Pediatric rashes

Measles (Rubeola)

• 10d incubation period
• 3d prodromal period
  • URI symptoms: fever, cough, conjunctivitis, coryza
• Rash
  • Begins 14th day after exposure
  • Spreads from central to peripheral
  • Initially is erythematous and maculopapular; rapidly progresses to confluence (face)
  • Lasts 7d
  • Koplik spots
    • Pathognomonic enanthem
    • White to bluish-white lesions w/ red base on buccal mucosa

Scarlet Fever

-Incubation of 2-5days then...

-fever, HA, sore thrt, vomiting prodrome 12hrs before rash

-Erythematous, punctiform that blanches w/ pressure, starts on flexor areas then spreads to generalized in 24hrs.

-Forehead & cheeks smooth red flushed but circumoral pallor.

-See lesions most on neck, axilla, inguinal area, popliteal folds

-INVOLVES HANDS & FEET unlike measles

-Desquamation follows

-STRAWBERRY TONGUE IS PATHOGN.

-Etiol: Grp A strep.

-Rx= pcn for 10 days or bicillin IM x1

Rubella (German Measles)

• Incubation 2-3wk
• Prodrome 1-5d
  • Fever, malaise, headache, sore throat
• Rash
  • May be short-lived or protracted (2-3d)
  • Pink macules/papules on face, spreads to neck, trunk, arms
    • Coalesces on face as it reaches the lower extremities
• Lymphadenopathy
  • Suboccipital and posterior auricular nodes

Erythema Infectiosum (Fifth disease)

• Caused by parvovirus B19
• "Slapped cheeks" rash
  • Abrupt appeance
  • Spares eyelids and chin
  • Lasts 4-5d
• Macular erythema develops on trunk/limbs 2d after apperance of facial rash
  • May last 1wk
• Assoc symptoms include fever, HA, sore throat, cough, coryza, N/V

Roseola Infantum (exanthem subitum)

• Likely caused by HHV-6
• 3-5d prodrome of high fever, then defervescence, then rash for 1-2d
• Rash
  • Erythematous macular eruption of discrete, pink lesions
  • Mostly on neck, trunk, buttocks
  • No mucus membrane involvement

Enteroviral Infections

• Includes echovirus and coxsackie
• Rubella-like appearance of rash w/ discrete maculopapular nonpruritic rash
• No specific therapy; self-limited

Hand Foot Mouth Disease

• Caused by coxsacke virus
• Brief prodrome w/ low fever, anorexia, sore mouth
• Oral lesions appear 1-2d later
  • Vesicles on erythematous base
  • Painful
• Hand/foot lesions
  • Red papules that change to gray vesicles

Herpangina

• Caused by coxsackievirus
• Whitish ulcers on soft palate and posterior pharynx
  • Similar to hand, foot, mouth disease but w/o skin lesions

Varicella

• Pruritic generalized vesicular exanthem w/ mild systemic manifestations
• Usually affects children <10y
• Rash
  • Starts on trunk or scalp as pruritic, red macules, spreads to extremities
  • W/in 24hr rash becomes vesicular (on erythematous base)
  • Palms/soles spared
  • Lesions in various stages of development
  • Contagious until last lesion crusts over
• Treatment
  • Tylenol, antihistamine
  • Immunocompromised: IV acyclovir or high-dose PO tx (600mg/m2/day)

HSV

• Herpes labialis (cold sore)
• Herpes gingivostomatitis
• Herpetic whitlow
  • Ensure that has not spread to cornea
• Eczema herpeticum
  • Development of vesicular eruptions in areas of epidermis previously affected by eczema
  • May be life-threatening
  • Bactrim 10mg/kg/d in 2 divided doses OR clindamycin 24mg/kg/d divided into 3 doses x10d
  • Acyclovir 80mg/kg/d in 3 divided doses x10

Infectious Mononucleosis

-abrupt or insidious, ha, fever & malaise common w/ st & lad to follow

-rash in 10-15% usu btwn 4th-6th day of illness

-red macular or maculopapular morbilliform rash of trunk & upper arms

-occ involves face, thigh & legs, periorbital & eyelid edema in 50% of cases

-pathognomonic= st, lad, splenomegaly, d/t EBV

HSP

-palpable purpura in lower ext and buttocks

Drug Rash

-sudden, usus morbilliform, often starts on face & trunk & spreads

Source

Tintinalli