Pediatric Rashes Flashcards
Name 5 bioterrorism agents that may have skin manifestations
Smallpox Anthrax Tularemia Plague Viral hemorrhagic fever
Smallpox:
Maculopapular rash on face, forearms, MM that becomes vesicular/pustular in 48h
Anthrax:
Painless pruiritic papule on skin that develops into a painless ulcerated black eschar within days
Tularemia:
Painful maculopapular lesion that ulcerates, associated with painful inflamed regional lymph nodes
Plague:
Acutely swollen lymph nodes called buboes
Viral hemorrhagic fever:
Maculopapular rash on trunk following by mucosal bleeding
What are the skin findings associated with syphilis?
Chancre
Rash
Condylomata lata
Gumma
Chancre (painless ulcer of skin and MM at site of inoculation)
Rash (maculopapular rash of secondary syphilis - palms/soles of hands)
Condylomata lata (cauliflower appearing warts on penis, labia and rectum)
Gumma (painless pink-dusky red nodules of various sizes that may necrose and ulcerate)
Describe perianal streptococcal dermatitis
6 mo to 10 years
Sharply circumscribed superficial perianal erythema
Bright red with wet surface OR dry and pink
No fever
What’s the diagnosis of chronic eczema and a painful vesicular eruption?
Eczema herpeticum
Herpes simplex virus
Can be complicated by a secondary bacterial infection
Viremia can progress to meningitis and encephalitis
May need to treat with Acyclovir IV for rapidly progressive or super sick kids
What are the features of measles?
Fever
Cough
Coryza
Conjunctivitis
Erythematous maculopapular rash that begins on the forehead and behind the ears, spreading to the face, neck, torso, and extremities
Koplik spots - bright red punctae with central white flecks on the buccal mucosa near the 2nd molars (pathognomonic)
Differentiate between EM, SJS, TEN
Erythema Multiforme
Stevens-Johnson syndrome
Toxic epidermal necrolysis
EM
Erythematous maculopapular rash - target lesions that coalesce into an annular or serpiginous border
Resolves in 2 weeks
SJS Severe drug eruption Febrile erosive stomatitis Ocular involvement Diffuse rash or discrete dark red macules Sometimes necrotic center <10% BSA
TEN Severe drug eruption Extensive loss of epidermis due to necrosis Leaves skin looking scalded >30% BSA
How does the rash of Rocky Mountain spotted fever change over time?
Starts as an erythematous macular rash –> becomes papular and frequently petechial
First appears on the wrist/ankles –> spreads centrally within hours to involve the proximal extremities and trunk and palms/soles
Describe phytophotodermatitis
Toxic photoreaction
When exposed to psoralen (photosensitizing agent in plants, perfumes, grasses, fruits and veggies - celery, limes, parsley) and then immediately to sunlight
Usually appears as hyperpigmentation
Describe pityriasis rosea
Begins with a large solitary oval lesion (herald patch) - on trunk or upper thighs
Followed by eruption of smaller, oval, slightly raised papules that are pink-brown and have peripheral scales
Christmas tree pattern on trunk
Spares the face, scalp and distal extremities
Eruptions usually last 4-8 weeks
Differentiate HSP (Henoch Schonlein Purpura) from Purpura Fulminans
HSP
Distribution usually limited to extremities (lower legs/buttocks, sometimes upper extremities)
Infants sometimes have facial involvement
Associated Sx: Arthralgias, abdo pain, hematuria
Otherwise kids look well
Normal platelets and coags
PURPURA FULMINANS Widespread purpura Associated Sx: lethargy, hypoventilation, shock Child appears ill and can be toxic Thrombocytopenia Abnormal coags
Name 5 skin manifestations of Kawasaki
1) Dry, cracked erythematous lips
2) Erythematous polymorphic truncal rash - morbilliform or scarlinatiform
3) Red, swollen hands and feet
4) Peeling nails and fingers
5) Desquamating perineal rash
Name 4 skin findings mistaken for child abuse
Lichens sclerosis
Mongolian spots
Coining
Accidental ecchymoses
Lichens sclerosis - indurated and shiny atrophic plaques found in vulvar and perinanal areas
Mongolian spots - hypermigmentation over the sacrum and back
Coining - asian remedy to rid body of “bad winds”
Accidental ecchymoses - normal childhood bruises over bony prominences (shins, knees, forearms, elbows, forehead, chins)
Name the cutaneous manifestations of disseminated gonococcemia
Small macules that progress to papules on the extremities and over involved joints
May develop a vesicle and grey umbilicated center
How does poison ivy spread
Only through contact with the sap
Not from person to person
How do you treat poison ivy
Supportive care Bland creams - glaxal base, calamine lotion Baths Cool compresses Oral antihistamines for itch Steroids only for severe cases
Topical steroids and antihistamines have minimal effect
Describe a pyogenic granuloma
Rapidly growing vascular proliferation
Develops in the site of an obvious or unnoticed trauma
Not infectious
Can have spontaneous bleeding - control with silver nitrate sticks
Ultimate treatment - electrodessication and curretage
Differentiate between transient pustular melanosis and erythema toxicum neonatorum
TRANSIENT PUSTULAR MELANOSIS Benign newborn rash Superficial vesiculopustular lesions Present at birth Lesions rupture easily with the first bath - leaves fine white scales and brown hyperpigmented macules Lesions fade in several weeks to months
ERYTHEMA TOXICUM NEONATORUM
Benign newborn rash
Appears during the first 3-4 days of life (up to day 10)
Blotchy erythema –> develops into pale yellow or white papules/pustules
Individual lesions last 2 days
How do you treat herpetic whitlow?
Single or mutliple vesicles localized to distal fingers/toes
Avoid I&D
Local care and PO acyclovir if it involves herpetic gingivostomatitis
What condition is associated with recurrent pustules on the feet of infants?
Infantile acropustulosis
7-10 day episodes of pruiritic pustules and papulovesicles on the hands and feet
Usually in infants 2-10 months - resolves at 2-3 years
Tx with mild-mod potency topical steroids
What is the diagnosis for a rash of diffuse papular, scaly and fissuring eruptions that does not respond to anti-inflammatory or anti-fungal agents?
Histiocytosis X
Proliferation of Langerhan’s histiocytes in the skin and other organ systems
Consider a biopsy in difficult to treat diaper rashes
What is the term for when skin can be rubbed off with minimal trauma?
Nicholsky’s sign
Seen in blistering epidermal diseases - scalded skin, pemphigus vulgaris, TEN
How long do you isolate kids with Parvovirus B19 (5th disease or erythema infectiousum) - slapped cheek and lacelike rash on arms and legs
No isolation
By the time the rash becomes clinically obvious the infectious period is over
Rash resolves in 3-5 days
Differentiate between granuloma annulare and tinea corpis
Both have:
Circular plaques consisting of a ring of papules around a depressed center
GRANULOMA ANNULARE
Non-scaly
Dorsal surface of hands and feet
Self-resolve in months to a year
TINEA CORPIS Scaly Multiple lesions All over the body Superficial fungal infection
Describe Roseola
Acute febrile illness Affects young kids 6 - 36 months Caused by human herpes virus 6 and 7 3 or more days high fever Fever goes away Rash develops - erythematous, morbilliform rash with discrete rose-pink macules Trunk to extremities, neck and face
List the findings of Gianotti-Crosti syndrome
Self-limiting Symmetrical erythematous papules Extremities, cheeks and buttocks Rash may last 2-8 weeks Can be recurrent Associated with viral infection - EBV, CMV, coxsackie
AKA papular acrodermatitis
Which organisms cause bullous and and nonbullous impetigo?
BULLOUS - toxin producing strains of Staph aureus
NON-bullous - GAS (Grp A Streptococcus)
What are the dermal manifestations of zinc deficiency?
Acrodermatitis enteropathica
Erythema, crusting and fissuring of the perioral skin and cheeks
Diffusely erythematous diaper rash
Psoriasiform lesions on the anus and buttocks and feet
Tx with dietary Zinc supplements - dramatic improvement
Compare and contrast smallpox and chickenpox
SMALLPOX
Presn: Febrile with systemic symptoms for several days prior to the rash
Severity: Very ill from the start
Lesions: Hard circumscribed pustules
Distribution: face and distal extremities, involving palms and soles
Lesion development: Slow, with all lesions at the same stage of development
CHICKENPOX
Presn: Mild fever with minimal Sx for 1-2 days prior to rash
Severity: Not severely ill unless complications develop
Lesions: vesicles on erythematous base
Distribution: face and trunk, with no involvement of the palms or soles
Lesion development: rapid, with lesions at different stages
Describe the name of the skin finding with lyme disease
Erythema chronicum migrans
Develops 4-20 days after a tick bite
1st sign may be a red papule from the tick bite
Then an annular ring with a flat border grows with a white central clearing
Some develop multiple annular rings
What is the skin finding following a bite from a brown recluse spider?
Painful hemorrhagic blister
Over several days a dry gangrenous eschar develops
Define morbilliform
“Measles-like”
Eruptions that are generalized, discrete red to pink macules
Seen in several viral infections - rubella, enterovirus, adenovirus, roseola, parvovirus, EBV
What are the diagnostic criteria for neurofibromatosis
Type 1:
6 or more cafe au lait spots > 5mm in diameter (prepubertal kids) or >15mm diameter (older kids)
What skin features are present in kids with scarlet fever?
Flushed face with perioral pallor
Diffuse, blanching, erythematous rash that has a sandpaper consistency with accentuation in the axilla and groin
Pastia’s lines in the flexural surface of the elbow
Desquamation as the acute phase of the illness resolves
Distinguish irritant contact diaper rash from candidal diaper dermatitis
DIAPER RASH
Due to contact of skin with urine/feces in moist closed environment
Red papules or patches in diaper exposed areas
CANDIDAL DIAPER DERMATITIS
Due to gut flora Candida albicans
Perianal erythema and maceration spreading to produce moist, bright red, confluent plaques in the diaper area, esp. interriginous folds
Satellite lesions are common
How long does acne neonatorum last?
Start at 3 weeks of age
Last for 4 months
Most resolve by 6 months
Name 5 cutaneous manifestations of lupus
1) Erythematous maculopapular butterfly facial rash
2) Discoid lesions - chronic persistent skin changes that progress to scarring and pigmentary changes
3) Photosensitive rash - Transient annular papulosquamous lesions in sun exposed areas
4) Erythema on the palms and pulps of fingers and diffuse erythematous scaly macules on the dorsum of the fingers
5) Raynaud’s - pallor and cyanosis of the digits when exposed to the cold
What are the two main types of epidermolysis bullosa (EB)?
Inherited condition of blisters after mild trauma
2 categories:
1) Nonscarring types (EB simplex and junctional type EB)
2) Scarring and dystrophic forms of EB
Name 5 signs/Sx of scabies in infants
1) Irritability
2) Eczematous lesions
3) Characteristic burrows on the hands and feet
4) Axillae, groin, palm, and sole involvement
5) Dermatitis - trunk, face, neck, scalp
