common Rashes.ppt

8/9/2019 common Rashes.ppt

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Approach to Rash

• What else is wrong?

• Is the child well or unwell?

• History of rash and evolution

• Describe the rash – colour, blanching, size,distribution, raised

• Is it a !iller rash"?

• Is it a classic rash" rash of childhood?

• #anage$ent advice and follow up asappropriate


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#eningococcus

• Rare % &'&((,(((, sporadic epide$ics

• )(* in + yrs, )* - .(

•Wide clinical spectru$

• #ay $i$ic viral illness early

• /i$b pain, $yalgia, refusal to wal!,

cold hands and feet – early signs&• Red rash initially 0- petechiae 0-

purpura1. Inkelis SH, O'Leary D, Wang VJ, Malley R, Nicholson MK, Kupperann N!, Extremity pain

and refusal to walk in children with invasive meningococcal disease. "e#ia$rics! %&&%

Jul((&)( "$ (*+e


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1nteroviral

Rash

• Maculopapular

• ± Petechiae

Includes many viruses

•Coxsackie, Echo,

poliovirus etc


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Hand 2oot and #outh

Brief prodrome

• Mild fever, mouth

painRash/lesions

• Mouth

• Palms

• Sides of feet + soles

• Buttocks/nappy area


10/73

Hand 2oot and #outh

Advice?

• Hihly contaious

• Hand!ashin

M"

• Symptomatic• #ylocaine viscous

– $autious use in younchildren due to risk ofto"icity


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1rythe$a #ulti$for$e


12/73

3tevens 4ohnson

3yndro$e


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3tevens

4ohnson3yndro$e


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Urticaria


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Urticaria


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5rticaria

• Blanchin

• %heals

•&tchy

• Pink

• Raised

• 'emarcated

• (ransient

• Advice?

---!allergy!org!au


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6awasa!i Disease

)* ever lastin ≥ days-* Bilat con.unctival

in.ection

* 0rythematous rash

1* 'ry/red 2ssured lipsor stra!3erry tonue+ red oropharyn"

* 4edema of hands/feet

→ des5uamation6* $ervical 78s at least )

9 :)*cm

Need fever + 4 criteria


24/73

6awasa!i Disease

Advice?

&"?M"?


25/73

"a$ien$ charac$eris$ics sugges$ing #isease

other than Ka-asaki #isease+•e.u#a$i/e con0unc$i/i$is,•e.u#a$i/e pharyngi$is,•#iscre$e in$raoral lesions,• 1ullous or /esicular rash, or•generali2e# a#enopa$hy

3lgori$h 4or incople$e KD

3erican Hear$ 3ssocia$ion )3H3* an# $he 3erican

3ca#ey o4 "e#ia$rics )33"*

h$$p+55---!up$o#a$e!co5con$en$s5incople$e6a$ypical6ka-asaki6#isease7source8see9link

http://www.uptodate.com/contents/incomplete-atypical-kawasaki-disease?source=see_linkhttp://www.uptodate.com/contents/incomplete-atypical-kawasaki-disease?source=see_linkhttp://www.uptodate.com/contents/incomplete-atypical-kawasaki-disease?source=see_linkhttp://www.uptodate.com/contents/incomplete-atypical-kawasaki-disease?source=see_link


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3carlet 2ever

Rash• 4ften 2rst on head and

neck

• Most prominenta"illae/roin

• (hen trunk + lim3s

• Palms/soles are spared

• 0rythematous

• Maculopapular

• Sandpaper


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Scarlet Fever

•Incub period 2 days

•Prodrome

•Tonsillitis

•Rash

•Flushed face•Circumoral pallor

•tra!berry ton"ue


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3carlet 2ever

#dvice $

Infectious untilPen is

"iven for 2%

hours


32/73

3carlet 2ever

• Des7ua$ation after one wee!


33/73

3carlet 2ever


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#easles

Rash• Maculopapular

• Mor3illiform

•Starts 3ehind ears

• (hen face, trunk, incl* palms/soles;cephalocaudal spread<

• ades 3y 1= days• (hen 3ro!n stainin

• 8o des5uamation


36/73

#easles

Prodrome• = days

• >opliks spots

• Runny nose

• $on.unctivitis

• 'ry couh

• Hih fever/chills

•Malaise/headache

• SYSTEMIC TOXICITY


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41/73

Rubella

Rash

• Pink maculopapular

• Starts on face, 3ehindears

• (hen trunk, lim3s

•'isappears over -=/@

• ± Petechiae soft palate

;orchheimer spots<


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Rubella – .rd disease"

• Prodrome• Lymph nodes may

appear 3efore rash

• Rash

• Mild illness

• A3sence of hih fever

Advice?

• &nfectious period )=-!eeks 3efore rash →

days after


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8ongenital Rubella


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1rythe$a


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1rythe$aInfectiosu$93lapped 8hee!

– )th Disease"Rash 3 phases

• 0rythema/slappedcheek

• Maculopapular rash onlim3s/trunk ;ne"t day<

• Reticulate/lacy pattern as rash fades

;day 6<• 'uration of rash =-1

days


50/73

1rythe$a Infectiosu$

Advice?

• $omplics

Arthritis/arthralia• Aplastic crises

• etal e"posure

• &nfectious period

durin prodromeonly


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Roseola – :th Disease"Prodrome

• ever = days

• &rrita3le

• ± '+, couhRash after prodrome

• Maculopapular

• Well child oncerash appears Advice?


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8lassic Rashes of 8hildhood

• &st disease – #easles

• nd disease – 3carlett fever

•

.rd

disease – Rubella• ;th disease – Du!e

•

)th

disease – 3lapped 8hee!• :th disease – Roseola


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aricella

• &ncu3 period

• Prodrome

• Rash

&nitially maculesesicles in 6= hrs

$rops

Starts trunk, face, scalp

&ntensely itchy

$rust over =- days


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•Conta"ious 2% hrs before rash till all

crusted

•&sually '() days

•Incub period

•*I+$

•accine$•Fetal exposure

•Complics$

Advice?


58/73

8ongenital aricella


59/73

aricella I$petigo

3hi l


60/73

3hingles


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1cze$a Herpeticu$

• HS infection inecCematous skin

• $an 3e severe• 4ften need &

acyclovir

•

Most resolve!ithout se5uelae


66/73

HSV

H i Whi l


67/73

Herpetic Whitlow


68/73

Herpetic Whitlow


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H3


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71/73

Drug Rash

• $eclor

• Bactrim

• Sulphur • Penicillin

• Amo"il/Ampi +0B


72/73

#olluscu$


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Approach

• What else is wrong?

• Is the child well or unwell?

• History of rash and evolution

• Describe the rash – colour, blanching,size, distribution, raised

• Is it a !iller rash"?

• Is it a classic rash" rash of childhood?• #anage$ent advice and follow up as

appropriate

Date post:	01-Jun-2018
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common Rashes.ppt

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