Paeds Rashes Flashcards
What are the clinical features of Measles?
- Prodrome - 4-7 days - Coryza, cough, conjunctivits, Fever, Koplik spots
- Exanthem Stage >/= 7 days - High fever, malaise, Generalised lymphadenopathy, Erythematous Maculopapular rash, partially confluent - begins behind ears
What are the following in context of a child with paritally confluent erythematous maculopapular rash which started behind the ears, fever and general malaise?
Koplik spots - white necrotic lesions on an erythematous base.
What might the following rash indicate in terms of cause in a child with high fever, general malaise, cervical lymphadenopathy and white lesions on mucosal surfaces of the mouth?
Measles
How would you manage a child with the following rash, features of general malaise, high fever, and white lesions visible on oral mucosa?
Suspected measles infection
- Mainly supportive
- Consider admission in immunocompromised
Is a notifiable disease
What complications can occur from measles infection?
- Otitis media: the most common complication
- Pneumonia: the most common cause of death
- Pncephalitis: typically occurs 1-2 weeks following the onset of the illness)
- subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
- Febrile convulsions
- Keratoconjunctivitis, corneal ulceration
- Diarrhoea
- Increased incidence of appendicitis
- Myocarditis
What would you suspect with the following rash, and a history of fever, malaise, headache, sore throat and a red tongue?
Scarlet fever
How would you describe the rash in scarlet fever?
Fine, erythematous, maculopapular (sandpaper-like texture)
Where does the rash for scarlet fever begin?
Begins in neck region
What would your differential be for the following tongue changes?
- Scarlet fever
- Kawasakis Disease
- Toxic Shock syndrome
What organism is suspected to precipitate the development of scarlet fever?
S. Pyogenes
What would be your differential for a child with the following skin changes?
- Scarlet fever
- Kawasakis disease
- TSS
What are the clinical features of scarlet fever?
- Acute tonisllitis phase
- Exanthem phase - sandpaper rash, initially appears around neck, blaches with pressure, can have non-blanching petechiae, pastia lines (groin, under armpit, elbow creases)
How would you manage a child with scarlet fever?
Oral penicillin V
What might be the cause of the following rash in a child with prodromal features of post-auricular and sub-occipital lymphadenopathy, low grade fever, mild sore throat, cough, conjunctivitis, headache and aching joints?
Rubella
Where does the rash for rubella begin?
Primarily behind the ears, and extends to trunk and extremities, sparing palms and soles of feet
What infectious differentials would you consider for paediatric rashes?
- Measles
- Mumps
- Chickenpox
- Roseola infantum
- Erythema infectiosum
- Rubella
- Kawasakis disease
- TSS
How would you manage a child with rubella?
Supportive management
Consider anti-histamines for pruritis
What complications can occur from rubella infection?
- Chronic arthritis (especially women)
- Thrombocytopenic purpura
- Rubella during pregnancy (TORCH infection): congenital rubella syndrome
- Rare: rubella encephalitis, bronchitis, otitis, myocarditis, pericarditis
What might the following rash be caused by in a child which was preceeded by abrupt onset fever, cervical and postauricular lymphadentopathy, inflamed tympanic membranes, oedematous eyelids, and small papular spots on the uvula and soft palate?
Roseola infantum
How would you manage roseola infantum?
Symptomatic management
What might cause the following rash?
Erythema infectiosum
What virus causes the following rash?
Parvovirus B19
What might cause the following rash in a child with prodromal features of a fever, malaise, headache and myalgia?
Chickenpox - VZV
Where do lesions in those with chicken pox tend to manifest the most?
Centrally - over trunk, scalp and face - then spread to extremitis
Can have ocular and mucous membrane involvement
How would you manage a child with chickenpox?
Supportive as starting point
May need antivirals if symptoms persist
Topical thearpies - calamine lotion
Monitor for disseminated infection/complications
What are complications of chickenpox infection?
- Bacterial superinfection
- Scarring
- Encephalitis
- VZV pneumonia
- Congenital varicella syndrome (in foetus)
What might you suspect in a child with the following rash?
Hand, foot and mouth
What might you suspect in a child with the following skin features which were preceeded by fever, malaise, irritability, and diffuse localised erythema?
Staph scalded skin syndrome
What might you suspect in a child with the following skin features which were preceeded by fever, malaise, irritability, and diffuse localised erythema?
Staph scalded skin syndrome
How would you manage a child with the following skin features which were preceeded by fever, malaise, irritability, and diffuse localised erythema?
- Admit to hospital
- Isolation
- Consider ICU
- IV abx
- Supportive therapy
What might the following skin changes be caused by?
Molluscum Contagisoum
What might the following skin changes be caused by?
Molluscum contagiousum
What might cause the following skin changes?>
Impetigo
How can impetigo be classified?
- Bullous - most often caused by s. aureus
- Non-Bullous
How would you manage impetigo?
NICE CKS recommend
* Hydrogen peroxide cream - those who are not systemically unwell/high risk
* Topical antibiotic creams: fusidic acid, mupirocin (if fusidic acid resistant)
* Extensive disease - Oral fluclox or erythromycin if fluclox allergic
How long would you keep a child from attending school if had the following skin infection?
Should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment
What might you think has caused the following disseminated and painful rash in a child with fever, malaise, lymphadenopathy?
Eczema Herpaticum
How would you manage a child with the following disseminated and painful rash in associated with fever, malaise, lymphadenopathy?
- Admit to hospital for IV aciclovir
- Opthalmology review
