Pediatric rashes

Measles (Rubeola)

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

Rubella (German Measles)

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
  • 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

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

See Also

Source

Tintinalli