Pediatric Rashes Flashcards
Kid has a rash for 5 days. What disease should come to mind and what other symptoms help to confirm the diagnosis?
Kawasaki
Fever > 5 days with 4 of the 5 following:
(CRASH)
Conjunctivitis, Rash, Adenopathy (cervical), Strawberry tongue, Hands and feet erythema
Kid has a fever for 5 days, red hands and feet, lymph nodes in the neck, a strawberry tongue, and a rash. What is the treatment and feared complication of this disease?
Concern for Kawasaki’s
IVIG and High dose aspirin to help prevent coronary artery aneurysm
Kid has palpable purpura on buttocks and legs. What other symptoms are common and what is the cause of this disease?
Henoch-Schonlein Purpura
IgA vasculitis of the small arteries leading to blood leakage and issues with perfusion leading to abdominal pain, arthralgias, hematuria, and kidney injury
Kid has palpable purpura on buttocks and legs. What is the workup and treatment?
HSP
Usually self limited, but can affect the kidneys for long term.
Check UA for protein and red casts
Labs for kidney and liver function
Coags and platelet count
Rule out intussusception if needed
Supportive care with NSAID’s and if severe, steroids
What is the prognosis of HSP?
Usually resolves within 3–4 weeks
Can have lasting kidney issues and needs to be monitored
1/3 will have recurrence
Many can be treated at home
What is the classic rash pattern in measles?
Morbiliform rash (maculopapular) from head to toe Red circles flat, 1–10mm with healthy skin in between
What disease has koplik spots?
Measles
What are the classic symptoms of measles?
Cough, Coryza, Conjunctivitis
Koplik spots
What are the complications of measles?
Pneumonia, Myocarditis, Pericarditis, Weakens immune system, Encephalitis, Death
ADEM: acute disseminated encephalitis
SSPE: subacute sclerosing panencephalitis that progresses to a vegetative state
What is the treatment for measles?
Isolation as this is a very infectious disease! The most infectious known to man!
Infectious from 4days before and after the rash starts
Supportive care otherwise
What infection causes an itchy anus in kids and what is the treatment?
Enterobius (Pinworm)
Single dose of mebendazole or pyrantel
Treat all family members
What is eczema?
Atopic dermatitis
Chronic pruritic skin condition
Inflammatory condition
What makes eczema worse and how is it treated?
Skin dryness and winter months make it worse
Triggers such as bathing, dessicants, heat, contact irritants, allergens
Treated with steroids, strong steroids cannot be used on the face
Use vaseline, aquaphor, emmolients QID
benadryl for itchiness, minimize bathing and drying soaps
Patient with eczema presents with weeping skin lesions. What should come to mind?
Bacterial superinfections including strep
Which viral kid disease causes Subacute sclerosing panencephalitis or an acute disseminated encephalopathy?
Measles
Kid has had a high fever that resolved and then a rash appeared. What is this classic disease?
Roseola infantum or exanthem subitum (“sudden flowering”)
Generally benign
A patient with eczema has been treated with topical steroids and is complaining of a change in the rash with increased pain and vesicles. What is the issue and what is the treatment?
Concern for Herpes infection of the eczema
Eczema herpeticum
Mortality as high as 10%!
Need to start IV acyclovir immediately and admit and test for HSV
Cover for bacterial infection as well if indicated
Brought on by immune suppression, possible from the topical steroids
What is the best approach when using steroids to treat eczema?
Use lowest dose that works
Only low potency on the face or groin and medium on the trunk or extremities
Potency is a measure of vasoconstriction
If increased potency is needed, it is better to change the drug than to change the concentration
Steroids cause tachyphylaxis and therefore brief periods of a break can be helpful to prevent this
Is eczema more common on flexor or extensor surfaces?
Eczema on flexor
Psoriasis on extensors
Kid has a dry and peeling scalp that is at times yellow and crusty. What is the likely cause and treatment?
Seborrheic dermatitis or cradle cap
Treat with anti-fungal shampoo (ketoconazole)
Kid has a fever, is miserable, is refusing to eat or drink. They are dehydrated. There are red lesions in the back of the throat. What other symptoms are likely, what disease and cause, and treatment?
Hand-Foot-Mouth
Coxsackie virus
This is NOT Herpetic gingivostomatitis, which has anterior lesions
This IS herpangina
Check hands, feet, and buttocks for lesions
Give analgesics to help kid drink
Admit if cannot drink and dehydrated, otherwise supportive care at home
Mouth rinses are not recommended
Remind parents that the kid won’t eat and that is fine
Why are mouth rinses not a good idea for kids with mouth pain?
Benzocaine leads to methemoglobinemia, especially in kids less than 2
Magic mouthwash cannot be swallowed and can lead to sedation and seizures
What is the rash location progression in varicella?
Face to trunk
Which disease has lesions in various stages or groups?
Varicella
