What clinical condition is shown in the image below?

NORCERT 8 Mains-2025

Medical & Surgical Nursing

Medium

Appeared in: NORCERT 8 Mains-2025

Explanation

The image displays classic features of urticaria (hives), which are raised, red, itchy wheals on the skin. Some lesions show an annular (ring-like) shape.
Drugs are one of the most common triggers for acute urticaria.
This option is the most accurate general diagnosis because it correctly identifies the type of reaction (urticaria) and its likely cause (drug-induced) without making an unconfirmed assumption about the specific medication.
The diagnosis is based on identifying the characteristic skin lesions and considering the common causes presented in the options.

Option B: Stevens-Johnson syndrome (SJS) is a much more severe condition characterized by blistering, skin detachment (necrosis), and severe mucosal involvement. The image shows wheals, not the blisters or target lesions typical of SJS.
Option C: While ibuprofen is a common cause of drug-induced urticaria, it is impossible to confirm this specific drug as the cause from the image alone. This diagnosis is too specific and requires a patient history.
Option D: Similar to the ibuprofen option, this is too specific. Although carbamazepine can cause urticaria, a definitive diagnosis requires a medication history. Furthermore, carbamazepine is more often associated with severe reactions like SJS or DRESS syndrome.

Visual 1: Side-by-side comparison chart. Left side shows an image of urticarial wheals (like the one in the question). Right side shows an image of the atypical target lesions and blistering seen in Stevens-Johnson Syndrome. This visually reinforces the key differences.
Visual 2: Infographic. A flowchart titled 'Approach to a Drug Rash' starting with 'New Rash' and branching based on lesion type (Wheals vs. Blisters/Target Lesions) to differentiate between Urticaria and severe cutaneous adverse reactions (SCARs) like SJS.

Clinical Relevance

Nursing practice connection: Use the key finding related to Differential diagnosis of drug-induced skin reactions to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary role when a patient presents with a suspected drug rash is to take a thorough medication history, including prescription drugs, over-the-counter medications (like NSAIDs), and supplements. The timing of new medications is a critical clue.
The priority intervention for drug-induced urticaria is to identify and discontinue the offending agent. Patient education should focus on avoiding the identified drug in the future and understanding the signs of a more severe reaction.
What if? If the patient in the image also reported painful sores in their mouth and eyes, the nurse should have a high suspicion for Stevens-Johnson Syndrome, which is a medical emergency requiring immediate escalation and hospitalization.

How to Approach the Question

First, carefully analyze the image to identify the primary type of skin lesion. Note the characteristics: raised, red, well-defined, and ring-shaped (annular). This points to urticaria (wheals).
Next, evaluate the provided options in the context of your visual analysis. You have identified urticaria. Options A, C, and D all relate to urticaria, while option B is a different condition (SJS).
Eliminate the clearly incorrect option. Stevens-Johnson syndrome involves blisters and mucosal damage, which are absent here. So, option B is incorrect.
Compare the remaining options. Options C and D name specific drugs (Ibuprofen, Carbamazepine), while option A is a general category (Drug induced).
Ask yourself: Can I confirm a specific drug from the image alone? The answer is no. Therefore, the more general, encompassing diagnosis ('Drug induced urticaria') is the most accurate and least speculative choice.
Select the option that is supported by the evidence without making unproven assumptions.

Concept Tested & Keywords

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