What are the skin signs of Still’s disease?

The diagnosis of Still’s disease (juvenile rheumatoid arthritis) can be perplexing because a significant number of these patients (25% to 30%) do not present with arthritis but with an evanescent eruption, spiking fever, leukocytosis, lymphadenopathy, and splenomegaly. The disease can be rapidly progressive, with severe bone and joint destruction and growth retardation. The rash, which occurs in 25% to 40% of patients, can be present for months to years before the arthritis. The eruption is typically but not always fleeting, lasting up to 24 hours, and usually occurs in conjunction with fever. The rash may be diffuse with truncal accentuation and consists of coral-salmon red, flat macules to slightly elevated papules. Treatment for this disease usually consists of locally injected or systemic steroids. Other immunosuppressive drugs have also been used successfully.