VIRAL EXANTHEM

Question 1

Approach to Enterovirus Rash

Answer 1

Coxackie, echovirus, poliovirus

Summer & early fall

Symptoms range from Fever, URTI, LRTI, GI symptoms, meningitis, myocarditis

Rashes Vary:
Diffuse macular eruption
Morbiliform erythema
Vesicular lesions
Petechial and purpural eruptions
Rubeliform rash
Roseola-like rash
Scarlatiniform rash

Hydration
Antipyretics / analgesics

Question 2

Approach to Hand-foot-and-mouth / Herpangina

Answer 2

Coxsackie A

Fever, anorexia, malaise, sore mouth

Hand-foot-and-mouth disease:

Oral lesions appear day 2 or 3, very painful 4 to 8 mm vesicles on an erythematous base that ulcerate

Skin lesions on palms, soles, buttocks start as red papules that change to grey 3 to 7 mm vesicles that head in 7 to 10 days

Herpangina:
Oral lesions appear day 2 or 3, very painful 4 to 8 mm vesicles on an erythematous base that ulcerate

does not involve the hands and feet

Hydration
Antipyretics / analgesics
Combined 1:1 suspension diphenhydramine (benadryl) liquid and Maalox swish and spit tid

Question 3

Approach to Erythema Infectiosum (5th disease)

Answer 3

Parvovirus B19

Spring

5-15 yrs

Bright red macular rash on cheeks - closely grouped tiny papules on an erythematous base with slightly raised edges

Sparing of eyes and chin

1-2 later nonpruritic erythematous macular or maculopapular rash appears on the trunk and limbs

Rash fades into a lacy reticular appearance

Supportive Treatment

Question 4

Approach to Varicella (Chicken Pox)

Answer 4

Varicella-Zoster Virus

<10 yrs

Late winter / early spring

Crops of vesicular lesions in multiple stages of development

Spreads in centrifugal fashion

Palms / Soles spared

Acetaminophen 15 mg / kg PO q 4 hrs

Diphenhydramine (Benadryl) 1.25 mg / kg / dose PO q 6 hrs

Question 5

Approach to Roseola Infantum

Answer 5

Human Herpesvirus 6

Abrupt high fever lasting 3 to 5 days

When fever resolves, blanching macular or maculopapular rash, rose or pink descrete lesions develop

Rash lasts 1 to 2 days

Symptomatic Treatment

Question 6

Approach to Eczema Herpeticum

Answer 6

Rare

Life-threatening

Herpes Simplex

Existing eczema

Bacterial superinfection with staph or strep

Fever

Vesicular eruption in areas affected by exzema

Acyclovir 20 mg / kg / dose PO q 6 hr

Clindamycin 10 mg / kg / dose tid for 10 days

Question 7

Approach to Erythema Multiforme

Answer 7

Medication
Herpes (MC)

Abrupt onset rash without pruritis

Target lesions: dark ruddy appearing center and a lighter coloured area surrounding the center with a red appearing outer ring

Coalescent plaques the frequently involve the palms and soles

Mucus membranes spared