Rashes - HSP, ITP, Eczema, Eczema herpeticum, Parvovirus B19, Hives, Impetigo, Erythema multiforme, Hand, foot and mouth, Erythema toxicum, Rubella, Scabies, Scarlet fever, Roseola infantum Flashcards
Henoch Schonlein purpura
-what is it
-presentation
-management
-prognosis
IgA small vessel vasculitis
-follow infection
Pulpable purpuric rash
-buttocks
-extensor surfaces
Abdo pain
Polyarthritis
IgA nephropathy - hematuria, renal failure
Analgesia
Supportive
Monitor BP and urinalysis
1/3 relapse
Idiopathic thrombocytopenia
-what is it
-presentation
-investigation
-management
T2 hypersensitivity reaction
-AB against GP2b3a
Follows viral infection
-bruising
-petechial/purpuric rash
-bleeding less common (epistaxis, gingival bleeding)
FBC - isolated low platelets
Blood film
If atypical features => BM examination
Normally self limiting within 6 months
Avoid activities leading to trauma
Platelets U10 or significant bleeding
-PO/IV CS
-IV IG
-platelet transfusions in an emergency (quickly destroyed by circulating AB
Eczema
-ages
-presentation
-management
Presents before 2y/o
-clears up in 50% by 5
-clears up in 75% by 10
Itchy red rash
-repeated scratching may exacerbate affected areas
ATOPIC TRIAD
-dry to identify trigger
Infants - face , trunk
Young children - extensors
Older children - flexors, face, neck creases
Avoid irritants
Large quantities of emollients
TOP steroids
Wet wrapping over emollient, may need CS
Severe => PO ciclosporin
Eczema herpeticum
-causative organism
-presentation
-management
Eczema infected by herpes simplex
RAPIDLY PROGRESSING PAINFUL RASH
-monomorphic punched out erosions
-systemic illness
FBC, U&E, CRP, culture
HSV viral swab
Bacterial swab
CAN BE LIFE THREATENING => ADMIT, IV ACICLOVIR
Parvovirus B19
-presentation in immunocompetent children, adults, immunocompromised children, sickle cell, pregnant
-investigation
-management
Resp spread
Mild feverish illness => slapped cheek rash for 1 week before fading
Several months afterwards, rash may recur after warm bath, fever, sunlight
Adults - +arthritis
Immunocompromised - pancytopenia
Sickle cell - aplastic crisis (as hematopoesis is suppressed)
Pregnant - hydrops fetalis
CLINICAL DIAGNOSIS
-confirm with parvovirus PCR, serology
Supportive treatment
No school exclusion needed once rash appears
Hives
-presentation
-investigations
-management
Weals => resolves within hours
-circumscribed, raised erythematous plaques, central pallor
-ITCHY
Angioedema => resolves within hours to days
-face, hands, feet, genitalia
Identify trigger
1st line - loratidine, ceterizine for 6wks after acute episode
To help with sleep, add chlorphenamine
Severe, resistant - pred
Impetigo
-causative organism
-types and their presentations
-investigations
-management
GAS, staph aureus - 4-10day incubation
-primary infection or complication of existing skin condition
Spread by direct contact with discharge from scabs
SCHOOL EXCLUSION NEEDED UNTIL 48HRS ABx or LESIONS CRUSTED AND HEALED
Face, flexures, limbs not covered by clothing
-golden crusted lesions
-can be vesicular
CLINICAL DIAGNOSIS
-can take bacterial swab of fluid
-FBC, U&E, CRP if systemically unwell
1st line if not systemically unwell or high risk of complications - 1% hydrogen peroxide cream
-TOP fusidic acid
Extensive - PO fluclox or erythro if penallergic
Hand, foot and mouth
-causative organism
-presentation
-investigations
-management
Enterovirus - coxsackievirus
HIGHLY INFECTIOUS
Systemic upset - fever, sore throat, anorexia, fatigue, mild diarrhoea
Mouth ulcers - red macules/vesicles on hard palate, tongue
Flat pink patches on fingers, dorsal/palmar on hands and feet => blister and peel off in 1wk
CLINICAL DIAGNOSIS
Symptomatic
Exclusion not needed, can return when child feels better
Erythema multiforme
-what is it
-causes
-presentation
-investigations
-management
Hypersensitivity reaction, commonly triggered by infection
MOST COMMON - CIRAL
Idiopathic
Bacteria - mycoplasma, strep
Drugs - pen, sulphonamides, carbemazepine, allopurinol, NSAIDs, COCP
Connective tissue - lupus
Macular target lesion - back of hands, feet => spread to torso
-dark center
-pale, edematous middle
-bright red halo
Burning, itching
Koebner
CLINICAL DIAGNOSIS
Treat underlying cause if identified
Supportive
Erythema toxicum
-what is it
-presentation
-investigations
-management
Appears within 1st few days of life, fades in 1week
-thought to be immune related
Neonate systemically well
-blotchy red rash, small fluid filled pustules
CLINICAL DIAGNOSIS
Supportive treatment
Scabies
-causative organism
-presentation
-investigations
-management
Scabies mite
Itchy papular rash with visible burrows
-between fingers and toes, wrists, trunk, thigh
CLINICAL DIAGNOSIS
1st line - 5% permethrin
2nd line - 0.5% malathion
Itch lasts 4-6wks after eradication - can use hydrocortisone cream
Avoid close physical contact until treatment complete
TREAT ALL HOUSEHOLD AND CLOSE CONTACTS EVEN IF ASYMPTOMATIC
Rubella
-causative organism
-presentation
-investigations
-management
-complications
Rubella virus
Maculopapular itchy rash - neck => face and extremities
Tender LN- post auricular, suboccipital, cervical
Systemic illness
CLINICAL DIAGNOSIS - confirm with nasopharyngeal swabs, PCR
Self-limiting
School exclusion - 1wk before and after rash appears
NOTIFIABLE DISEASE
Arthritis
Thrombocytopenia
Encephalitis
Myocarditis
Scarlet fever
-causative organism
-presentation
-investigation
-management
-complications
GAS - respiratory spread
-2-6 year olds
Fever, fatigue, headache
N+V
Sore throat
Strawberry tongue
Rough sandpaper rash with fine punctate erythema
Throat swab - but don’t delay ABx
PO phenoxymethylpenicilin or azithro if penallergic
RETURN TO SCHOOL 24HRS AFTER STARTING ABx
OM - most common
Rheumatic fever - 20days after infection
Glomerulonephritis - 10days after infection
Invasive complications - bacteremia, meningitis
Roseola Infantum
-causative organism
-presentation
-investigation
-management
HHV6 - 6months to 2 years
High fever followed by maculopapular rash
-high fever => risk of febrile seizures
Red spots in mouth
School exclusion not needed
Supportive
