Rashes Flashcards
What is the differential for a maculopapular rash in children?
Measles Roseola infants Erythema infectiosum Scarlet fever Rubella (more macular) Non-specific viral rash e.g. associated URTI Drug reaction
What is the differential for a vesicular rash in children?
Chicken pox
Herpes simplex
Hand, foot + mouth disease
Bullous impetigo
What is the differential for a purpuric (haemorrhagic) rash in children?
Meningococcaemia Henoch-Schonlein purpurn Thrombocytopenia: - ITP - leukaemia - aplastic anaemia - DIC - HUS Trauma (direct or barotrauma e.g. vomiting/coughing)
What is the rash like in idiopathic thrombocytopenia purpura?
Affects buttocks then legs
Follows URTI
Resolves in 6-8 weeks
What are the clinical features of chicken pox?
Papules –> vesicles –> pustules –> crusts
Starts on head, trunk/back, then peripheries
Prodrome of 2 days of fever
What is the management for chicken pox?
Conservative
Paracetamol (not NSAIDs)
VZ Ig + aciclovir for:
- neonates
- immunosuppressed
- cardiovascular or respiratory disease
What are the acute complications of chicken pox?
Secondary bacterial infection
Encephalitis
Pneumonia
DIC
What should be done if a pregnant women is exposed to chicken pox?
If she has never had chicken pox:
- -> check VZV IgG
- if negative + less than 10 days since exposure, give VZ Ig
What is rubella also known as?
German measles
What are the clinical features of Rubella?
Macular rash on face –> then spreads
Itchy
Painful sub occipital + post auricular lymphadenopathy
What are the complications of rubella infection?
Small joint arthritis
If contracted in first 4 months of pregnancy:
- fetal malformations, deafness, blindness or heart defects
What are the features of measles?
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)
How is measles diagnosed?
Serum IgM +/- throat swab PCR
What is the management for measles?
Rest, fluids + paracetamol
Isolate
Post exposure prophylaxis for vulnerable contacts
What are the complications of measles?
Giant cell pneumonia (commonest cause of death) Otitis media Meningitis or encephalitis Hepatitis Febrile convulsions Fetal malformations
What is erythema infectiosum and what causes it?
Slapped cheek –> parvovirus B19
What are the features of slapped cheek?
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
What are the complications of parvovirus B19 infection?
Aplastic crisis:
- higher risk in sickle cell, thalassaemia + spherocytosis
Foetal death or hydrops
What are the features of molluscum contagiosum?
Highly infectious
Pearly, skin coloured papules with central dimple
Can last up to 2 years
What causes hand foot + mouth disease?
Coxsackie A16
What are the features of hand foot + mouth disease?
Vesicular rash on mouth (1st), palms + soles
Fever, sore throat
What causes nappy rash?
Irritant effect of urine on skin
Can become complicated by Candida infection
What is the treatment for nappy rash?
Emollients
Topical fluconazole or clotrimazole
Topical steroids if severe
What is the management of impetigo?
Topical fusidic acid
Flucloxacillin if widespread
Stay off school until lesions crust over
What causes scarlet fever?
Group A strep
What are the features of scarlet fever?
Prodrome of fever + sore throat, followed by:
- red, sandpapery rash
- strawberry tongue
- red cheeks + circumoral pallor
What is the treatment for scarlet fever?
Phenoxymethylpenicillin (pen V) oral
What is Henoch-Schonlein purpura?
IgA mediated small vessel vasculitis
May follow infection such as strep URTI
What are the clinical features of Henoch-Schonlein purpura?
Classic 4:
- rash on buttocks + back of legs
- abdominal pain, bloody diarrhoea, N&V
- arthralgia
- glomerulonephritis due to IgA deposition
What is the management for Henoch-Schonlein purpura?
Simple analgesia
Corticosteroids may be kidney protective
What age group most commonly get Kawasaki disease?
Around age 2 (rare after 5)
What are the features of Kawaski disease?
Persistent fever > 5 days
Dry, bilateral conjunctivitis
Non-vesicular, desquamating rash which starts at the extremities (including palms and soles)
Strawberry tongue
How is Kawasaki disease managed?
Aspirin + IV Ig
–> the only time aspirin is used in children
What is erythema toxicum?
Self limiting rash on face and trunk in 50% of neonates
Red papules + vesicles surrounded by red blotches, giving halo appearance
What are milia?
Small, yellow-white, epidermoid cyst
Usually on face in neonates
What is a mongolian blue spot?
Large, light blue area, usually on buttocks at birth
