Infectious and Non-Infectious Pediatric Rashes

Question 1

varicella zoster virus:

Distribution: starting on __ and progressing __.

Rash: __, then __ then umbilicated and crusted. Appears in __.

Symptoms: pruritic vesicular rash with central __, on erythematous base with mild fever. __ signs.

Answer 1

Distribution: starting on trunk and progressing outwards.

Rash: papules, then vesicles then umbilicated and crusted. Appears in crops.

Symptoms: pruritic vesicular rash with central umbilication, on erythematous base with mild fever. URTI signs.

Question 2

symptoms of roseola. What virus is it caused by?

Answer 2

Etiology: human herpes virus 6 and 7

“Baby measles”

Symptoms: high fever >39.5 for 3-7 days followed by rash, febrile seizures with 10-15% of first presentation. MAy have URTI, GI or otitis media signs. Incubation period is 9-10 days.

Question 3

Erythema Infectiosum

Etiology:____

Prodrome: fever, malaise, myalgia, headache 7-10 days prior

May have no recollection of prodrome

Rash: red __ rash over cheeks, often __ pallor. Symmetric, maculopapular, lacklike and often pruritic rash starting on __ and spreading to the periphery. Rash my fluctuate with __

Answer 3

Etiology: parvovirus B19

Prodrome: fever, malaise, myalgia, headache 7-10 days prior

May have no recollection of prodrome

Rash: red macular rash over cheeks, often perioral pallor. Symmetric, maculopapular, lacklike and often pruritic rash starting on trunk and spreading to the periphery. Rash my fluctuate with temperature

Question 4

Impetigo

Rash: polymorphic __, erythematous, __,excoriated, __ crusting.

Microbiology:__s and __

Treatment: topical __, __. __ or __ if oral

Answer 4

Rash: polymorphic patches, erythematous, pustular,excoriated, yellow crusting.

Microbiology: S. Aureus and S. pyogenes.

Treatment: topical bacitracin, mupirocin. Cephalexin or cloxacillin if oral

Question 5

d. Scarlet fever

Microbio: ___ (group __ __ strep)- pyrogenic (__ toxin)

Symptoms: __ onset of fever, __ +/- abdo pain, headache toxicity, pharyngitis with __ and chills

Rash: generalized erythematous, punctate/finely papular rash. May have __ line on _, neck or axillae. __ tongue and __ on palate. May have __ of hands and feet after a week.

DDx: __, scarlet, streptococcal __, roseola, measles, drug eruption, EBC

Diagnosis and treatment: isolation of S. pyogenes. Treat with __ V or __, __/__/___ if allergic to pen.

Answer 5

Microbio: S. pyogenes (group A betahemolytic strep)- pyrogenic (erythorogenic toxin)

Symptoms: acute onset of fever, vomiting +/- abdo pain, headache toxicity, pharyngitis with exudate and chills

Rash: generalized erythematous, punctate/finely papular rash. May have pastia’s line on groin, neck or axillae. Strawberry tongue and petechiae on palate. May have desquamation of hands and feet after a week.

DDx: kawasaki’s, scarlet, streptococcal TSS, roseola, measles, drug eruption, EBC

Diagnosis and treatment: isolation of S. pyogenes. Treat with penicillin V or amoxicillin, cephalosporin/macrolide/clinda if allergic to pen.

Question 6

Key symptoms of kawasaki disease

Answer 6

WARM CREAM
Warm= fever

C= conjunctival symptoms

R= red skin rashes

E= edema

A= adenopathy

M= mucosal changes *strawberry tongue)

Question 7

Rash: generalized maculo-papular rash. Starts often on forehead, spreading over three days to the trunk and extremities. Rash more confluent over the head and upper extremities than lower body.
Prodrome: cough, coryza, conjunctivitis, koplik spots are pathognomonic, fever 40-40.5, lymphadenopathy including mesenteric

Complications: otitis media, pneumonia, encephalitis, subacute sclerosing panencephalitis, GI bleeding, DIC, mild liver involvement, blindness, death.

Incubation: 10-12 days

Answer 7

MEASLES

Question 8

Question 9

Rash: clusters of pearly papules with umbilicated centers. Cheese contents localized to trunk. May accompany STD’s in sexually active individuals. Asymptomatic generally speaking. May disseminate in immunocompromised

Incubation: 2-7 weeks, replicates in host epithelial cell.

Spread: direct contact, fomites, auto-inoculation

Treatment: usually self limited disease. May use liquid nitrogen or mechanical removal

Answer 9

MOLLUSCUM

Question 10

Epi: common in full term infants

Rash: small, yellow-white, firm, occasionally, vesiculopustular papules on an erythematous base. Face, trunk and extremities. Sterile with eosinophils.

1-3 days after birth, lasts 1 week.

Sparing of palms and soles.

Answer 10

Erythema Toxicum

Question 11

• Evanescent superficial pustules, ruptured with fine collaret of fine scale, hyperpigmented macules
• Lesions present at birth, pustular phase lasts 2-3 days, hyperpigmentation up to 3 months
• Anterior neck, forehead, lower back • Sterile, no eosinophils

Answer 11

Transient Pustular Melanosis

Question 12

Epsteins’ pearls:

Answer 12

small, white or gray lesions on the mucosa, alveolar ridge and hard palate. All asymptomatic and are usually shed within the first three months of life.

Question 13

tiny yellow macules or papules at the opening of each pore over the nose and cheeks of term newborns

Answer 13

Sebaceous Hyperplasia:

Question 14

caused by swear retention resulting from pore closure. Mild erythema or vesicles, patches of erythema studded with tiny vesicles. Often misdiagnosed as contact dermatitis.

Answer 14

Miliaria Crystallina

Question 15

Answer 15

nevus of ota

Question 16

compare and contrast salmon patch with port wine stain

Answer 16

Salmon patch: midline capillary malformation, often on forehead. Extremely common and often progresses over time. DIFFERENT THAN PORT WINE STAIN BECAUSE SALMON PATCH IS NOT DISFIGURING. Does not need treatment. If on nape of neck, it persists into adulthood (hard to see)

Question 17

Trigeminal PWS is associated with __, __, and __ involvement (sturge-weber syndrome)→ can cause __ because the venous malformation is __, leading to neural impairment.

Answer 17

Trigeminal PWS is associated with leptomeningeal, ocular, and CNS involvement (sturge-weber syndrome)→ can cause seizures because the venous malformation is intracranial, leading to neural impairment.

Question 18

PWS may occur on the trunk and extremities, with extremity lesions occasionally developing progressive lymphectasia and soft-tissue hypertrophy–? what’s this called

Answer 18

kipple trenaunay weber

Question 19

port winee stain:

Cosmetically __ due to congenital capillary and __ malformation

At birth, lesions are first noted as subtly, light pink patches, commonly appearing on the face and often in a __ dermatomal distribution.

Answer 19

Cosmetically disfiguring due to congenital capillary and venular malformation

At birth, lesions are first noted as subtly, light pink patches, commonly appearing on the face and often in a trigeminal dermatomal distribution.

Question 20

atopic dermatitis is associated with __ __ and ___. also associated with elevated serum __ levels and a fmaily history.

treatment: dry skin measures, sedating antihistamines, topical anti inflammatoryies like topical steroids or ___ inhibitors. Use emollients.

Answer 20

atopic dermatitis is associated with allergic rhinitis_ and asthma. also associated with elevated serum __ levels and a fmaily history.

treatment: dry skin measures, sedating antihistamines, topical anti inflammatoryies like topical steroids or calcineurin inhibitors. Use emollients.

Question 21

T/f generic steroids are the same as brand name products

Answer 21

false. generic topical steroid preparations do not duplicate the vehicle of the brand-name product

Question 22

T/F: when a stronger steroid is needed, consider switching to another steroid in the same class of steroid potency rather than increase the percentage of the same drug

Answer 22

true

Question 23

Answer 23

d. Seborrheic dermatitis

Question 24

differentiate between primary and irritant diaper dermatitis

Answer 24

Primary dermatologic diaper dermatitis: seborrheic dermatitis, psoriasis, candida, histiocytosis → involves folds.

Irritant diaper dermatitis: spares folds because it only involves the surfaces in contact with diaper → higher suspicion with reusable diapers.

Question 25

__-related erythema multiforme, characterized by ___ lesions and a predominantly inflammatory histopathologic pattern

Answer 25

HSV-related erythema multiforme, characterized by target lesions and a predominantly inflammatory histopathologic pattern

Question 26

SJS-TEN complex, primarily ___-related and characterized by atypical or no target lesions at all and a predominantly __ histopathologic pattern.

Answer 26

SJS-TEN complex, primarily drug-related and characterized by atypical or no target lesions at all and a predominantly necrotic histopathologic pattern.

Question 27

what virus causes this?

Answer 27

erythema multiforme is caused by HSV

Question 28

EBV can cause ___ ___ ___, aka gianotti-crosti syndrome

Answer 28

infantile papular acrodermatitis

NOT pruritic and may be accompanied by splenomegaly, hepatitis, lymphadenopathy.