Rashes

Question 1

What is the differential for a maculopapular rash in children?

Answer 1

Measles
Roseola infants
Erythema infectiosum
Scarlet fever
Rubella (more macular)
Non-specific viral rash e.g. associated URTI
Drug reaction

Question 2

What is the differential for a vesicular rash in children?

Answer 2

Chicken pox
Herpes simplex
Hand, foot + mouth disease
Bullous impetigo

Question 3

What is the differential for a purpuric (haemorrhagic) rash in children?

Answer 3

Meningococcaemia
Henoch-Schonlein purpurn
Thrombocytopenia:
- ITP
- leukaemia
- aplastic anaemia
- DIC
- HUS
Trauma (direct or barotrauma e.g. vomiting/coughing)

Question 4

What is the rash like in idiopathic thrombocytopenia purpura?

Answer 4

Affects buttocks then legs
Follows URTI
Resolves in 6-8 weeks

Question 5

What are the clinical features of chicken pox?

Answer 5

Papules –> vesicles –> pustules –> crusts
Starts on head, trunk/back, then peripheries
Prodrome of 2 days of fever

Question 6

What is the management for chicken pox?

Answer 6

Conservative
Paracetamol (not NSAIDs)

VZ Ig + aciclovir for:

• neonates
• immunosuppressed
• cardiovascular or respiratory disease

Question 7

What are the acute complications of chicken pox?

Answer 7

Secondary bacterial infection
Encephalitis
Pneumonia
DIC

Question 8

What should be done if a pregnant women is exposed to chicken pox?

Answer 8

If she has never had chicken pox:

• -> check VZV IgG
• if negative + less than 10 days since exposure, give VZ Ig

Question 9

What is rubella also known as?

Answer 9

German measles

Question 10

What are the clinical features of Rubella?

Answer 10

Macular rash on face –> then spreads
Itchy
Painful sub occipital + post auricular lymphadenopathy

Question 11

What are the complications of rubella infection?

Answer 11

Small joint arthritis
If contracted in first 4 months of pregnancy:
- fetal malformations, deafness, blindness or heart defects

Question 12

What are the features of measles?

Answer 12

Maculopapular rash spreads from behind ears to whole body, including palms + soles
Child is miserable
Prodrome 2-3 days of fever + 4Cs:
- coryza
- conjunctivitis
- cough
- Koplik spots (white spots on buccal mucosa)

Question 13

How is measles diagnosed?

Answer 13

Serum IgM +/- throat swab PCR

Question 14

What is the management for measles?

Answer 14

Rest, fluids + paracetamol
Isolate
Post exposure prophylaxis for vulnerable contacts

Question 15

What are the complications of measles?

Answer 15

Giant cell pneumonia (commonest cause of death)
Otitis media
Meningitis or encephalitis 
Hepatitis
Febrile convulsions
Fetal malformations

Question 16

What is erythema infectiosum and what causes it?

Answer 16

Slapped cheek –> parvovirus B19

Question 17

What are the features of slapped cheek?

Answer 17

Malar erythema then maculopapular or ‘lace work’ rash on trunk + limbs
Prodrome of fever, malaise, headache + myalgia
In adults - symmetrical poly arthritis of small joints or knees

Question 18

What are the complications of parvovirus B19 infection?

Answer 18

Aplastic crisis:
- higher risk in sickle cell, thalassaemia + spherocytosis
Foetal death or hydrops

Question 19

What are the features of molluscum contagiosum?

Answer 19

Highly infectious
Pearly, skin coloured papules with central dimple
Can last up to 2 years

Question 20

What causes hand foot + mouth disease?

Answer 20

Coxsackie A16

Question 21

What are the features of hand foot + mouth disease?

Answer 21

Vesicular rash on mouth (1st), palms + soles

Fever, sore throat

Question 22

What causes nappy rash?

Answer 22

Irritant effect of urine on skin

Can become complicated by Candida infection

Question 23

What is the treatment for nappy rash?

Answer 23

Emollients
Topical fluconazole or clotrimazole
Topical steroids if severe

Question 24

What is the management of impetigo?

Answer 24

Topical fusidic acid
Flucloxacillin if widespread
Stay off school until lesions crust over

Question 25

What causes scarlet fever?

Answer 25

Group A strep

Question 26

What are the features of scarlet fever?

Answer 26

Prodrome of fever + sore throat, followed by:

• red, sandpapery rash
• strawberry tongue
• red cheeks + circumoral pallor

Question 27

What is the treatment for scarlet fever?

Answer 27

Phenoxymethylpenicillin (pen V) oral

Question 28

What is Henoch-Schonlein purpura?

Answer 28

IgA mediated small vessel vasculitis

May follow infection such as strep URTI

Question 29

What are the clinical features of Henoch-Schonlein purpura?

Answer 29

Classic 4:

• rash on buttocks + back of legs
• abdominal pain, bloody diarrhoea, N&V
• arthralgia
• glomerulonephritis due to IgA deposition

Question 30

What is the management for Henoch-Schonlein purpura?

Answer 30

Simple analgesia

Corticosteroids may be kidney protective

Question 31

What age group most commonly get Kawasaki disease?

Answer 31

Around age 2 (rare after 5)

Question 32

What are the features of Kawaski disease?

Answer 32

Persistent fever > 5 days
Dry, bilateral conjunctivitis
Non-vesicular, desquamating rash which starts at the extremities (including palms and soles)
Strawberry tongue

Question 33

How is Kawasaki disease managed?

Answer 33

Aspirin + IV Ig

–> the only time aspirin is used in children

Question 34

What is erythema toxicum?

Answer 34

Self limiting rash on face and trunk in 50% of neonates

Red papules + vesicles surrounded by red blotches, giving halo appearance

Question 35

What are milia?

Answer 35

Small, yellow-white, epidermoid cyst

Usually on face in neonates

Question 36

What is a mongolian blue spot?

Answer 36

Large, light blue area, usually on buttocks at birth