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8/13/2019 #Common Childhood Rashes in General Practice.docx
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Common Childhood Rashes in General Practice
Common problem encountered in General Practice
◦ 49.1% pre-school children affected at any one time 29.4% eczema
19.5% seborrhoeic dermatitis
15% Nappy rash
0.9% Tinea
Approach to rashes
History
History
History Then examine!
Investigations rarely needed/ appropriate
Common skin lesions
Macule circumscribed area of change in normal skin color with no skin elevation
Papule solid raised lesion up to 0.5 cm in diameter , variable color
Nodule larger & deeper than papule
Plaque confluence of papules
Pustule circumscribed area of skin containing purulent fluid
Vesicle circumscribed elevated ,fluid filled lesion up to 0.5 cm in diameter
Bulla larger than vesicle
Petechiae small red or brown macules up to 0.5 cmin diameter that do not blanch on pressure
Purpura petechiae > 0.5 cm
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VIRAL MACULOPAPULAR RASH
ROSEOLA MEASLESRUBELLA
(GERMAN MEASLES)
ERYTHEMA INFECTIOSUM
(5TH
DISEASE)
aka ‘slapped cheek disease’
Cause HHV6/7 Measle virus Rubella virus Parvovirus B19
General
feature
- Affects those aged 6-36 months
- 3-5 days high fever with no
obvious source
- Sub-occipital nodes
IP = 8-14 days
Prodromal illness 3-4 days
- Fever- conjunctivitis
- runny nose (coryza) & cough
Infectious 1-2 days before prodrome
Later symptoms : Koplik spots (appear 1 day
before and 1 day after rash appear)
IP = 14-21 days
No prodrome
Infectious 5-7 days before rash
- Fever & lymphadenopathy
(occipital & postauricular)
- May have petechiae on hard
palate & asscociated
arthralgia/arthritis
- Lasts 10 days
IP = 4-14 days
- Fever in 15-30% for 1-2 days
- Slapped cheek appearance
Rash Rose-pink macular rash appears
once fever settles
- Starts on trunk, may spread toface & extremities
- Lasts up to 2 days
** Diffuse erythematous maculopapular rash all
over the trunk, face and extremities, blotchy and
irregular. Coalesce into patches of different sizeand shapes
Fine pink maculopapular rash on
face then trunk & limbs
Generalised maculopapular rash
for 7-10 days
- lace-like
**Dx
features
rash appears once fever settles **Koplics spots : multiple red spots with white
dots in the centre resting on inflamed mucous
membrane of the hard palate opposite to the
upper second molar tooth
**Diffuse erythematous patch
on the cheeks with circumoral
pallor giving slapped cheek
appearance
Managemt Treat symptomatically
Reassurance
Supportive
Symptoms usually last 10 days
Supportive Supportive
Complications:
- Otitis media
- Bronchopneumonia
- Encephalitis (1/1000)- Myocarditis/pericarditis
- SSPE (rare)
- 30% mortality in developing countries
DDx of maculopapular rash (see above)
Complications :
- Arthritis (esp. adolescents)
- Thrombocytopenia (rare)
- Encephalitis- Peripheral neuritis
- Birth defects in 1st
trimester
* Hence importance of vaccinating
girls!
DDx of slapped cheek:
- Cushing syndrome
- Malar flush (SLE)
- Scarlet fever- Corticosteroid (drug)
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Roseola Infantum Measles Koplik’s spot Erythema Infectiousm Rubella (German measles)
Rubella (German measles) Follicular tonsillitis Scarlet fever Strawberry tongue Chicken Pox
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BACTERIAL MACULOPAPULAR RASH VIRAL VESICULAR RASH
Scarlet Fever Chickenpox
Cause Group A beta-haemolytic Streptococcus
(toxigenic stains)
Varicella zoster virus
General feature IP = 2-4 days
Bright red blanching rash (sandpaper)
First in axila/groins, then widespreadRed face with circumoral pallor
Strawberry tongue (white then red)
Hx of strep. Tonsillitis
IP = 14-21 days
Very commonProdrome mild fever & malaise
Infectious for 1-2 days before rash & 5 days afterwards
Rash ** rash is pinpoint, red fine granular macules, Bright
red blanching rash (sandpaper) mainly on the trunk
giving the appearance of goose skin
Vesicles on erythematous base
- Change to macule→ papule→vesicle→crust
- Last 3-4 days
- Mainly on trunk
- Can appear in mouth/genital region
- Usually no scarring
**Dx features **tongue is swallowen, edematous, hyperemic, with
prominent papilla with circumoral pallor giving the
appearance of red strawberry tongue
- multiple vesicles centripetal in distribution mainly found on the face and trunk
and scattered on the extremities.
- oval in shape, resting on erythematous base, filled with clear fluid, about 0.5
cm in diameter.
- Some vesicles erupted and show crustation
Management Symptomatic relief
Penicillin V 7-10 days
Supportive – fluids/paracetamol/calamine lotion
Admit if complications suspected
Dx of streptococcal tonsillitis:
(2 out 3)- diffuse erythematous tonsils
- pus on top of tonsil
- enlarged tender lymphadenopathy
DDx of congested tonsil with white spots:
- diphtheria - infectious mononucleosis
- thrush - milk
Complications:
- Always look carefully at child if fever persists > 5 days after appearance rash secondary bacterial infection
- Pneumonitis
- Encephalitis
- Cerebellar ataxia
- Eczema herpeticum
- Risk to neonates & pregnant women 1st trimester especially
DDx of vesicular vesicular rash (see above)
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