Exanthems and Drug Eruptions - JKB

Question 1

What is the difference between Exanthems and Enanthems?

Answer 1

Exanthem: skin eruption bursting forth or blooming. comes quickly and affects several areas of the skin at the same time

Enanthem: an eruption on a mucous membrane (usually oral)

Question 2

How is measles typically transmitted?

Answer 2

-Respiratory droplets from infected individuals (mostly benign)

Question 3

What are the prodromal symptoms of Measles?

Answer 3

• Severe cough & nasal congestion
• Conjunctivitis & photophobia
• Fever
• Koplik’s spots (1-2 days before exanthem)

Question 4

What are the characteristics of a measles exanthem?

Answer 4

• Blue/White with red halo
• begins behind the ears and spreads to trunk/extremities
• Peaks at day 3 and fades by day 10
• Slightly elevated maculopapules varying in size and color

Question 5

What is the Tx for measles exanthems?

Answer 5

• Supportive Tx
• Vitamin A
• Tx any associated complications

Question 6

What is the cause of Hand-Foot-Mouth Dz (HFMD)?

Answer 6

Coxsackievirus A16 and enterovirus 71 spread via fecal-oral route & respiratory routes

Question 7

What are the clinical manifestations of HFMD?

Answer 7

• Oral lesions (90%)
• Cutaneous lesions (66%)
• Red macules that become pale white, oval vesicles with red areola
• Palms, soles, dorsal aspects of finger toes

Question 8

What is the Tx for HFMD?

Answer 8

Symptomatic relief and reassurance

Question 9

What is the cause of Scarlet Fever (Scarlatina)?

Answer 9

• contagious Dz produced by streptococcal toxin
• originates in pharynx or skin
• Children MC
• 2-4 day incubation period

Question 10

What are the hallmarks of a Scarlet Fever prodrome?

Answer 10

• N/V/HA
• Red oral cavity
• Strawberry tongue

Question 11

What are the characteristics of a Scarlet Fever rash?

Answer 11

• Begins in Neck and face and spreads to trunk/extremities
• Sandpaper quality
• Pastia’s sign (linear petechiae found in skin folds)
• Desquamation

Question 12

What is the Tx for Scarlet Fever?

Answer 12

• Penicillin
• Cephalosporins
• Erythromycin

Question 13

What population does the rubella virus affect with the greatest consequences?

Answer 13

• The “unborn”

- miscarriages, stillbirths, fetal anomalies (congenital rubella syndrome)

Question 14

What are the characteristics of the rubella enanthem?

Answer 14

• Soft palate petechiae (20%)
• Round or oval, pinkish/rosy red (Blueberry Muffin) macules or maculopapules
• Fades in 24-48 hours, followed by fine desquamation

Question 15

What is the classical triad associated with congenital rubella?

Answer 15

• Cardiac malformation
• Hearing deficits
• Ocular anomalies

Question 16

What is Erythema Infectiosum associated with, and how is it transmitted?

Answer 16

• Parvovirus B19 or Fifth’s Dz

- Transmitted via respiratory route

Question 17

What are the 3 phases of Erythema infectiosum?

Answer 17

1) Facial erythema (slapped cheeks)
2) Net pattern erythema (begins on extremities and spreads to trunk)
3) Recurrent phase (eruption fades and reappears)

Question 18

What is an alternative presentation of a parvovirus rash?

Answer 18

Papular Purpuric Gloves and Socks Syndrome (PPGSS)

• Painful and pruritic papules, petechiae, and purpura of hands and feet
• Very contagious

Question 19

What is the Tx for Erythema Infectiosum?

Answer 19

Reassurance and evaluate if there are pregnant women exposed to the virus

Question 20

What virus infection is associated with Roseola infantum?

Answer 20

Human Herpes Virus 6 & 7 infection

Question 21

What are the clinical manifestations of Roseola infantum?

Answer 21

• Very high fever, fever subsides and then rash appears
• Rash: many pale pink, almond shaped macules on the trunk and neck, they become confluent and fade within a few hours to 2 days

Question 22

What is the Tx for Roseola infantum?

Answer 22

Supportive Tx and reassurance

Temperature control with tylenol/motrin

Question 23

What is Kawasaki’s Dz, in what population is it seen, and what is the main cause of morbidity?

Answer 23

• Acute multisystem vasculitis of unkown etiology
• Children: 7 weeks to 12 years of age
• Cardiovascular manifestations are the main cause of morbidity

Question 24

What are the 3 clinical phases of Kawasaki’s Dz?

Answer 24

1) Acute: febrile phase with conjunctivitis and oral changes, swelling of extremities
2) Subacute: After fever, desquamation of fingers/toes, arthritis, thrombocytosis
3) Convalescent: clinical signs disappear through normalization of the ESR

Question 25

What is the diagnostic criteria for Kawasaki’s Dz?

Answer 25

Conjunctival infection
Rash
Extremity changes
Adenopathy (cervical lymphadenopathy)
Mucous Membrane Changes (Oral)

Question 26

What is the Tx for Kawasaki’s Dz?

Answer 26

• high dose ASA
• IV IG
• Tx within 10 days to prevent cardiac complications

Question 27

What is the most common exanthematous rash and what is it caused by?

Answer 27

The Viral Rash (enteroviruses: ehovirus and coxsackievirus exanthems)

Question 28

How long after initiation of a medication will a cutaneous drug reaction become apparent?

Answer 28

Typically 7-10 days after