Rashes Flashcards
macules and patches
flat circumscribed non-palpable macule: <1cm patch: >1cm
papules and nodules
raised
palpable circumscribed lesion
papule: <1cm
nodule: >1cm
vesicles, bulla and pustules
vesicle: clear fluid filled lesion (blister) <0.5cm
bulla: blister with clear fluid >0.5cm
pustule: blister contains pus
erythematous
red and blanching
purpura
red, non blanching
petechia
purpura <2mm
wheal
an area of oedema in the upper epidermis
scale
flakes or plates that represent compacted desquamated layers of stratum corneum
crust
the result of drying plasma or exudate on the skin
lichenification
refers to a thickening of the epidermis seen with exaggeration of normal skin lines
usually due to chronic rubbing or scratching of an area
excoriation
traumatized or abraded skin caused by scratching or rubbing
annular (ring shaped) lesions
tinea corporis
erythema migrans (lyme disease)
granuloma annulare
multiform lesions
erythema multiforme
fluid filled lesions
clear fluid - vesiculobullous rash:
varicella zoster, impetigo, scalded skin syndrome, HSV, eczema hepeticum, erythema multiforme, SJS, insect bites, burns
pustular rash:
acne, transient neonatal pustular melanosis, psoriasis
papular rashes
urticaria molluscum contagiosum scabies warts keratosis pilaris
eczematous rash
red and scaly with epidermal breakage
atopic eczema
other dermatitis
papulosquamous rash
red and scaly with no epidermal breakage
seborrheic dermatitis, psoriasis, tinea corporis, pityriasis rosea
erythematous rash
red, non-scaly and blanching
erythema infectiosum, roseola infantum, other viral exanthems, kawasaki disease, cellulitis
purpuric rash
red, non-scaly, non-blanching
menningcoccaemia, septicaemia, henoch-schonlein purpura, ITP, NAI, trauma, enterovirus, leukaemia
blue and black rash
haemangiomas, vascular malformations
hypopigmented rash
pityriasis versicolour and alba, vitiligo
hyperpigmented rash
naevi - congenital and acquired
measles
incubation 7-14 days prodrome 4-5d before rash fever, malaise Coryza Cough Conjunctivitis koplik spots 1-3d before rash
rash lasts 4-7 days, starts behind ears, forehead and around mouth
dusky red, florid maculopapular rash that spreads over trunk and limbs, lasting 5 days. non itchy
infective till 4d after the rash
transmission: respiratory droplet or direct contact
complications:
ears - OM
lungs - pneumonia
CNS encephalitis
scarlet fever
strep pyogenes
1-3d incubation
1-2d fever and sore throat, headache, flushed cheeks
punctate erythematous central blanching rash
signs: circumoral pallor strawberry tongue desquamation post rash pastia lines (pink/red lines of confluent petechiae forming in the skin folds)
infective up to 3 weeks
transmission is resp
complications:
septicaemia, endocarditis, OM, quinsy, rheumatic fever, acute nephritis
rubella
incubation 14-23d
prodrome: none or mild fever before the rash
rash: none or for 1-3d a pink macular rash on the face/trunk. itchy
otherwise well
mild disease
sub-occipital lymphadenopathy
infectivity: 7d before to 5d after rash
transmission: resp droplet or direct contact
complications: in-utero - congenital rubella syndrome: deafness, cataracts, cardiac abnormalities, hepatomegaly, splenomegaly, purpura 30% mortality 25% if exposure in first 4 months 60-80% in first month rarely encephalitis at 10d
erythema infectiosum
parvovirus B19
slapped cheek rash
lace-like patterned rash (might be itchy)
more severe in adults, with arthritis and lymphadenopathy
benign course and rare complications
transient marrow depression and rarely aplastic crisis
dangerous in pregnancy (5% anaemia and miscarriage)
roseola infantum
children between 6 months-3 years
high fever
rash appears after fever subsides
3 day fever
kawasaki disease
small and medium vessel vasculitis mnemonic: Warm CREAM diagnosis: Warm - fever >5d plus 4 of: Conjunctivitis - bilateral, non-purulent Rash - erythematous, maculopapular or mobilliform Erythema - palms and feet, with swelling Adenopathy, cervical -1 unilateral node Mucous membrane - dry, red strawberry tongue
complications: coronary artery aneurysm, myocarditis - so do an echo
chicken pox
herpes zoster
itchy
highly infectious, 14-16d post exposure
vesicular rash on red background
starts on trunk, spreads to face and limbs
macules, vesicles, papules, pustules present at once, finally crusting over
Tx: antipyretics, antihistamines, calamine lotion, systemic antiviral for immunocompromised
lifelong immunity but can recur as shingles
meningococcal septicaemia
neisseria meningitidis
meningitis, septicaemia or both
high mortality and morbidity
serotype C included in immunisation regime, B to start this year
early recognition and Tx vital - ben pen/cefotaxime
ABC assessment and resus
prophylaxis for contacts eg rifampicin, ciprofloxacin
impetigo
staph a, beta haem strep
highly infectious
primary of complicated with other conditions eg eczema
vesicles or bullae surrounded by narrow margin of erythema
vesicles/bullae rupture to release thin cloudy yellow fluid, which dries to from yellow crusts
usually around nose and mouth
stay off school until lesions are crusted and healed, or 48h after starting ABx
Tx: topical fusidic acid or mupirocin, oral flucloxacillin
erythema multiforme
immunologically mediated
precipitated by mycoplasma infection or drugs (sulphonamides, penicillin)
target lesions (purple centre, erythematous ring)
steven-johnson syndrome/toxic epidermal necrolysis
hand foot and mouth disease
cause: coxsackie viral infection
features:
low grade fever, headache, vesicles on hands and feet lasting 3-10days (can be widespread)
mouth lesions - yellow ulcers with red borders
can be complicated by aseptic meningitis
management: supportive
eczema
begins 2-3 months on cheeks extensor surfaces flexures (antecubital, popliteal) improves 3-5yo pruritis FHx higher risk of atopy at later stage
HSP
Henoch-Schönlein purpura (HSP) is a rare condition causing vasculitis
rash and joint and tummy pain
HSP can affect people of any age, but the majority of cases occur in children under 10
blood vessels throughout the body become irritated and swollen, which can cause problems such as bleeding into the skin (resulting in a rash) and occasionally problems affecting the kidneys and bowel
HSP is not usually serious and most cases get better within a few weeks
complications tend to involve the kidneys eg haematuria, proteinuria, HTN and oedema
HSP - signs and Sx
purpura - usually on the buttocks, around the elbows and on the legs, and sometimes also on the face and upper body
arthropathy in the knees and ankles, which can also become swollen, tender and warm
abdo pain, which can develop suddenly before the rash appears
HSP can also cause some other symptoms, including passing blood in your urine or stools, vomiting and diarrhoea
The condition is often associated with a previous infection so you or your child may initially have symptoms of an infection as well, such as a fever and feeling generally unwell
ITP
immune thrombocytopenia (ITP) autoimmune disorder in which the number of circulating platelets is reduced due to their increased destruction, and sometimes also due to reduced production
ITP aetiolgy
In ITP, otherwise normal platelets are destroyed, most often in response to an unknown stimulus. This may occur in isolation (primary ITP) or in association with other disorders (secondary)
Causes of secondary ITP include:
Other autoimmune disorders (including antiphospholipid antibody syndrome and systemic lupus erythematosus)
Viral infections (including cytomegalovirus, varicella zoster, hepatitis C and HIV)
Infection with Helicobacter pylori
Medication
Lymphoproliferative disorders
