Pediatric rashes

Classic Diseases

Measles-1st disease

Scarlet fever- 2nd

Rubella-3rd

Dukes-4th

Erythema infectiosom- 5th

Exanthem subitum (roseola)- 6th

Measels (Rubeola)

-10-14days of incubation

-Fever, Cough, Conjunctivitis(non-purulent), Coryza, usu. before rash

-Koplick spot's= pathognomonic, grains of salt on red background on buccal mucousa

-Rash is "bucket of paint dumped on head"

-Reddish brown on face & neck rather confluent spreads down trunk & extrems (less confluent) & generalized on 3rd day.

-Fades on 5-6 day w/ brownish staining then desquamation.

-Etiology: Rubeola virus

Scarlet Fever

-Incubation of 2-5days then...

-fever, HA, sore thrt, vomiting prodrome 12hrs before rash

-Erythematous, punctiform that blanches w/ pressure, starts on flexor areas then spreads to generalized in 24hrs.

-Forehead & cheeks smooth red flushed but circumoral pallor.

-See lesions most on neck, axilla, inguinal area, popliteal folds

-INVOLVES HANDS & FEET unlike measles

-Desquamation follows

-STRAWBERRY TONGUE IS PATHOGN.

-Etiol: Grp A strep.

-Rx= pcn for 10 days or bicillin IM x1

Rubella (German Measles)

-Incubation 2-3wks

-NO PRODROME

-Rash often first, LYMPHADENOPATHY often asymptomatic in kids.

-Rash is pink starting on face/neck down to trunk & extrems faster than w/ measles, general in 24-48hrs.

-lesions discrete not confluent.

-By third day face clear only extrems. are involved (first to form, first to fade.

-NO desquamation.

-In contrast to measles will see confluent vs discreet.

-LYMPHAD. is PATHOGN. post-auricular, occipital, but can see in other diseases

-Etiology is Rubella virus.

Erythema Infectiosum (Fifth disease)

-incubation 6-14days

-No prodrome often starts w/ rash.

-Starts w/ "slapped cheeks", then urticarial/morbilliform rash on extrems & trunk, w/ pruritis sometimes

-As rash fades gets reticular or lacey appearance. Can see this for one week or 8wks.

-Pathognomic is slapped cheeks in well-appearing child.

-Etiology is parvovirus B19

-if pregnant bad, can =fetal hydrops & death (2-6%), risk greatest 1st 1/2 of preg

Exanthem Subitum (Roseola)

-Incubation of 5-15days

-Prodrome of 3-4 days of high fever & irritability, then rash as temp falls to normal

-Rash is rose-red maculopapules often appearing on chest & trunk first then face & extremities

-Eruption fades in 2 days/ several hrs

-Pathogen is rash as fever fades

-Etiology is HSV 6,7

Enteroviral Infections

-ECHO virus & Coxsackie are common examples

-Incubation about 3-6d but variable in ECHO

-ECHO can see prodrome w/ fever but lower than roseola

-Rubella-like appearance of rash, w/ discrete maculopapular nonpruritic rash that is generalized.

-No desquamation, rarely w/ petechial lesions in ECHO & COXSACKIE A9 or B5

-Coxsackie A16 gives hand/foot/mouth disease.

^^all rash ask is it discrete or confluent

Hand Foot Mouth Disease

-brief prodrome w/ low fever, anorexia & ap

-oral lesions (macules to vesicles on red base to ulcers)

-lesions on soft & hard palate, gingiva

-usu on dorsal hands & lateral feet, frequently on buttocks

-pathognomonic= hand, feet & mouth

-d/t cox A16 & enterovirus 71

Varicella

-Incubation 10-21 days (usu 14-16)

-vesicular eruption, 1st on trunk, scalp or face, later to ext, lesions in various stages of development, very pruritic

-pathognomonic= macules, papules, vesicles & crusts of diff stages

-d/t varicella zoster virus

-Contagious until the last lesion crusts over which is usually about 7-10 days into dz!!

Infectious Mononucleosis

-abrupt or insidious, ha, fever & malaise common w/ st & lad to follow

-rash in 10-15% usu btwn 4th-6th day of illness

-red macular or maculopapular morbilliform rash of trunk & upper arms

-occ involves face, thigh & legs, periorbital & eyelid edema in 50% of cases

-pathognomonic= st, lad, splenomegaly, d/t EBV

HSP

-palpable purpura in lower ext and buttocks

Drug Rash

-sudden, usus morbilliform, often starts on face & trunk & spreads

Source

Inkelis 7/04- By Lampe