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Approach to Rash

What else is wrong?


Is the child well or unwell?
History of rash and evolution
Describe the rash colour, blanching, size,
distribution, raised
Is it a killer rash?
Is it a classic rash rash of childhood?
Management advice and follow up as
appropriate

Meningococcus

Rare ~ 1:100,000, sporadic epidemics


50% in < 2yrs, 25% > 30
Wide clinical spectrum
May mimic viral illness early
Limb pain, myalgia, refusal to walk,
cold hands and feet early signs 1
Red rash initially -> petechiae ->
purpura
1. Inkelis SH, O'Leary D, Wang VJ, Malley R, Nicholson MK, Kuppermann N., Extremity pain
and refusal to walk in children with invasive meningococcal disease. Pediatrics. 2002
Jul;110(1 Pt 1):e3

Enteroviral
Rash
Maculopapular
Petechiae
Includes many viruses
Coxsackie, Echo,
poliovirus etc

Hand Foot and Mouth


Brief prodrome
Mild fever, mouth
pain
Rash/lesions
Mouth
Palms
Sides of feet + soles
Buttocks/nappy area

Hand Foot and Mouth


Advice?
Highly contagious
Handwashing
Mx
Symptomatic
Xylocaine viscous
Cautious use in young
children due to risk of
toxicity

Erythema Multimforme

Stevens Johnson
Syndrome

Stevens
Johnson
Syndrome

Urticaria

Urticaria

Urticaria

www.allergy.org.au

Blanching
Wheals
Itchy
Pink
Raised
Demarcated
Transient
Advice?

Kawasaki Disease

Need fever + 4 criteria

1. Fever lasting 5 days


2. Bilat conjunctival
injection
3. Erythematous rash
4. Dry/red fissured lips
or strawberry tongue
+ red oropharynx
5. Oedema of hands/feet
desquamation
6. Cervical LNs at least 1
= >1.5cm

Kawasaki Disease
Advice?
Ix?
Mx?

Algorithm for incomplete KD


Patient characteristics suggesting disease
other than Kawasaki disease:
exudative conjunctivitis,
exudative pharyngitis,
discrete intraoral lesions,
bullous or vesicular rash, or
generalized adenopathy

American Heart Association (AHA) and the American


Academy of Pediatrics (AAP)
http://www.uptodate.com/contents/incomplete-atypica
l-kawasaki-disease?source=see_link

Scarlet Fever
Rash
Often first on head and
neck
Most prominent
axillae/groin
Then trunk + limbs
Palms/soles are spared
Erythematous
Maculopapular
Sandpaper

Scarlet Fever
Incub period 2 days
Prodrome
Tonsillitis
Rash
Flushed face
Circumoral pallor
Strawberry tongue

Scarlet Fever
Advice ?
Infectious until
Pen is
given for 24
hours

Scarlet Fever

Desquamation after one week

Scarlet Fever

Measles
Rash
Maculopapular
Morbilliform
Starts behind ears
Then face, trunk, incl.
palms/soles
(cephalocaudal spread)
Fades by 4-5 days
Then brown staining
No desquamation

Measles
Prodrome
3-5 days
Kopliks spots
Runny nose
Conjunctivitis
Dry cough
High fever/chills
Malaise/headache
SYSTEMIC TOXICITY

Rubella
Rash
Pink maculopapular
Starts on face, behind
ears
Then trunk, limbs
Disappears over 2-3/7
Petechiae soft palate
(Forchheimer spots)

Rubella 3rd disease


Prodrome
Lymph nodes may
appear before rash
Rash
Mild illness
Absence of high fever
Advice?
Infectious period 1-2
weeks before rash 5
days after

Congenital Rubella

Erythema
Infectiosum/Slapped Cheek
5th Disease
Rash 3 phases
Erythema/slapped
cheek
Maculopapular rash on
limbs/trunk (next day)
Reticulate/lacy
pattern as rash fades
(day 6)
Duration of rash 3-24
days

Erythema Infectiosum
Advice?
Complics
Arthritis/arthralgia
Aplastic crises
Fetal exposure
Infectious period
during prodrome
only

Roseola 6th Disease

Advice?

Prodrome
Fever 3-5 days
Irritable
D+V, cough
Rash after prodrome
Maculopapular
Well child once
rash appears

Classic Rashes of Childhood

1st disease Measles


2nd disease Scarlett fever
3rd disease Rubella
4th disease Dukes disease (virus
never isolated)

5th disease Slapped Cheek


6th disease Roseola

Varicella
Incub period
Prodrome
Rash
Initially macules
Vesicles in 6-8 hrs
Crops
Starts trunk, face, scalp
Intensely itchy
Crust over 5-25 days

Advice?
Contagious 24 hrs before rash till all
crusted
Usually 5-7 days
Incub period
ZIG?
Vaccine?
Fetal exposure
Complics?

Congenital Varicella

Varicella Impetigo

Shingles

Eczema Herpeticum
HSV infection in
eczematous skin
Can be severe
Often need IV
acyclovir
Most resolve
without sequelae

HSV

Herpetic Whitlow

Herpetic Whitlow

HSV

Drug Rash

Ceclor
Bactrim
Sulphur
Penicillin
Amoxil/Ampi +
EBV

Molluscum

Approach

What else is wrong?


Is the child well or unwell?
History of rash and evolution
Describe the rash colour, blanching,
size, distribution, raised
Is it a killer rash?
Is it a classic rash rash of childhood?
Management advice and follow up as
appropriate