Pediatric rashes

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Neonatal Rashes

Erythema Toxicum

  • Benign, self-limited (1wk) rash that occurs in 50% of newborns
  • Erythematous macules develop on face, trunk, extremities
  • No treatment necessary

Neonatal Acne

  • Occurs around 3rd week of life
  • Commonly on face, may also see on trunk
  • No treatment necessary (resolves by 3rd month of life)

Seborrheic Dermatitis

  • Starts between 2-6wk of life; improves by 6 months
  • Greasy yellow-red scales
  • Proclivity for scalp (cradlecap), but may find around ears, cheeks, neck
  • Not pruritic
  • DDX
    • Atopic dermatitis, tinea capitis, psoriasis
  • Treatment
    • Salicylic acid shampoo (Sebulex) OR
    • Application of mineral oil followed by washing and removal of scales w/ comb

Atopic Dermatitis

  • Must distinguish from seborrheic dermatitis
    • Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
    • Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)
  • Dry skin, erythematous papular lesions
  • Face most commonly involved; nose and diaper areas spared
  • DDX
    • Seborrheic dermatitis, scabies
  • Treatment
    • Identify and eliminate triggers
    • Reduce drying of skin
    • Liberal application of emollients (vaseline)

Diaper Dermatitis

  • Contact dermatitis VS candidal dermatitis
  • Contact dermatitis
    • Erythematous, macular or papular, w/ well demarcated borders
    • Treatment
      • Good hygiene, air drying, use of barrier creams (zinc oxide)
  • Candidal dermatitis
    • Erythematous w/ papular and pustular lesions and scaling around margins
    • Classic finding is "satellite lesions"
    • Must examine for oral thrush
      • If present: Oral nystatin 2mL QID infants, 4-6mL QID children
        • Administer for up to 2d after resolution of oral lesions
    • Treatment
      • Nystatin cream 100K U/gram TID x10-14d
      • If use zinc oxide must apply after nystatin
      • Hydrocortisone 1-2% after nystatin, before zinc oxide, may be used for severe lesions

Measles (Rubeola)

  • 10d incubation period
  • 3d prodromal period
    • URI symptoms: high fever, cough, conjunctivitis, coryza
  • Rash
    • Begins 14th day after exposure
    • Spreads from central to peripheral
    • Initially is erythematous and maculopapular; rapidly progresses to confluence (face)
    • Lasts 7d
    • Koplik spots
      • Pathognomonic enanthem
      • White to bluish-white lesions w/ red base on buccal mucosa

Scarlet Fever

  • Caused by GAS
  • Prodrome of fever, sore throat, vomiting, abd pain followed by rash 1-2d later
  • Rash
    • Enanthem
      • Tonsils/pharynx are red and covered w/ exudate
      • Tongue may have initial exudate followed by erythema ("strawberry tongue)
      • Soft palate have bright-red spots
    • Exanthem
      • Starts on neck, axillae, groin, spreads to trunk and extremities
      • Red, finely punctate, sandpaper feel
      • Desquamation follows
  • Treatment (to reduce rheumatic fever / nephritis)
    • Penicillin VK 50mg/kg BID x 10d OR amoxicillin 40mg/kg/d in 2 divided doses x10d
    • If pen allergic: Azithromycin 10mg/kg on day 1, 5mg/g days 2-5

Rubella (German Measles)

  • Incubation 2-3wk
  • Prodrome 1-5d
    • Fever, malaise, headache, sore throat
  • Rash
    • May be short-lived or protracted (2-3d)
    • Pink macules/papules on face, spreads to neck, trunk, arms
      • Coalesces on face as it reaches the lower extremities
  • Lymphadenopathy
    • Suboccipital and posterior auricular nodes

Erythema Infectiosum (Fifth disease)

  • Caused by parvovirus B19
  • "Slapped cheeks" rash
    • Abrupt appeance
    • Spares eyelids and chin
    • Lasts 4-5d
  • Macular erythema develops on trunk/limbs 2d after apperance of facial rash
    • May last 1wk
  • Assoc symptoms include fever, HA, sore throat, cough, coryza, N/V

Roseola Infantum (exanthem subitum)

  • Likely caused by HHV-6
  • 3-5d prodrome of high fever, then defervescence, then rash for 1-2d
  • Rash
    • Erythematous macular eruption of discrete, pink lesions
    • Mostly on neck, trunk, buttocks
    • No mucus membrane involvement

Enteroviral Infections

  • Includes echovirus and coxsackie
  • Rubella-like appearance of rash w/ discrete maculopapular nonpruritic rash
  • No specific therapy; self-limited

Hand Foot Mouth Disease

  • Caused by coxsacke virus
  • Brief prodrome w/ low fever, anorexia, sore mouth
  • Oral lesions appear 1-2d later
    • Vesicles on erythematous base
    • Painful
  • Hand/foot lesions
    • Red papules that change to gray vesicles

Herpangina

  • Caused by coxsackievirus
  • Whitish ulcers on soft palate and posterior pharynx
    • Similar to hand, foot, mouth disease but w/o skin lesions

Varicella

  • Pruritic generalized vesicular exanthem w/ mild systemic manifestations
  • Usually affects children <10y
  • Rash
    • Starts on trunk or scalp as pruritic, red macules, spreads to extremities
    • W/in 24hr rash becomes vesicular (on erythematous base)
    • Palms/soles spared
    • Lesions in various stages of development
    • Contagious until last lesion crusts over
  • Treatment
    • Tylenol, antihistamine
    • Immunocompromised: IV acyclovir or high-dose PO tx (600mg/m2/day)

HSV

  • Herpes labialis (cold sore)
  • Herpes gingivostomatitis
  • Herpetic whitlow
    • Ensure that has not spread to cornea
  • Eczema herpeticum
    • Development of vesicular eruptions in areas of epidermis previously affected by eczema
    • May be life-threatening
    • Bactrim 10mg/kg/d in 2 divided doses OR clindamycin 24mg/kg/d divided into 3 doses x10d
    • Acyclovir 80mg/kg/d in 3 divided doses x10

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

Tintinalli