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