RASHES

Question 1

• Epidermal vesicles/pustules forming a honey color crust
• Usually starts under nose and child can autoinnoculate it to other areas
• S. pyogenes, S. aureus ß use oral meds to cover staph (Mupirocin)

Answer 1

Impetigo

Question 2

• Lichenified dry pruritic skin, hyper pigmented plaques seen in 10-20% of skin
• Almost all kids that have it present with it 90% by age 5
• Associated with asthma (same disease in different body parts)
• Locations
  o Infants = cheeks and forehead NOT nose
  o Toddler = extensor surfaces
  o School age/Teens = behind neck
• Treatment
  o Break the “itch-scratch cycle”. Use a cream/emollients for dryness
  o No harsh soaps
  o Non-sedating anti-histamines during school
  o Small area could use OTC 1% hydrocortisone
  o Short oral steroid burst if severe
  o Calcineurin inhibitors

Answer 2

Atopic Dematitis (Eczema)

Question 3

• Circumscribed sharp patch, scaly border

- Treat – OTC like imidazole and treat for 1 week even after symptoms subside and you cant see it

Answer 3

Tinea Corporis (Ringworm)

Question 4

• More in males and African Americans
• Black dot, broken shaft tinea capitis
• Treat – oral griseofolvan w/ a fatty meal for better absorption, ketoconazole shampoo 2x per week

Answer 4

Tinea Capitis

Question 5

• Hypersensitive reaction to long standing tinea capitis

- Treat – oral griseofolvan w/ a fatty meal for better absorption

Answer 5

Tinea Capitis Kerion

Question 6

• Adolescent males in the inner groin

- Treat – topical antifungal

Answer 6

Tinea Cruris

Question 7

• Very RARE before puberty

Answer 7

Tinea Pedis

Question 8

• Patient uses hydrocortisone cream and that lightens the rash but does not get rid of it. Tinea infection
  will still be there because it was just treated with steroids

Answer 8

Tinea Incognito

Question 9

• Yeast infection seen in late summer, pigment is high or low
• Scaling papules coalesce
• Treat - Selenium sulfide, Ketoconazole cream

Answer 9

Pityriasis Versicolor

Question 10

• Mimics tinea corporis but no scaling, seen on dorsum of hands and feet

Answer 10

Granuloma Annulare

Question 11

• Pearly papules that are umbilicated caused by the Pox virus
• Child can autoinoculate themselves à axilla, trunk, face
• Treat – leave alone or curettage if lots of them

Answer 11

Molluscum Contagiosum

Question 12

• Single oval patch precedes eruption of oval papules/plaques oriented along skin lines w/ a collarette
  scale. It is a viral infection of HHV-7
  o “my childs ring worm is spreading” – classic story
• Prevalent of school age kids
• Treat – moisturizers, oatmeal bath, anti-histamines, consider secondary syphilis testing cause rash may
  look like it

Answer 12

Pityriasis Rosea

Question 13

• Papules/vesicles with intense pruitis, can do a skin scraping to check
• Spread by direct contact
• Treat – must treat everyone in the house, Permethrin 5% cream over all skin

Answer 13

Scabies

Question 14

• Target lesions that coalesce

o Be aware of SJS but its rare

Answer 14

Urticaria Multiforme

Question 15

• Wheels (raised and spongy areas) that moves all around and intensifies and fades throughout

Answer 15

Urticaria

Question 16

• Exquisitely tender erythematous plaques on anterior tibia

- Strep is the #1 cause (coccidiodomcosis in western USA)

Answer 16

Erythema Nodosum

Question 17

• Lyme Disease and patients usually present 8-9 days after tick bite
• Fever, arthralgias, myalgias
• Testing in the first 1-4 weeks is negative usually
• Treat – 14-21 days of amoxicillin or doxycycline (treat for 28 days if arthritis is present)
  o Check EKG cause it may lead to a heart block

Answer 17

Erythema Migrans

Question 18

• Caused by staph toxins
• (+) Nikolsky sign – skin comes off when you touch it
• Usual site is nasopharynx
• Treat – oral mupiricin or IV antibiotics if later on

Answer 18

Staph Scalded Skin

Question 19

• M>F and most common in under 5 yrs of age. Highest in Asians
• Fever for 5 days, conjunctival infection, stomatitis (mouth inflammation), exanthema, cervical nodes
• Erythema of palms/sole of feet
• Labs = elevated ESR, CRP, white cells in urine
• Need to admit patient and check ECG
• Treat – IV immunoglobulin and aspirin 80-100 mg/kg/day

Answer 19

Kawasakis Disease

Question 20

• Fine sandpaper rash, antecubital inguinal erythema, strep pharyngitis

Answer 20

Scarlet Fever

Question 21

• Fever for 3-5 days, fever will go away in morning then couple hrs later pink fine lacy rash appears.
  Periorbital edema

Answer 21

Roseola Infantum

Question 22

• Parvovirus B-19

- Intense erythema of cheeks (slapped cheeks disease) w/ some lacy eruption on arm

Answer 22

Erythema Infectiosum (fifths disease)

Question 23

• Anterior vesicular eruption = HSV herpes stomatitis
  o Can autoinoculate themselves à herpatic whitlow on finger
• Symptoms 7-10 days
• Treat – cool foods and fluids, magic mouthwash, viscous lidocaine

Answer 23

Perioral Problems

Question 24

• Can cause Herpangina – vesicle on uvula

Answer 24

Hand, Foot, Mouth Disease Coxsackie A

Question 25

• Vaccine now used

Answer 25

Varicella

Question 26

• Most Common exanthema in kids – basically the rash you’re seeing is just due to the virus and it will go away on its own

Answer 26

Viral Exanthems

Question 27

• Rash on buttocks inferiorly also arm extensor

- Beware of GI bleed and nephritis

Answer 27

Henoch-Schonlein Purpura