Pediatric rashes

DDX

• Measles (Rubeola)
• Rubella (German Measles)
• Erythema Infectiosum (Fifth disease)
• Roseola Infantum
• Varicella
• HSV
• Infectious Mononucleosis
• Henoch-Schonlein Purpura
• Drug Rash

Scarlet Fever

• Caused by GAS
• Prodrome of fever, sore throat, vomiting, abd pain followed by rash 1-2d later
• Rash
  • Enanthem
    • Tonsils/pharynx are red and covered w/ exudate
    • Tongue may have initial exudate followed by erythema ("strawberry tongue)
    • Soft palate have bright-red spots
  • Exanthem
    • Starts on neck, axillae, groin, spreads to trunk and extremities
    • Red, finely punctate, sandpaper feel
    • Desquamation follows
• Treatment (to reduce rheumatic fever / nephritis)
  • Penicillin VK 50mg/kg BID x 10d OR amoxicillin 40mg/kg/d in 2 divided doses x10d
  • If pen allergic: Azithromycin 10mg/kg on day 1, 5mg/g days 2-5

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
• Prodrome
  • Sudden onset of high fever, sore throat, malaise
• Rash appears 24-48hr after prodrome
  • Vesicles 1-2 mm in size that rupture leaving shallow, painful whitish ulcers on soft palate/posterior pharynx
  • Similar to hand, foot, mouth disease but w/o skin lesions
• Lasts 7-10d

See Also

• Neonatal Rashes

Source

Tintinalli