-including the drug-induced lymphocyte stimulation test, skin testing, and drug provocation testing-should be selected based on clinical phenotype, disease severity, and timing. A structured, time-conscious diagnostic strategy may reduce inappropriate drug allergy labeling and facilitate safer long-term pharmacotherapy.

Hand, foot, and mouth disease (HFMD) is a self-limiting viral illness predominantly affecting children under 10 years of age, with peak incidence in those aged one to four years. Recent outbreaks of Coxsackievirus A6 (CVA6) have increased its incidence across all age groups, including adults. Onychomadesis, a proximal nail plate detachment due to transient matrix arrest, is a recognized but underreported delayed complication of HFMD. We report a case of a 60-year-old man who developed onychomadesis three weeks after clinical recovery from CVA6-induced HFMD. Initial symptoms included fever, sore throat, gastrointestinal disturbances, and vesiculopapular lesions on the hands, feet, scalp, and oropharynx. He later presented with Beau's lines, onycholysis, and complete nail shedding involving all 10 fingernails and two toenails on each foot. Conservative management led to complete nail regrowth within eight to 12 weeks. Although the pathophysiology of HFMD-associated onychomadesis is not fully understood, potential mechanisms include direct viral cytotoxicity, localized inflammation, and systemic stress. CVA6 has been increasingly linked to adult cases, often with more severe mucocutaneous and nail manifestations compared to other serotypes. This case highlights CVA6 as an important and emerging cause of onychomadesis in adults following HFMD. Clinician awareness is essential for timely recognition, appropriate patient reassurance, and avoidance of unnecessary investigations. Further studies are needed to explain the underlying mechanisms and risk factors.

We present the case of an HIV-positive patient with fever, arthralgia and maculopapular exanthema following a stay in Thailand, in whom acute chikungunya infection was serologically confirmed. Treatment was purely symptomatic, as no specific antiviral therapy is available. In view of the increasing number of cases in tropical endemic areas, but also in regions close to the borders of our neighbouring countries, and the steady spread of the tiger mosquito in Switzerland, tropical viral infections such as chikungunya, dengue and Zika are becoming increasingly important for clinical practice in Switzerland.