demr and exanthems Flashcards
Acne Neonatorum
Closed comedones on face
- self resolves in 4 mo
erythema toxicum neonatorum
pustules on face, trunk, proximal limbs, “flea bitten”. Spares palms and soles.
Resolves in 1 week, up to several weeks.
infantile hemangioma
benign vascular tumour
may grow then resolve, most gone by age 7
milia
1-2mm pearly papules, forehead, cheeks, nose, chin
self resolve in 1-3mo
transient neonatal pustular melanosis
vesicopustular rash, more common in black babies.
Pustules + erythema. Can be anywhere.
Self limiting – collarette + scale, pigmented macule fades in 3-4 weeks.
Diaper Contact Dermatitis Description
shiny, erythematous rash, +/- maceration. Spares folds.
Diaper contact dermatitis treatment
barrier cream, zinc oxide +/- 1% hydrocortisone. Increase diaper changes.
diaper candidiasis description
beefy red plaques, satellite papules + pustules with confluent lesions. Involves skin folds. Fine scale.
Diaper candidiasis treatment
1% clostrimazole or nystatin.
Infantile psoriasis
sharply demarcated red plaques + papules, involving folds. No treatment.
Scabies
Macules, pustules, excoriations, nodules. Burrows in webs. ++ pruritic. Spares face.
tx: Permethrin 5% for whole family, 2 applications 1 wks apart.
Impetigo
honey coloured crusts, face, extremities. S. Aureaus (or GA strep).
Tx: PO cephalexin or erythromycin. IV if severe.
Tinea
capitis, corporis, onychomycosis. Annular lesions, maceration in folds. Tx: topical anti-fungal for skin (azoles, terbinafine, tolnaftate), oral for nails or scalp (terbinafine). Don’t use nystatin.
Urticaria
tx: stop offending agent. Antihistamine (eg loratidine)
Molluscum Contagiosum
pox virus infection. Domed, pearly, flesh coloured to transluscent, umbilicated. Face, trunk, limbs. +/- pruritic.
Tx: self-resolving. Curretage, cryotherapy, cantharidin possible.
Measles
incubate 8-13d. Contagious 4d before + after rash.
rash starts at hairline, goes down. Conjunctivitis, cough, coryza. Koplik spots (white buccal)
Tx: vitamin A, supportive.
Contacts: Ig + MMR vaccine.
Complications: pneumonia, AOM, encephalitis, myocarditis (rare).
Rubella
Incubate 14-21d. Infectious 7d before and after rash.
Pink, maculopapular rash on face/neck/trunk. Occipital + retroauricular nodes. Low fever.
Petechiae on soft palate.
Complications: STAR - sore throat, arthritis, rash. Congenital anomalies in preg.
Roseola
HHV-6 + HHV-7
incubate 5-15d
pink, maculopapular on neck, arms, trunk. After fever breaks.
Red papules on soft palate + uvula.
complications: febrile seizures.
erythema infectiosum
fifth’s disease. Parvovirus b19.
Incubates 4-14d.
“slapped cheek”, maculopapular lacy rash (may appear later /w heat).
petechai in mouth.
Complications: STAR, PPGSS glove + sock, aplastic crisis (esp sickle cell)
chicken pox
varicella zoster virus
incubate 10-21d, infectious 2d before + 5d after rash
airborne + contact
tichy, vesico-bullous, macules, papules, crusts, new lesions q2-3d, “dew drop on a rose petal”.
Prevention: VZ-Ig within 96hrs of contact, vaccine
complications: bacterial super-infection, nec fasc, encephalitis, cerebellar ataxia, hepatitis, DIC
Herpes Simplex
HSV1,2
grouped vesicles on erythma +/- erosions in anterior mouth.
Herpetic whitlow = on finger.
tx: topical or oral anti-virals
complications: secondary infection, keratitis, gingivostomatitis, encephalitis, hepatitis, DIC
hand-foot-mouth disease
coxsackie virus
vesicles + pustules on red base, tongue + posterior pharynx
atypical: generalized vesicobullous, excema, petechia, or gianotti-crosti like
complications: dehydration, nail shedding
Gianotti-crosti syndrome
EBV, HBV, coxackie, parvo
asymptomatic papular acrodermatitis, viral prodrome. Cheeks + extensors, pseudovesicles.
Self limiting but lasts 3-12wks
Scarlet Fever
Group A Strep
generalized red papules, sandpaper. Flexural accentuation (pastia’s lines). Strawberry tongue, palatial petechia.
Tx: pen V, amp, amoxil x10d.
Complications: pneumonia, pericarditis, meningitis, hepatitis, glomerulonephritis, rheumatic fever.
Unilateral laterothoracic exanthem
aka asymmetric periflexural exanthem
unknown etiology
prodrome fever, URTI/GI
erythematous, papular eruption, flexural area (“statue of liberty”), then spreads to other side
can last 6 weeks
Kawasaki Disease
vasculitis, unknown etiology
fever 5d and 4/5 of:
- rash
- hand/foot edema/erythema
- lymphadenopathy (usually unilateral)
- oral lesions: strawberry tongue, dry cracked lips
- conjunctivitis - non-purulent
labs supportive: WBC high, anemia, ESR + CRP high, plt high, transaminases up, low albumin, sterile pyuria
tx: high dose ASA, IVIG, baseline echo + repeat in 6 weeks. No live vaccines until 1 year.
complications: coronary artery aneurysm. Need cardiac f/u longterm if occurs.
atopic dermatitis
plaques, papules, poorly defined, red, lichenified, dry, pruritic
baby: face, extensors
kids: flexural
adults: face, feet+hand, eyelid
tx: emollients, topical steroids (high potency, then low for maintenance), calcinurin inhibitors
eczema herpeticum
small punched out, monomorphic grouped erosions
HSV on eczema
emergency, blindness/organ failure, death
high dose PO or IV acyclovir
optho consult if near eye
seborrheic dermatitis
greasy, yellow, scale + red plaques. Scalp, diaper, folds. Not itchy.
etiology ?malassezia
tx - antifungals (eg ketoconazole), steroids. Selenium or zinc pyrithione shampoo.
Nummular dermatitis / discoid eczema
coin shaped plaques, edema, erythema, crusting
lower legs, pruritic
tx - similar to AD. PRevemt trauma
allergic contact dermatitis
red, papules, plaques, vesicles, bullae Localized.
erosions, crusting, superinfection.
pruritic.
pityriasis rosea
large herald patch –> christmas tree. Central scale.
HHV7?
HSP
IgA complex deposition, small vessel vasculitis.
Purpura, abdo pain, arthritis, arthralgia.
Ix: Cr, lytes. U/A (blood, prot). Coags (r/o bleed disorder), CBC (r/o ITP, plt N in HSP).
skin or renal bx can show IgA deposits.
tx: supportive, anti-inflammatories, steroids, immunosuppressants depending on severity.
HSP complications
- glomerulonephritis, hemorrhagic cysts, nephrotic syndrome, renal failure, obstruction, HTN
- bowel infarction/perf, obstruction, intussusception
- alveolar hemorrhage, infiltrates, pulm effusion
- seizures, CNS bleed, blind, neuropathy
- orchitis, test torsion, scrotal edema
- anterior uveitis
- myocarditis, myositis
