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