Rashes Flashcards

1
Q

Discuss a systematic approach to assessing rashes

A

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
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2
Q

Identify ‘red flags’ associated with rashes that may indicate a life threatening condition

A
  • 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

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3
Q

What are the 4 categories of rash based on visual and tactile characteristics?

A
  • Petechial/pupuric
  • Erythematous
  • Maculopopular
  • Vesiculobullous
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4
Q

Identify and discuss a petechial/purpural rash

A
  • 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

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5
Q

Identify and discuss a erythematous rash

A
  • 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
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6
Q

Identify and discuss a maculopapular rash

A
  • 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

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7
Q

Identify and discuss a vesiculobullous rash

A
  • 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)
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8
Q

Non-infectious rashes

A

Atopic dermatitis (eczema)
Cellulitis
Uricarial (hives)

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9
Q

Infectious rashes

A

Chicken pox (Varicella)
Herpes Zoster (Shingles)
Impetigo
Measles
Meningococcal disease

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10
Q

Presentation and management of eczema

A
  • 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

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11
Q

Presentation and management of cellulitis

A
  • 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

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12
Q

Presentation and management of urticarial rash (hives)

A
  • 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
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13
Q

Presentation and management of chicken pox

A
  • 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

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14
Q

Presentation and management of Herpes Zoster (Shingles)

A
  • 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

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15
Q

Presentation and management of Impetigo (school sores)

A
  • 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

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16
Q

Presentation and management of measles

A
  • 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

17
Q

Presentation and management of Meningococcal disease

A
  • 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)

18
Q

Vasculitis rashes

A

Henoch-Schonlein pupura

Kawasaki disease

Stevens-Johnson syndrome

19
Q

Presentation and management of Henoch-Schonlein pupura

A

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
20
Q

Presentation and management of Kawasaki Disease

A
  • 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

21
Q

Presentation and management of Stevens-Johnson syndrome (SJS)

A

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​

22
Q

flow charts

A