Rashes

Question 1

History

Answer 1

Duration, site of onset, evolution and spread
Does it come and go (eg urticarial)
Itch (eczema, scabies)
Recent drug ingestion/exposure to provocative agents (sunlight, food, allergens, detergens)
Other contacts affrected (viral exanthems, infestations)
Other symptoms (sore throat, URTI)
FH (atopy, psoriasis)

Question 2

Examination

Answer 2

Check for non-derm features: fever; mucous membranes; lymphadenopathy; splenomegaly; arthropathy
Describe rash in derm language - morphology (size, shape, colour, macules, papules, nodules, vesicles, pustules, bullae, petechiae, purpura, ecchymoses); arrangement and distribution (flexors, extensors, mucus membranes - measles, Kawasaki)
Palpate - scale thickness, texture, temp, dry skin

Question 3

Causes: scalp

Answer 3

Seborrheic dermatitis
Eczema
Psoriasis
Fungal

Question 4

Causes: mucous membranes

Answer 4

Measles
Kawasaki disease
Stevens-Johnson syndrome
Herpes

Question 5

Causes: trunk

Answer 5

Viral exanthems

Molluscum contagiousum

Question 6

Causes: flexor surfaces

Answer 6

Eczema

Question 7

Causes: extensor surfaces

Answer 7

Psoriasis

HSP

Question 8

Causes: web spaces

Answer 8

Scabies

Question 9

Causes: nails

Answer 9

Fungal infections

Psoriasis

Question 10

Causes: shin

Answer 10

Erythema nodosum

Question 11

Maculopapular rash

Answer 11

Generalised

Most likely viral exantham, might be drug induced eruption

Question 12

*Measles

Answer 12

Maculopapular rash
Prodrome of fever, corysa and cough
Koplik’s spots in mouth just before rash appears
Rash tends to coalesce

Question 13

*Rubella

Answer 13

Maculopapular rash
Discrete, pink macular rash
Starts on scalp and face
Occipital and cervical lymphadenopathy may precede rash

Question 14

*Roseola infantum

Answer 14

Maculopapular rash
<3years
3 days of sustained fever followed by pink morbilliform eruption appears as temp subsides
HHV-6 or HHV-7

Question 15

*Enteroviral infections

Answer 15

Maculopapular rash
Generalised, pleomorphic rash
Mild fever

Question 16

*Glandular fever

Answer 16

Maculopapular rash
Malaise, fever, exudative tonsillitis
Lymphadenopthy and splenomegaly commonly found

Question 17

*Kawasaki disease

Answer 17

Maculopapular rash
Protracted fever
Generalised rash
Lymphadenopathy
Conjunctival inflammation

Question 18

*Scarlet fever

Answer 18

Maculopapular rash
Fever and sore throat
Rash starts on face
Strawberry tongue

Question 19

Chickenpox

Answer 19

Vesicular rash
Papulovesicles on erythematous base
Vesicals become encrusted
Lesions at different stages
Involvement of mucous membranes

Question 20

Eczema herpeticum

Answer 20

Vesicular rash

Exacerbation of eczema with vesicular spots caused by a herpes infection

Question 21

Haemorrhagic rash

Answer 21

Due to extravasated blood
Do not blanche
Classified on size
Petechiae - smallest
Purpura - middle
Ecchymoses - biggest

Question 22

*Meningococcal septicaemia

Answer 22

Haemorrhagic rash

Petechial or purpuric, may be preceded by maculopapular

Question 23

Acute leukaemia

Answer 23

Haemorrhagic rash
Pallor
Hepatosplenomegaly

Question 24

*Idiopathic thrombocytopenic purpura

Answer 24

Haemorrhagic rash
Child looks well
Petechial rash
+/- nosebleeds

Question 25

*Henoch-Schoenlein purpura

Answer 25

Haemorrhagic rash Legs and buttocks Arthragia Abdominal pain

Question 26

Bleeding disorders

Answer 26

Haemorrhagic rash Heamophilia, von Willebrands disease and Ehlers-Danlos usually present with easy bruising and prolonged bleeding following trivial trauma nb. non accidental injury

Question 27

Urticarial rash

Answer 27

``` Hives Transient, occurs rapidly and fades Itchy Raised weals Food, drug, contact allergy; infections ```

Question 28

Erythema multiform

Answer 28

Distinctive, symmetrical rash Annular 'target' lesions and various other lesions including macules, papules and bullae Severe form with mucus membrane involvement is Stevens-Johnson syndrome Causes include infections (HSV, EBV, mycoplasma) and drugs. Most commonly idiopathic and self-limiting

Question 29

Erythema nodosum

Answer 29

Red, tender, nodular lesions On shins Important causes are strep infections and TB

Question 30

*Impetigo

Answer 30

Highly infectious Commonly occurs on face, especially if pre-existing skin condition (eczema) Erythematous macules develop into characteristic honey-coloured lesions Topical antibiotics (eg mupirocin) if mild Systemic abx (eg fluclox) if more severe Nasal carriage important source of reinfection - eradicated by nasal cream containing clorhexadine and neomycin