Mimi Lu, MDClinical Assistant Professor
University of Maryland
DEADLY PEDIATRIC RASHES
DISCLOSURES
• None
OBJECTIVES
• Review pearls to recognize life threatening rashes
• Discuss treatment of life threatening pediatric rashes
TAKE HOME
• Viral exanthem
• Supportive care
• Follow up with your pediatrician
THANK YOU!!!
DEADLY RASHES
• Characteristics
• Altered LOC
• Mucous membrane involvement
• Multiorgan involvement
• Extensive blisters or desquamation
• Pain out of proportion to exam
• Petechiae or purpura
DEADLY RASHES
1. Palms/ Soles
• MRS TECK
2. Blistering/ mucosal involvement
3. Purpura/ Petechiae
“PALMS AND SOLES”
MRS TECK
• Meningiococcemia
• Rocky Mountain Spotted Fever
• Syphillis, Stevens-Johnson Syndrome, SSSS
• Toxic shock syndrome, Toxic Epidermal Necrolysis
• Erythema Multiforme
• Coxsackie
• Kawasaki
KAWASAKI DISEASE
KAWASAKI DISEASE
• Fever plus 4 of 5 characteristics
1. Bilateral conjunctival injection without exudate
2. Rash
• maculopapular, erythema multiforme, scarlatiniform
3. Unilateral cervical adenopathy, ≥ 1.5 cm
4. Strawberry tongue, erythema of oral & pharyngeal mucosa, dry/cracked lips
5. Edema & erythema of hands & feet
C
R
A
S
H
SSS
• photos
Nikolsky’s
Sign
STAPHYLOCOCCAL SCALDED SKIN SYNDROME
• Malaise
• Fever
• Paradoxical irritability
• Sunburn rash
• Intense around neck, intertriginous areas, perioral
• Nikolsky’s sign
• No mucous membrane involvement
• Mucous membranes
• Adverse med reaction
• NSAIDS
• Penicillins
• Sulfonamides
• Anticonvulsants
• Rx: IVF
• Burn center
• ?IVIG
STEVENS JOHNSON SYNDROME
ERYTHEMA MULTIFORME
Etiology: 90% infectious (60% HSV)
meds, malignancy, autoimmune diseases
Supportive:
Topical emollients, antihistamines, NSAIDs
Recurrent: prophylactic oral acyclovir
Lesions typically resolve in 2 weeks
COXSACKIE (HAND-FOOT-MOUTH)
Vesicular lesions on the anterior mouth and an
exanthem on the hands and feet (and buttocks) in
association with fever
Peak incidence in the summer and fall
Infants and children younger than 5 years
Tx: supportive
HENOCH-SCHONLEIN PURPURA
• Vasculitis of small vessels
• Non-thrombocytopenic purpura
• “palpable purpura”
• Edema in dependent regions
• Arthritis
• Abdominal pain/ GI bleed
• Intussusception
• Renal involvement
IDIOPATHIC THROMBOCYTOPENIC PURPURA
• Fever + petechial rash + headache
• Tick-borne illness
• Clinical diagnosis
• Spreads inwards
• Rx: Doxycycline or chloramphenicol
ROCKY MOUNTAIN SPOTTED FEVER
• Fever + petechial rash
• Rapid progression to purpura
• Transmission in close quarters
• URI prodrome
• Fulminant shock
MENINGOCOCCEMIA
DEADLY RASHES
1. Palms/ Soles
• MRS TECK
2. Blistering/ mucosal involvement
3. Purpura/ Petechiae