The common and the dangerous

Why does an adult ED Dr have to know;• Common paediatric presentation• Useful knowledge for the lay consult• Frequent adult fast track patient

presentation• Knowledge of at risk contacts• Recognition is 99% of the problem,

treatment/advice is usually simple

Nomenclature of dermatology Classification system of different

rashes Management

Pattern recognition• Age group• Progression of rash• Associated symptoms• Lesions

Type Distribution Special features

8yo, fever, headache then rash Explosion of crops of lesions, first

face/scalp, then trunk and limbs over 1 day

Spares palms and soles

10yo, coryza, conjunctivitis, cough, fever

Maculopapular rash, starts behing ears, descends, becomes confluent on upper body

5yo girl, fever, arthralgias, malaise Day 3 rash on face, fevers resolved Day 7 lacy rash on body

4yo boy Fever, coryza, lethargy, mild

diarrhoea Painful lesions in/around mouth

1yo, high fever, irritable Day 3, florid rash, fever abates

8yo, sore throat, fever Day 2 – rash on trunk, spreads widely

3yo girl, Asian descent 3 days high fever, irritable, rash =

lower abdo and groin, hands and feet Mild transaminitis, high platelets

4yo, non blanching rash on lower limbs

Painful feet, mildly swollen Afebrile, systemically well 1 week post URTI

14 yo girl, onset of rash over 1 week, been present for 3 weeks

Seen 2 GPs Systemically well, no other Sx

5yo boy, African descent Referred by GP with massive painless

abscess on scalp for surgical review Systemically well

3yo, 1 week post first coldsore Onset of rash, mildly itchy, mild

fever, systemically well

Progression of rash Associated symptoms Be a detective! Look in/at the;

• Mouth• Hands and feet• Nappy area and creases