Pediatric rashes
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
- If present: Oral nystatin 2mL QID infants, 4-6mL QID children
- 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
- Enanthem
- 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