Rash Flashcards
The rash in an allergy will be… c.f. Eczema?
allergy - bumpy and itchy, may come and go. eczema - also itchy but will come with a longer history, and be associated with dry skin.
T/F: In many cases there is simply a new rash with no obvious cause in a well child.
true
The specific questions you need to ask for a rash if it is not from an obvious cause such as allergy?
- fever?
- irritable or lethargic?
- eating and drinking?
- Any other symptoms?
Plenty of open questions and allow the parents to talk
The sort of things that might be picked up on Hx include cough and sore eyes in (1) or red eyes in (2) disease, abdominal pain in (3), a recent burn in (4), bleeding gums or nosebleeds and lethargy in (5)
Joint pains occur with a rash in several conditions, which include…(6)
- measles
- Kawasaki
- Henoch-Schonlein Purpura
- toxic shock syndrome
- leukaemia
- Meningococcal septicaemia, Henoch Schonlein purpura, juvenile onset arthritis and leukaemia.
T/F: Headache and photophobia are key symptoms for diagnosing meningitis in a child under 5
false - not common complaints until a child is 6/ 7
Vomiting or seizures may be signs of meningitis. They won’t say they have a HA, but may be irritable/ inconsolable/ have an unusual cry.
In meningococcal septicaemia rigors or joint pains may occur before the rash and cardiovascular collapse a few hours later.
There are 2 parts to the examination of a child with a rash
- The first is a general assessment of how the child is;
- look at the rash itself.
Around 30% of children with meningococcal septicaemia have what kind of rash to begin with? (before the classic rash appears)
a blanching, erythematous rash
What is thie describing: ‘usually innnocent and is the commonest type of mild viral rash’
Erythema (simply means redness)
what is this describing: transient rash in babies < 1 week old and tends to have raised, blotchy areas.
erythema toxicum neonatorum
macular vs papular rash?
- macular rash: splotchy and under the skin, so you can’t feel it
- papular rash: also splotchy with raised areas.
The two often happen together and are often described as maculo-papular. This happens in mild viral rashes, in rubella, measles, and also in Kawasaki’s disease.
Vesicles are little blisters. Seen in what sort of conditions?
Chickenpox, Herpes simplex and shingles.
If the blisters are pus filled it may be a Streptococcus or Staphylococcus infection.
Petechiae vs purpura?
- Petechiae: little pink/ purple dots ≤1mm, flat
- Purpura: purple areas ≥2mm, mean that blood has leaked from the vessels.
what causes the characteristic rash in Meningococcal septicaemia? (a severe bacterial infection)
Neisseria meningitidis secretes a toxin which causes damage to blood vessels > blood leaks out into the skin > characteristic rash which doesn’t blanch when pressed
Looks more like a bruise than pinkness of the skin.
- inflamed-looking, itchy, bumpy rash, usually all over the body.
- caused by allergy, and may occur in anaphylaxis.
- can come up and go back down quite quickly, and seem to affect different areas of the body within an hour or two.
urticaria
a common skin condition which often runs in families and causes dry, itchy skin.
Eczema
(similar reaction can occur as an allergy - allergic dermatitis)
eczema in younger vs older children?
- older children: will see scratch marks, and the ezcema is usually around the neck, elbows, knees, armpits and face. It can look quite inflamed, and secondary bacterial infection sometimes occurs, which tends to make it weepy with scabs.
- younger children: skin appears dry and bumpy with prominent follicles, and the appearance is more generalised.
What is this describing: a variation of eczema, bumpy and usually happens on dry skin. Babies with this condition may have a flaky scalp condition called cradle cap.
seborrhoeic dermatitis.
The bacterium ___ ___ is carried in the nose of a lot of people, but in some people it spreads through the bloods stream, leading to meningitis or meningococcal septicaemia
Neisseria meningitidis
Meningococcal septicaemia is most common in what age groups?
<2 and 16-21
presents like any serious bacterial infection, although may cause joint pain. The rash can be non-specific, or petechial or purpuric.
what is this describing: a disease which causes a rash and also affects the mouth and other mucous membranes.
Stevens-Johnson syndrome
Characterstic rash in SJS?
very characteristic appearance of circles called target lesions. (red target with a pale centre)
Cases of SJS where there is just the rash and no mucous membrane involvement are called what?
erythema multiforme. Children tend to be miserable, and often need hospital admission if they can’t drink. The disease may become quite severe.
Toxic shock syndrome is caused by what?
- by a toxin secreting bacteria, either Streptococcus or sometimes Staphylococcus.
- may occur 2-3 days after a minor burn (burn itself tends to look normal, but the child has a fever, diarrhoea, appears unwell and has an erythematous rash).
- Can become unwell quickly, needs Abx as soon as the diagnosis is suspected
what is this describing: a disease of childhood, most common in the under 2’s, which has serious complications involving the heart and coronary arteries.
Kawasaki disease
(With the right drug treatment, started early, these serious problems can be prevented)
features of kawasaki disease?
rash usually maculo-papular.
an immune disease which causes bleeding into the skin.
Henoch Schonlein purpura
HSP vs meningococcal septicaemia?
causes a similar rash however in HSP the child is generally well, so your physiological assessment of the child will be normal.
HSP typical distribution of the rash?
tends to be worst on the backs of the legs and the buttocks.
Other features of HSP?
- Bleeing also occurs in the wall of the intestine, which causes pain, and can even cause intussusception.
- Bleeding can occur in the joints and cause quite severe joint pain.
- Kidney disease
why is it important to diagnose HSP early?
Anaphylaxis means a severe allergic reaction. What does the skin reaction tend to be?
widespread erythema and itchy flushing/ urticaria/ both
Potential dangers of anaphylaxis?
- can affect the airway, in terms of lip or throat swelling
- can affect breathing by causing bronchospasm
- can affect circulation by causing peripheral vasodilation and hypotension
- can affect the gut, with diarrhoea
In anaphalaxis if only the skin is affected > no cause for alarm. If it affects A, B or C are affected however, what treatment is needed?
urgent treatment with IM adrenaline can work within minutes and save lives.
What is idiopathic thrombocytopaenic purpura (ITP)? Signs?
- an immune disease which affects the platelets and therefore the blood clotting
- causes petechiae in the skin. The child will be completely well other than the rash.
It is important to diagnose it with a full blood count and refer the child to a paediatrician, in case they need treatment with steroids.
What kind of skin lesions can leukaemia sometimes present with?
petechiae or purpura. The child will usually appear clinically anaemic. In all children with petechiae it is important to do a full blood count, so you don’t miss leukaemia or ITP, one of the other red flag conditions.
Petechiae vs purpura?
Petechiae: pink/ purple dots ≤1mm and flat.
Purpura: purple areas ≥2mm. Mean that blood has leaked from the vessels.
What causes the rash in Meningococcal septicaemia?
Neisseria meningitidis secretes a toxin which causes damage to blood vessels > blood leaks out into the skin causing characteristic non-blanching rash
Appears more like a bruise than pinkness of the skin.
