Rashes Flashcards
Discuss a systematic approach to assessing rashes
History:
- Date of onset
- Sequence of onset
- Current meds
- Recent exposure to similar condition/travel
- Skin routine
Assess the:
- Appearance (blanching, raised, discharge etc)
- Site
- Pattern of development
- Associated symptoms
Identify ‘red flags’ associated with rashes that may indicate a life threatening condition
- fever
- toxic appearance
- mucosal lesions
- severe pain
- very old/young in age
- immunosuppressed
- commencement of new medications
Rash associated with fever or hypotension = potentially life threatening
What are the 4 categories of rash based on visual and tactile characteristics?
- Petechial/pupuric
- Erythematous
- Maculopopular
- Vesiculobullous
Identify and discuss a petechial/purpural rash
- small, red lesions due to leaking of blood from ruptured capillaries (purpura when lesions >0.5cm diameter)
- non-blanching
- usually starts on dependent areas (inc, legs)
- may be raised or palpable (due to perivascular inflammation)
- may not be palpable due to low platelets or DIC
*patients with this rash and fever should be characterised as having a life threatening condition until proven otherwise
Identify and discuss a erythematous rash
- diffuse red skin from capillary congestion - like a ‘bad sunburn’
- can be due to multiple inflammatory/infectious diseases that are life threatening
- Check for ‘Nikolskys sign’ - sloughing
Identify and discuss a maculopapular rash
- most commonly due to viral illness
- can also be bacterial, drug reactions and immune-mediated
Macules = lesions which are flat, red splotches
Papules = solid, raised lesions
*check for febrile, and if the lesions are central or peripheral
Identify and discuss a vesiculobullous rash
- characterised by involvement of the dermal-epidermal junction resulting in fluid filled lesions.
- Lesions = vessicles <1cm, bullae >1cm
investigate if lesions are diffuse over the body (eg varicella) or concentrated in a single area (eg HFM disease - febrile, herpes - afebrile)
Non-infectious rashes
Atopic dermatitis (eczema)
Cellulitis
Uricarial (hives)
Infectious rashes
Chicken pox (Varicella)
Herpes Zoster (Shingles)
Impetigo
Measles
Meningococcal disease
Presentation and management of eczema
- chronic inflammatory skin condition
- skin does not moisturise well, becomes dried out and open to allergens/irritants, mediators cause an itch which is further exacerbated with scratching.
- common in people with allergies, thought to have a genetic link
Clinical manifestations:
- skin becomes red, scaley and itchy. May develop small blisters and weep.
- most common in creases of elbow, behind knees, across ankles, face, ears and neck
Treatment:
- moisturiser 4-6 times/day
- avoid irritants eg soap
Flair ups
- topical corticosteroids then moisturiser on top
- wet dressings
- antihistamines can help itch
- prevent and treat infection - eg staph
Presentation and management of cellulitis
- infection of the skin, usually by staph through a break in the skin or oedema due to poor blood flow
- presents as a red, swollen area, hot and tender to touch
Clinical manifestations:
Skin - red, swollen, tender, painful, warm
Fever
Malaise
Red spots
Blisters
Skin dimpling
*diagnosis on clinical manifetations and history*
Treatment:
Prevention
ABx - penicillin
Drainage of abcyss
Presentation and management of urticarial rash (hives)
- caused by superficial swellings on the surface of the skin that can occur in all age groups
- due to the release of histamine from mast cells which irritate nerve endings to cause a localised itch and irritation and vasodilation of small blood vessels
- rash ranges insize and is pink or red in colour, surrounded by a red flair
- Can be acute (allergy) or chronic (underlying immune cause)
Treatment:
- Non-drowsy antihistamine
- keep cool, wer loose clothing
- avoid aspirin/NSAIDS
- Immune modilators for chronic
Presentation and management of chicken pox
- airborn transmission or direct contact with vescicle/fluid. Scabs not infectios.
Infectious period:
<5 days before the rash until lesions have crusted over
Identification:
Initially maculopopular –> vesicular –> crusted lesion
Lesions more numerous on the trunk
Diagnosed with:
Cultures, serology for antibodies
Management:
Isolation
Symptom management
Infection prevention
?antiviral
Presentation and management of Herpes Zoster (Shingles)
- unilateral vesicular eruption along a nerve associated with severe pain
- rash can last up to several weeks, pain for months
- be aware of rash near eye as blindness can result
Management:
Analgesia
Antiviral
Presentation and management of Impetigo (school sores)
- rapidly spreading, highly contageous superficial skin infection
- Due to strep
- mostly around the mouth and nose, mildly irritating blisters that become pustural and evolve to a honey coloured crust
- cen become systemically unwell
Management:
Antibiotics
Presentation and management of measles
- droplet precautions
- generalised maculopapular rash, first appears on the face
- associated with fever, severe cough, conjunctivitis and Koplik spots on buccal membranes
Complications:
- otitis media
- pneumonia
- encephalitis
Diagnosis:
Pathology and antibody presence
Incubation period:
Approx 10 days
Treatment:
Symptomatic
Presentation and management of Meningococcal disease
- reportable illness
- present with meningitis/sepsis
Clinical menifestations:
- stiff neck, headache, nausea, fever, photophobia
- petechial/purpuric non-blanching rash
Incubation period:
short -> hours-days
Diagnosis:
- blood culture CSF
- gram stain CSF
Management:
IV penicillin if suspected (do not wait for lab confirmation)
Vasculitis rashes
Henoch-Schonlein pupura
Kawasaki disease
Stevens-Johnson syndrome
Presentation and management of Henoch-Schonlein pupura
Most common vasculitis in children
Inflammation damages the epithelial lining resulting in fluid leaking into the skin, intestines, kidneys and joints
- cause unknown, ?abnormal immune response to an infecition
- approx 75% occur days after an IRT
Clinical manifestation:
- Rash starts out looking like hives and then progresses to a petechial/purpuric non blanching raised rash
- HTN
- Arthritis
- Abdo pain (bowel obstruction/peritonism/GI bleed)
- Respiratory distress
- Neuro dysfunction (heammorgage/encephalopathy)
- Proteinuria
Management:
- symptomatic
- raised head of bed
- elevation of affected limbs
Presentation and management of Kawasaki Disease
- inflammation in the walls of some blood vessels, most common in children of asian descent
- consider with fever, rash and evidence of systemic inflammation
Complications:
Dialation of coronary arteries prgress to aneurysm, can cause thrombosis and AMI. Also other coronary complications.
Clinical manifestations:
Diagnosis = fever + 4 of..
-conjunctivitis
- lymphadenopathy
- polymorphous rash without vesicles, bullae or crusts
- lips and oral mucosa hyperaemia/strawberry tongue
Hyperaemic, oedematus hands/feet
Management:
Echocardiogram
Path
IV immunoglobulin
Corticosteroids
Presentation and management of Stevens-Johnson syndrome (SJS)
medical emergency
-flu like symptoms, followed by development of a painful red/purple rash that spreads across the body, then blisters to the mucous membranes, then skin sheds and epidermous layer dies
Complications:
Dehydration from fluid movement
Sepsis
Eye issues
Respiratory distress from inflammation
Permanent skin damage
Treatment:
- Supportive care
fluid replacement
wound care
eye care
Analgesia
Antiinflammatories
ABx
Corticosteroids, immuoglobulin
flow charts
