Rashes Review Flashcards
Rashes Terminology- Definition for each, eg not needed but there.
Macule
Papule
Patch
Plaque
Vesicle
Pustule
Annular
Discoid
Bulla
Erosion
Excoriation
Nodule
Petechiae
Purpura
Ulcer
Urticaria
Macule
A small area of colour change, often defined as less than 1 cm diameter. Smooth and not palpable.
Viral exanthem
Papule
Small palpable lesions. The usual definition is that they are less than 1 cm diameter. They are raised above the skin surface.
Viral exanthem
Patch
A large area of colour change, with smooth surface
Port wine stain birth mark
Plaque
Palpable scaling lesion
Psoriasis
Vesicle
Small fluid-filled blisters less than 1cm in diameter. Impetigo (early stages)
Pustule
A collection of pus (similar to vesicle)
Acne vulgaris
Annular
Refers to lesions grouped in a circle
Fungal (e.g. Tinea)
Discoid
Coin shaped Discoid
Eczema
Bulla
Large fluid-filled blister greater than 1 cm in diameter. It may be a single compartment or multiloculated Pemphigus
Erosion
Loss of the surface (epidermis) of a skin lesion; it is a shallow moist or crusted lesion
TEN - nikolsky
Excoriation
Scratch mark or surface injury penetrating the dermis Scabies
Nodule
It is a solid lesion more than 1 cm in diameter (a large papule)
Erythema nodosum
Petechiae
Petechiae are small red, purple or brown spots that are non-blanching. Often defined as <1mm
SVC (Sup Vena Cava) pressure effect
Purpura
Large red, purple or brown spots, non-blanching often defined as >1mm.
Meningococcal septicaemia
Ecchymosis
Bruise- therefore think bleeding disorder or NAI
Ulcer
Full thickness loss of epidermis or epithelium and dermis and may involve subcutaneous tissue
Pressure sores
Urticaria
Oedematous papule or plaque caused by swelling in the dermis, often called a wheal.
Allergy / Hypersensitivity
Name the 6 important rashes in children
1 - Measles/ Rubeola
2- Scarlatina/ Scarlet fever
3- Rubella/ German measles
4- SSS or SSSS (Staphylococcal scalded skin syndrome)
5- Erythema Infectiosum/ Fifth Disease/ Slapped cheek
6- Roseola Infantum
Measles aka 1
Presentation:
4 + 1* key presentation word
Rash- description, where dose it start + end and after how long?
-
- labs:
-
-
EXTRA POINT THAT IS NEEDED
aka Rubeola
Presentation:
- coryzal + cough
- conjunctivitis
- child miserable + v high temp
- intense photophobia
- Koplik spots*
- Rash: Maculopapular, starts hairline 9 + behind ears) spreads to trunk + extremities (cephalo-caudally) within 36 hours, fades after 3-4 days
Diagnosis (clinical)
- Koplik spots in mouth!
- moribilliform rash
- labs: Measles IgM
Complications
- Pneumonia
- Otitis medi (deafness)
- Contact in pregnancy
- Subacute sclerosing panencephalitis (SSPE)
ITS NOTIFIABLE
Scarlatina/ Scarlet Fever
Pathogen cause 1
- *key word
- Rash: description and key word and where?
Treatment
- if allergic…
Scarlatina/ Scarlet Fever
Pathogen cause:
Strep. pyogenes
Presentation
- Pyrexial and v miserable
- sore throat + strawberry tongue! (white and red)
- Rash: maculopapular and sand-paper feel! on trunk and limbs
Treatment
- 10 days PO penicillin V (azithromycin if penicillin allergy)
German Measles/ Rubella Presentation - - - - Rash: Description and where do they start + how long do they last? Hint: most cases do not present!
Anything else?
German Measles/ Rubella
Presentation
- Upper resp tract features
- Arthralagia (joint pain)
- Tender posterior cervical and occipital lymphadenopathy
- Rash: Macules usually start around face and last up to 5 days
Complications:
- Contact in pregnancy can cause severe abnormalities of foetus death
NOTIFIABLE DISEASE
SSS =
Usually seen in... How does skin appear? Where? 2 Extras: - - -
Staphylococcal scalded skin syndrome
Usually seen in neonates How does skin appear? Scaled Where? Umbilicus + flexural areas Extras: - toxin mediated - mild fever - baby in pain when being handled
Erythemia Infectiosum aka 2
Pathogen cause: 1
Presentation
- Rash: 3 stages
-
Fifth Disease/ Slapped cheek
Pathogen cause:
Parvovirus B19
Presentation
- Rash: comes in 3 stages
1) slapped cheek
2) lacy rash on extremities
3) rash on trunk
Complications
- Aplastic crisis (in blood disorders)
- Contact with pregnancy can cause miscarriage
Roseola aka
Pathogen cause: 1
Presentation - - - 30% of cases have... - Rash:
-
Sixth Disease
Pathogen cause:
Human Herpes Virus - HHV6 (+ possibly 7)
Presentation
- High grade fever
- Coryzal signs
- eye lid oedema in 30% of cases
- Rash: Pink, maculopapular rash, non-itchy, painless, some have a ‘halo’ of pale
-
Eczema
What is it?
Distribution:
- Infants
- Children
Severity Assessment:
Mod
Mild
Severe
What should you watch out fir in eczema?
Caused by 2
And their treatments
Atopic condition causing itchy, erythematous rash in specific distributions:
- infants: trunk and face
- Children: flexor surfaces
Severity assessment:
Mild- areas of dry skin, itching, +- small areas of redness
Mod- Areas of dry skin and freq itching +- exoriation and skin thickening
Severe- widespread areas of incessant itching redness (+- exoration, skin thickening, bleeding, oozing)
Secondary Infections:
- Herpeticum (viral): PO/ IV aciclovir given
- Bacterial: topical treatment if very localised but flucoxacillin/ erythromycin if systemic
BOTH CAN EXIST TOGETHER
Kawasaki Disease
Cause-
potentially 3
Presentation/ Diagnostic criteria: KNOW THIS
late sign =
Investigation:
4
Complications
2
Management
2
Cause
• Poorly understood – potential viral, environmental or autoimmune.
Presentation - criteria
• Fever for >5 days plus 4/5 of:
L 1) Tender cervical lymphadenopathy
P 2) Polymorphous rash
C 3) Bilateral (non purulent) conjunctivitis
P 4) Peripheral changes – red palms, oedema (sausage fingers) / erythema/ desquamation
M 5) Mucous membrane changes
- Peeling of hand and feet skin is a late sign
Investigations
• ASOT (anti-streptolysin O Titre), echo, platelets, ESR, CRP.
Complications
• Coronary artery aneurysm +
other cardiac problems such as myocarditis
Management
• IV Ig (Intra-venous Immunoglobulin)
• High dose aspirin
Erythema Multiforme and SJ
Cause
• Hypersensitivity to drugs (NSAIDS, Barbituates, Penicillins) or infection (HSV, varicella, mycoplasma)
Presentation
• Abrupt start to rash, symmetrically on limbs
moving to trunk within 3 days of above.
• Rash: Initially macular / plaque. Central
papule/vesicle - classic “TARGET LESIONS”
Complications
• Stephen Johnson Syndrome- where the mucosal layer involved ( eyes, genitalia, oral cavity)/ Toxic Epidermal Necrolysis
Chicken Pox aka
What is it?
Presentation
Rash: Develops in 4 stages
Complications: - - - -
Varicella Zoster
Febrile illness with a rash that occurs in crops
Presentation - Start n stomach, back, face - very itchy Rash develops through stages - Maculo-papular, vesiculopapular, haemorrhagic, scabs
Complication:
- Contact with preg, complications
- Super-added bacterial infection
- pnemonia
- meninngo-encephalitis
- late reactivation (when older) causing Shingles/ Herpes Zoster
Henoch-Schonlein Purpura
Cause 1
Presentation - Rash: description and where Triad 1) 2) 3) - pain somewhere also
-
-
-
-
-
-
-
Cause
- Unknown, postulated autoimmune with viral trigger.
Presentation - triad
- Characteristic rash (petechial across extensors of
lower limbs and buttocks)
• Triad=
1)Abdominal pain (most)
2) Arthralgia (66%),
3) haematuria due to vasculitic nephritis (80% on dip)
can present.
• Scrotal pain, nephrotic syndrome are rare.
• Usually self limiting – can last for months. Shorter
course in under 3s
Investigation
• Blood pressure
• FBC, U&E, Clotting
• Urine dip
Complications
• Renal involvement – 50% of children but only serious
in 10%. Less than 1% develop renal failure.
• Rarely MI, GI bleed, bowel infarction, intussusception
seizures
Management
• Long term follow up
• Urine dips for home
• BP checks at regular intervals for 12 months
Treatment of complications or symptoms
• NSAIDs for pain and arthralgia (caution in renal)
• Steroids – can alleviate arthralgia and GI symptoms.
• Symptoms recur in 25%
ITP stands for?
Presentation
- age
- Rash
Investigations - - - -
Complications - - - -
Management - only required if... - - - Paretns shold be given 24 hr access, advised to avoid trauma, follow up
ITP• Immune Thrombocytopenic Purpura
Cause
Often follows viral illness – thought to be due
to antiplatelet IgG
Presentation
• Mostly 2-10 years. Develop petechiae / purpura / superficial bruising all over body.
• Can cause mucosal bleeding or epistaxis – significant bleeds are rare.
Investigation
- FBC (+film)
- bone marrow aspirate if any suspicion of other cause.
- U&E
- Coag.
Further based on presentation (e.g. SLE /
antiphospholipid in adolescent girls)
Complications • Self limiting, acute and benign in 80% • Intracranial bleeding (0.1-0.5%) • Other forms of major bleeding are rare • 20% develop chronic (>6 months)
Management
• Only required in serious bleeding or
persistent minor bleeding causing
disruption to life.
• Oral steroids, Anti-D and IV Ig are options
but all have significant side effects
• Platelet transfusions only raise platelets for
a few hours
• Parents should be given 24 hour access.
Advised to avoid trauma. Follow up
