Pediatric Rashes

Slide set by Dr Cathy Cantway:  pediatric-rashes
A quick terminology review:
– macule: flat, small color change
– papule:  elevated, small
– vesicle:  small blister
– bulla:  big blister
– plaque:  a big macule
– nodule:  a big papule
– ulceration:  loss of superficial skin
Slapped cheek rash:
– Parvovirus B19, or Fifth Disease
– Associated with joint pain
– Worry about exposed pregnant women, concern for fetal loss
Hand-foot-mouth disease
– coxsackie virus
– DDx includes herpangina (HFM only in the mouth!) and HSV
– usually benign and self-limited
– can exfoliate all their fingernails and toenails
Scarlet fever
– exposure to streptococcus
– ST, LAD, abdominal pain
– appears 1-2 days after symptoms start
– sandpaper rash, strawberry tongue –> desquamation
– HHV 6
– centrifugal rash (central –> extremities)
– 6 mos – 2 years
– fever and rash do not happen together
– r/o new exposures
– discuss sxs of anaphylaxis
– treat with H1/H2 blockers and steroids
– one time “freebie” then consider further workup; more worrisome if predictable “if this, then this…”
– cheeks, extensor surfaces in younger kids
– flexural surfaces in older kids
– associated with atopy and asthma
– topical steroids
Mononucleosis with amoxicillin rash
– generalized maculopapular rash
– not a true drug allergy
– mechanism not well-understood
Pityriasis rosea
– “Christmas tree” pattern rash after herald patch
– self-limited
Staphylococcal paronychia
– infection of lateral nail fold, often from oral inoculation
– common in infants
– usually staph or strep, but think Gram negatives or fungal if chronic
– Tx: flucloxacillin/floxacillin, cephalexin; I&D and warm soaks
Bullous impetigo
– Staphylococcus aureus
– DOL 5-10 onset typical
– Any body site can be involved
– Flaccid bullae with yellowish, clear or turbid fluid
– Tx with systemic Staph antibiotics
Staphylococcal pustule
– first few DOL
– neck, axillae, inguinal area
– if one lesion, can treat expectantly with chlorhexidine application
– if > 1 lesion, PO antibiotics against Staph
Herpes Simplex
– skin, mouth or eyes
– DOL 5-10 onset of lesions
– grouped vesicles, often in linear pattern, maybe shallow ulcerations
– lesions on lips look like “cold sores”
– aggressive treatment with antivirals!
– infection of umbilical cord
– Staph, Strep, occasional Gram negatives
– culture if possible
– IV antibiotics to cover both G+ and G- organisms
Congenital Syphilis
– variable derm findings
– petechiae, hemorrhagic vesicles and bullae early
– lesions VERY infectious

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