The infant or child with a rash Flashcards
Etiology
1. Viral Chicken pox EBV CMV Fifth disease Roseola HIV Hepatitis B/C HFM Rubella Measles HSV Molluscum contangiosum 2. Inflammatory Atopic dermatitis, seborrhoeic, contact, psoriasis, pityriasis rosea, mastocytosis 3. Bacterial Impetigo Folliculitis 4. Fungal Tinea corporis Scabies Candidiasis 5. Tick borne RMSF Lyme disease 6. Drug eruptions 7. Systemic bacterial Meningicoccal, syphillis, gonorrhea, endocarditis SSS Scarlet fever TSS 8. Hypersensitivity 9. Vasculitis/rheumatological Kawasaki JA HSP SLE, RF, Sarcoidosis 10. Child abuse
Important history
Is the child well Could this be an inset bite or allergic reaction Morphology Duration Distribution, progression Pruritis Systemic features Recent viral infection/Strep throat Family history Recurrent Contact, travel, exposures Complete medical history, medications Treatment attemtps
Unwell child systemic, erythematous rash etiology
- Erythematous rash
a. Hypersenitivity->insect, bites, allergies, medications
b. Scarlet fever->desquamating, pharyngitis, contact history
c. SSS->superficial desquamation, recent infection, fever, malaise, tender skin
d. TSS->trunk, palms, soles, hyperemic oral mucosa, tampon use
e. SJS
f. RF
g. JA
h. SLE
i. Sarcoidosis
j. Lyme
Unwell child systemic, maculopapular
a. Meningicoccal septicemia
b. Bacterial endocarditis
c. Systemic hypersensitivity syndrome
d. Kawasaki
e. Measles
f. HBV/HCV acute
g. HIV
h. RMSF->wrists, ankles, palms and soles, spreads central, spares face, outdoor
Unwell child systemic, vesiculobulous
a. SJS/TEN
Unwell child systemic, pertehchiael/purpuric
a. Meningicoccal
b. Leukemia
c. HSP
d. RMSF
Well child, mild systemic
Erythema multiforme Roseola Erythema infectiosum Drug reaction CMV EBV Rubella VZ HFM Syphilis Gonorrhea ITP Child abuse
Well child no systemic
Psoriasis Pityriasis rosea Contact/irritant Nappy rash Atopic dermatitis Seberroiec Tinea Scabies Impetigo Folliculitis Mastocytosis
Physical examination
General, systemic involvement
Describe the rash: raised/flat, crusty/scaly, colour, blanching, size, distribution
Full examination->including LN, CVS, RS, abdominal, ENT
Acute rash onset history
Well/febrile Itchy Associated symptoms? Bleeding, arthritis and abdominal pain, stridor and urticaria PMH Immunisations Contact
Investigations
Generally not required Rubella serology in pregnant Cultures if systemic/sepsis FBC/PLT, coagulation in ITP Widespread urticaria->RAST consider FBC, ESR, CRP, biochemical/urinalysis in systemic Serology->ASOT, anti-DNAse B, IgM/IgG for lyme, ELISA for S aureus in SSS Serology HIV, HBV, HCV Blood cultures LP Echo->RF, BE, Kawasaki CXR->RF, sarcoidosis Biopsy->SSS, SJS, DRESS, HSP
Features of scarlet fever: rash, presentation, treatment
Sandpaper Blanching Neck, axilla, groin Face spared Red tongue Fever, headace Group A strep infection, 12 hours post tonsilitis
Treatment: phenoxymethylpenicillin 15mg/kg up to 500mg BD for 10 days
Features of measles rash, management
Face->trunk
Koplik spots
Fever, ill, lymphadenopathy
Cough, coryza, conjunctivitis
Notifiable
Supportive care + vitamin A supplementation
Measles IgM/IgG serology
Features of rubella rash, complications in congenital rubella
Tiny macules->face to trunk
Generally well child
Suboccipital LN
IP of 14-21 days
Congenital->in first trimester= death, retardation, CHD, deafness, cataracts
Features of Fifth disease
Slapped cheeks
Lacy appearance
Mild fever
Lasts up to 6 weeks
Presentation of chicken pox
IP 10-21 days
Prodromal fever, lethargy, anorexia, then 3-5 days of eruption
Papules->vesicular->crusting in 10 days
+On scale, face, trunk, mouth and conjunctiva
Complications of chicken pox
Pneumonia Arthritis Hepatitis Encephalitis Superinfection Cerebellitis Reye
+in infants, >15 yo and immunocompromised children
Management of chickenpox
- Consider admission IV aciclovir, discussion with consultant:
- ->immunocompromised,
- ->steroid received,
- ->prematures,
- ->impaired mental state,
- ->cough/tachyP/dys and CXR shows pneumonia/nitis (add antibiotics) - If none of these features, >12 yo->discuss and consider oral aciclovir if
Exposure porphylaxis in chickenpox
Exposed, no rash
Symptomatic management of chickenpox
Calamine lotion Cool compresses Keeping skin cool Oral antihistamines for sleep Don't scratch, cut nails short
Infection precautions in hickenpox
Infectious 1-2 days prior to rash appearing, until fully crusted over. Exclude from school until fully recovered->at least one week after eruption first occurs
Types of nappy rash (4)
- Ammoniacal->irritant, papulovesicular, fissure, erosisons
- Candidial
- Seborrhoeic
- Psoriatic
Factors which contribute
Excess hydration–>water in nappy and stool, nappy change frequency
Skin trauma
Ammonia, feces, soap/deterhen, nappy wiped, napkin powders and creams
Treatment of nappy rash
Disposable nappies
+Frequency of nappy changing and cleansing
Disposable towel/face washers soaked in water/olive oil to cleanse
Apply barrier cream atevert change->parrafin, vaseline. Apply +++thickness
Let child sleep as long as can without nappy->lay on absorbent sheet, change when wet
If candida->imidazole/nystatin cream +/- hydrocortisone cream
Consider differential
Differential diagnosis of nappy rash
Seberrhoiec Atopic Psoriasis Perianal cellulitis Zinc deficiency Threadworms Langerhands cell histiocytosis Malabsorption Crohns
Meningicoccal rash presentation
Petechiael, purpuric, morbilliform
Shock/coma
History and examination assessment of meningicocemia
History:
Rapid, fever, malaise, lethargy, vomiting, myalgia, -ve LOC
Examination:
May be shocked, rash, leg pain, neck stiff, photophobia
Blanching does not exclude
Preceeding viral does not exclude
Investigations in meningicoccal
Blood culture (if possible before antibiotics)
Meningicoccal PCR
Glucose, UEC, coagulation
VBG/ABG
Consider LP if meningitis