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| ==Neonatal Rashes==
| | ''This page is for pediatric patients; for other age groups see [[general approach to rashes]] and [[neonatal rashes]]'' |
| ===Erythema Toxicum===
| | ==Background== |
| *Benign, self-limited (1wk) rash that occurs in 50% of newborns
| | {{Skin anatomy background images}} |
| *Erythematous macules develop on face, trunk, extremities
| | {{Primary derm lesions names}} |
| *No treatment necessary
| | {{Rash red flags}} |
| ===Neonatal Acne===
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| *Occurs around 3rd week of life
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| *Commonly on face, may also see on trunk
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| *No treatment necessary (resolves by 3rd month of life)
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| ===Seborrheic Dermatitis===
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| *Starts between 2-6wk of life; improves by 6 months
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| *Greasy yellow-red scales
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| *Proclivity for scalp (cradlecap), but may find around ears, cheeks, neck
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| *Not pruritic
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| *DDX
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| **Atopic dermatitis, tinea capitis, psoriasis
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| *Treatment
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| **Salicylic acid shampoo (Sebulex) OR
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| **Application of mineral oil followed by washing and removal of scales w/ comb
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| ===Atopic Dermatitis=== | |
| *Must distinguish from seborrheic dermatitis
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| **Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
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| **Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)
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| *Dry skin, erythematous papular lesions
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| *Face most commonly involved; nose and diaper areas spared
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| *DDX
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| **Seborrheic dermatitis, scabies
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| *Treatment
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| **Identify and eliminate triggers
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| **Reduce drying of skin
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| **Liberal application of emollients (vaseline)
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| ===Diaper Dermatitis===
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| *Contact dermatitis VS candidal dermatitis
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| *Contact dermatitis
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| **Erythematous, macular or papular, w/ well demarcated borders
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| **Treatment
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| ***Good hygiene, air drying, use of barrier creams (zinc oxide)
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| *Candidal dermatitis
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| **Erythematous w/ papular and pustular lesions and scaling around margins
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| **Classic finding is "satellite lesions"
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| **Must examine for oral thrush
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| ***If present: Oral nystatin 2mL QID infants, 4-6mL QID children
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| ****Administer for up to 2d after resolution of oral lesions
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| **Treatment
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| ***Nystatin cream 100K U/gram TID x10-14d
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| ***If use zinc oxide must apply after nystatin
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| ***Hydrocortisone 1-2% after nystatin, before zinc oxide, may be used for severe lesions
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| ==Measles (Rubeola)== | | ==Clinical Features== |
| *10d incubation period
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| *3d prodromal period
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| **URI symptoms: fever, cough, conjunctivitis, coryza
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| *Rash
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| **Begins 14th day after exposure
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| **Spreads from central to peripheral
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| **Initially is erythematous and maculopapular; rapidly progresses to confluence (face)
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| **Lasts 7d
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| **Koplik spots
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| ***Pathognomonic enanthem
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| ***White to bluish-white lesions w/ red base on buccal mucosa
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| ==Scarlet Fever== | | ==Differential Diagnosis== |
| *Caused by GAS
| | {{Peds Rash DDX}} |
| *Prodrome of fever, sore throat, vomiting, abd pain followed by rash 1-2d later
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| *Rash
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| **Enanthem
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| ***Tonsils/pharynx are red and covered w/ exudate
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| ***Tongue may have initial exudate followed by erythema ("strawberry tongue)
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| ***Soft palate have bright-red spots
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| **Exanthem
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| ***Starts on neck, axillae, groin, spreads to trunk and extremities
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| ***Red, finely punctate, sandpaper feel
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| ***Desquamation follows
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| *Treatment (to reduce rheumatic fever / nephritis)
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| **Penicillin VK 50mg/kg BID x 10d OR amoxicillin 40mg/kg/d in 2 divided doses x10d
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| **If pen allergic: Azithromycin 10mg/kg on day 1, 5mg/g days 2-5
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| ==Rubella (German Measles)== | | ==Evaluation== |
| *Incubation 2-3wk
| | {{Pediatric rashes images}} |
| *Prodrome 1-5d
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| **Fever, malaise, headache, sore throat
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| *Rash
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| **May be short-lived or protracted (2-3d)
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| **Pink macules/papules on face, spreads to neck, trunk, arms
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| ***Coalesces on face as it reaches the lower extremities
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| *Lymphadenopathy
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| **Suboccipital and posterior auricular nodes
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| ==Erythema Infectiosum (Fifth disease)== | | ==Management== |
| *Caused by parvovirus B19
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| *"Slapped cheeks" rash
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| **Abrupt appeance
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| **Spares eyelids and chin
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| **Lasts 4-5d
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| *Macular erythema develops on trunk/limbs 2d after apperance of facial rash
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| **May last 1wk
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| *Assoc symptoms include fever, HA, sore throat, cough, coryza, N/V
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| ==Roseola Infantum (exanthem subitum)== | | ==Disposition== |
| *Likely caused by HHV-6
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| *3-5d prodrome of high fever, then defervescence, then rash for 1-2d
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| *Rash
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| **Erythematous macular eruption of discrete, pink lesions
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| **Mostly on neck, trunk, buttocks
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| **No mucus membrane involvement
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| ==Enteroviral Infections== | | ==See Also== |
| *Includes echovirus and coxsackie | | *[[Neonatal Rashes]] |
| *Rubella-like appearance of rash w/ discrete maculopapular nonpruritic rash | | *[[Rashes]] |
| *No specific therapy; self-limited
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| ===Hand Foot Mouth Disease===
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| *Caused by coxsacke virus
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| *Brief prodrome w/ low fever, anorexia, sore mouth
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| *Oral lesions appear 1-2d later
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| **Vesicles on erythematous base
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| **Painful
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| *Hand/foot lesions
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| **Red papules that change to gray vesicles
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| ===Herpangina===
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| *Caused by coxsackievirus
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| *Whitish ulcers on soft palate and posterior pharynx
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| **Similar to hand, foot, mouth disease but w/o skin lesions
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| ==Varicella== | | ==References== |
| *Pruritic generalized vesicular exanthem w/ mild systemic manifestations
| | <references/> |
| *Usually affects children <10y
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| *Rash
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| **Starts on trunk or scalp as pruritic, red macules, spreads to extremities
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| **W/in 24hr rash becomes vesicular (on erythematous base)
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| **Palms/soles spared
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| **Lesions in various stages of development
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| **Contagious until last lesion crusts over
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| *Treatment
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| **Tylenol, antihistamine
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| **Immunocompromised: IV acyclovir or high-dose PO tx (600mg/m2/day)
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| ==HSV==
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| *Herpes labialis (cold sore)
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| *Herpes gingivostomatitis
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| *Herpetic whitlow
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| **Ensure that has not spread to cornea
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| *Eczema herpeticum
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| **Development of vesicular eruptions in areas of epidermis previously affected by eczema
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| **May be life-threatening
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| **Bactrim 10mg/kg/d in 2 divided doses OR clindamycin 24mg/kg/d divided into 3 doses x10d
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| **Acyclovir 80mg/kg/d in 3 divided doses x10
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| ==Infectious Mononucleosis==
| | [[Category:Pediatrics]] |
| -abrupt or insidious, ha, fever & malaise common w/ st & lad to follow
| | [[Category:Dermatology]] |
| | | [[Category:Symptoms]] |
| -rash in 10-15% usu btwn 4th-6th day of illness
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| -red macular or maculopapular morbilliform rash of trunk & upper arms
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| -occ involves face, thigh & legs, periorbital & eyelid edema in 50% of cases
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| -pathognomonic= st, lad, splenomegaly, d/t EBV
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| ==HSP==
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| -palpable purpura in lower ext and buttocks
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| ==Drug Rash==
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| -sudden, usus morbilliform, often starts on face & trunk & spreads
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| ==Source==
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| Tintinalli
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| [[Category:Peds]] | |
| [[Category:Derm]] | |
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