Date post: | 11-Jan-2016 |
Category: |
Documents |
Upload: | anne-flynn |
View: | 214 times |
Download: | 2 times |
Children’s Rashesand things that go ‘itch’ in the night!
Janet YoudCalderdale and Huddersfield NHS Trust
Objectives•To understand the terminology used in describing rashes and skin lesions.
•To illustrate some common rashes seen in children.
Background• Ill children often present with
several symptoms, one of the most common being a rash.
• Any attempt to identify a rash should come after the systematic assessment of a sick child.
SYSTEMATIC APPROACH TO RASH
IDENTIFICATION•History/Examination•Distribution (Body Location)•Morphology of primary and
secondary lesions.•Configuration / Arrangement•Pattern of Distribution•Consult Textbook
History• Associated symptoms, timings and
sequence of onset. Aggravating/relieving factors
• Recent contacts/symptoms in family members/peers
• Social history/pets• Recent travel• Immunisation history• Past medical history• Drug history• Known allergies
Examination• Ensure privacy• Suitable environment• Will need full systems
examination if signs of systemic illness
• Look:– Total skin evaluation (including folds)– Evaluate hair and nails
• Feel:– Subtle changes in texture
Distribution
•Scattered/Generalised: spread throughout the body
•Localised: involve only a selected part
Morphology
MACULE–Derived from the Latin for Stain.
–Used to describe changes in colour or consistency without elevation above the surface of the surrounding skin.
–Typically less than 1cm•e.g. Freckles
PATCHAs a macule but greater than 1cm.
•e.g. Vitiligo or Café au Lait spot
PAPULERaised, palpable skin lesions smaller than 1cm in diameter that may or may not have a different colour from the surrounding skin.
NODULE•As a papule but greater than 1cm.
PLAQUERaised, palpable skin lesion greater than 1cm in diameter. Usually confined to the superficial dermis.•Typically seenin psoriasis.
WHEALSRaised circumscribed, oedematous plaques that usually are pink or pale and tend to be present only temporarily.
VESICLEA raised lesion of less than 1cm that contains clear serous fluid.•Typical of herpes simplex.
BULLAEAs a vesicle but greater than
1cm. It may be superficial within the epidermis or may be situated in the dermis below.•Commonly Seen in partial Thickness burns.
PUSTULESPapules filled with pus.
•Commonly seen in patients with acne.
PURPURAGeneral name for the escape of red blood cells into the skin.Petechiae are less than 0.5cm
Secondary Lesions•Excoriations
–Scratch marks
Secondary Lesions•Lichenification
–Typical thickening of the skin. Often seen in patients with chronic pruritus.
Secondary Lesions•Crusts
–Raised lesions produced by dried serum and blood cell remnants.
Secondary Lesions•Erosions
–Depressed lesions produced whenever the epidermis is either removed or sloughed. They are moist, usually red and well circumscibed. Classically seen in chicken pox after rupture of a vesicle.
Secondary Lesions•Ulcers
–Depressed lesions produced whenever not only the epidermis but also part of (or all of) the dermis is gone.
Secondary Lesions•Fissures
–Depressed lesions that present as narrow and linear skin cracks. They penetrate through the epidermis and reach at least part of the dermis.
Terms to describe configuration•Annular: Ring shaped
Terms to describe configuration•Linear: Lesions arranged in
a line
Terms to describe configuration•Reticular: Net-like clusters
Pattern of distribution•Clustered: Grouped
•Confluent: Multiple lesions that blend together
•Dermatomal: Distributed along neurocutaneous dermatomes
Information• 1-2 day history of general malaise
and low grade pyrexia.• Initially noticed itchy, scattered
rash of discrete lesions of varying morphology. Some are macular papular, that develop to vesicles.
• Within 24 hours developed some secondary crusts, whilst new lesions continued to erupt over then next 4-5 days.
• There are some ulcers within the mouth.
Chicken Pox
Information•3 day history of high fever,
cough, red and watery eyes. Child miserable.
•Developed non-itchy, scattered, maculopapular confluent rash. Started at the hairline and worked down.
•Koplick spots are noted on buccal mucosa.
Measles
Information•Tiny pink macules starting
on face and working down the body, associated with low grade pyrexia and slight post-auricular lymphadenopathy. Rash fades quickly.
Rubella
Information•Systemically well child with
discrete papules (1-5 mm) with a central dimple, clustered and localised to chest and abdomen.
Molloscum Contagiousum
Information•Tingling skin sensation
followed by clustered or isolated vesicles, localised to specific area, commonly face/lips. Develop secondary crusts. Resolve 5-14 days.
Herpes Simplex
Information•Localised flaccid blisters
rupture and form ‘golden’ crusts. Spreading occurs readily. Most commonly seen around the nose and mouth.
Impetigo
Information•Rapid onset (hours) flu-like
symptoms. May have scattered non-itchy maculopapular rash followed by development of petechiae and purpura.
Meningococcal Septicaemia
Information•Child presents with non-
itchy purpuric rash localised to legs and buttocks. May also have haematuria +/- abdominal pain. He is otherwise well.
Henoch-Schonlein Purpura
Information•Sudden onset widespread wheals following ingestion of strawberrries.
Urticaria
Information•Localised very itchy
oedematous and erythematous lesion may develop to vesicles followed by secondary crusting and scaling.
Contact dermatitis
Information• Intensely itchy, localised
papules and vesicles, some ‘burrows’ may be seen. Often secondary excoriation noted. Commonly found between fingers and on flexor surfaces at elbows, knees and groins.
Scabies
Information•Papular and vesicular rash
noted behind ears and on back of neck. This may lead to secondary excoriation and crusting.
Head Lice (Pediculosus Capitis)
Pitfalls•Beware ‘labelling’ any rash. If in doubt describe it.
•Assess the child properly and treat according to symptoms. Some very sick children have no rash. Some spectacular rashes are of little significance.
Summary• Understanding the terminology
will help you to document your findings.
• Repeated examination of rashes will aid your recognition.
• Consult the textbooks and experts before commencing treatment.