Childhood Rashes Flashcards
Maculopapular rash:
Differentials.
Measles Roseola infantum. Erythema infectiosum. Scarlet fever. Rubella (more of a macular rash). Non-specific viral rash e.g. associated with URTI. Drug reaction.
Vesicular rash: differentials.
Chickenpox
Herpes simplex.
Hand, foot, and mouth disease.
Bullous impetigo
Purpuric rash:
a) Define
b) 3 types
c) differentials.
a) Flat, haemorrhagic rash.
b) petechiae < 3 mm < purpura < 10 mm < ecchymoses
c) Meningococcaemia
Henoch-Schonlein purpura.
Thrombocytopenia: idiopathic thrombocytopenic purpura (affect buttocks then legs, follows URTI, and resolve in 6-8 weeks), leukaemia, aplastic anaemia, DIC, HUS.
Trauma: direct trauma or barotrauma (e.g. from vomiting or coughing).
Chickenpox presentation.
a) Pathogen
b) Transmission
c) Prodrome
d) Rash stages and distribution
e) Incubation period
f) Infectious period
a) VZV
b) Droplet
c) 2 days of fever.
d) - Crops of papules, then vesicles, then pustules, then crusts.
- Starts on head, trunk, and/or back, then spreads to peripheries
e) 1-3 weeks incubation.
f) Infectious for 2 days before and 5 days after symptoms start, which is usually when lesions crust over.
Chickenpox management.
a) In most cases
b) Which antipyretic and why?
c) Who to vaccinate?
d) avoid school for how long?
a) Conservative
b) For analgesia/antipyresis, paracetamol is preferred, as NSAIDs increase the risk of severe skin and soft tissue complications.
c) Consider anti-varicella zoster immunoglobulin (VZIG) plus aciclovir for neonates, the immunosuppressed, or those or at risk of complications e.g. patients with cardiovascular or respiratory disease
d) Avoid school for 5 days from rash onset.
Chickenpox complications.
a) Acute
b) Chronic
c) In pregnancy (think chicken)
a) - Secondary bacterial infection: Staph. aureus or Group A Strep, which may in turn lead to toxic shock syndrome or necrotizing fascitis.
- Encephalitis. Pneumonia. DIC.
b) Shingles
c) In the first 20 weeks in-utero (chicken related) IUGR, limb hypoplasia, microcephaly, cataracts
Rubella.
a) symptoms
b) complications
a) Macular rash on face which then spreads.
Itchy
b) Small joint arthritis.
- Fetal malformations, deafness, blindness, or heart defects if it happens during first 4 months in-utero.
Measles
a) Pathogen
b) symptoms (including 4Cs)
c) Ix
d) Management: patient and contacts
e) Complications: most common cause of acute death, rarer cause of death, long-standing disability
a) Measles Virus
b) Maculopapular rash spreads from behind ears to whole body. Child is miserable.
Prodrome of 2-3 days of fever and the 4Cs: Coryza, Conjunctivitis, Cough, Koplik spots (white spots on buccal mucosa).
c) Serum IgM and/or throat swab PCR.
d) Rest, oral fluids, and paracetamol. Post-exposure prophylaxis within 6 days for vulnerable contacts (immunocompromised, unvaccinated pregnant women, infants)
e) Giant cell pneumonia: commonest cause of acute death.
Otitis media.
CNS: acute meningitis or encephalitis (during or immediately post-infection), or subacute sclerosing panencephalitis (6-8 years later, with progressive decline to death over 1-3 years).
Febrile convulsions.
Fetal malformation if in-utero.
Molluscum contagiosum.
a) Presentation, lasts how long?
b) Management
Signs and symptoms
Pearly, flesh-coloured papules with central dimple. May spread through auto-infection i.e. itching and touching.
May last for up to 2 years, or even longer.
Management
Avoid scratching.
Emollients may help.
No time off school needed.
Hand foot and mouth disease
a) Pathogen
b) presentation
c) management
a) Coxsackie virus A16
b) Vesicular rash on mouth (1st), palms, and soles. Fever, sore throat, miserable.
c) Keep out of school when feeling unwell, but they can return once better even if the rash persists.
Nappy rash
a) Pathophysiology
b) Presentation
c) Management
d) How to tell if there is secondary fungal (candida) infection
e) If baby has candida infection, what 2 areas should you also assess for thrush?
Pathophysiology.
Irritant effect of urine on skin, which can then be complicated by Candida infection.
Signs and symptoms.
Erythematous groin including flexures.
Satellite pustules.
Management.
Emollients
Topical fluconazole or clotrimazole.
May be role for topical steroids.
Baby’s mouth, mum’s boobie
Impetigo
a) Often results where the skin has…?
b) Appearance
c) Management
a) Broken
b) , Pustules that rupture and leave yellow-brown plaque usually on face
c) Topical fusidic acid. Get crust off in warm bath first to ensure good penetration. Flucloxacillin PO if widespread. In kids, avoid school until lesions crust over.
Staphylococcal scalded skin syndrome.
- Appearance
- Common in what area?
- Management
- What causes peeling?
Essentially a generalized form of bullous impetigo, though can be considered a separate condition.
Presents with fever, diffuse erythema, and papery wrinkling of the epidermis. Then progresses to blistering – initially in the groin and axillae – which easily burst, giving the appearance of burns.
Commonly affects kids <5 years old, including as outbreaks in nurseries.
Treat with flucloxacillin IV.
- peeling caused by epidermolytic exotoxins A and B
Scabies
a) Presentation
b) Management
a) Papular rash and burrow marks in skin folds and finger webs.
May also affect scalp in kids, and flexor aspect of wrist in adults.
Burrow marks: fine, zig-zag grey line with a speck (mite) at one end.
Intensely itchy, and may be worse at night.
b) Permethrin 5%, given twice, 1 week apart. Itch may continue 4-6 weeks post-treatment.
Also treat family.
HSP.
a) Classic tetrad
a) Rash: initially macular then purpuric symmetrical rash on buttocks and back of legs.
Abdominal pain: may be accompanied by bloody diarrhoea, nausea, and vomiting.
Arthralgia: commonly knees and ankles, which may be swollen and tender.
Glomerulonephritis in following weeks, due to IgA deposition. Occurs in 30%, usually causing haematuria or proteinuria. Rarely causes nephrotic system or renal failure.
