#Common Childhood Rashes in General Practice.docx

8/13/2019 #Common Childhood Rashes in General Practice.docx

http://slidepdf.com/reader/full/common-childhood-rashes-in-general-practicedocx 1/5

Common Childhood Rashes in General Practice

Common problem encountered in General Practice

◦ 49.1% pre-school children affected at any one time 29.4% eczema

19.5% seborrhoeic dermatitis

15% Nappy rash

0.9% Tinea

Approach to rashes

History

History

History Then examine!

Investigations rarely needed/ appropriate

Common skin lesions

Macule circumscribed area of change in normal skin color with no skin elevation

Papule solid raised lesion up to 0.5 cm in diameter , variable color

Nodule larger & deeper than papule

Plaque confluence of papules

Pustule circumscribed area of skin containing purulent fluid

Vesicle circumscribed elevated ,fluid filled lesion up to 0.5 cm in diameter

Bulla larger than vesicle

Petechiae small red or brown macules up to 0.5 cmin diameter that do not blanch on pressure

Purpura petechiae > 0.5 cm



VIRAL MACULOPAPULAR RASH

ROSEOLA MEASLESRUBELLA

(GERMAN MEASLES)

ERYTHEMA INFECTIOSUM

(5TH

DISEASE)

aka ‘slapped cheek disease’

Cause HHV6/7 Measle virus Rubella virus Parvovirus B19

General

feature

- Affects those aged 6-36 months

- 3-5 days high fever with no

obvious source

- Sub-occipital nodes

IP = 8-14 days

Prodromal illness 3-4 days

- Fever- conjunctivitis

- runny nose (coryza) & cough

Infectious 1-2 days before prodrome

Later symptoms : Koplik spots (appear 1 day

before and 1 day after rash appear)

IP = 14-21 days

No prodrome

Infectious 5-7 days before rash

- Fever & lymphadenopathy

(occipital & postauricular)

- May have petechiae on hard

palate & asscociated

arthralgia/arthritis

- Lasts 10 days

IP = 4-14 days

- Fever in 15-30% for 1-2 days

- Slapped cheek appearance

Rash Rose-pink macular rash appears

once fever settles

- Starts on trunk, may spread toface & extremities

- Lasts up to 2 days

** Diffuse erythematous maculopapular rash all

over the trunk, face and extremities, blotchy and

irregular. Coalesce into patches of different sizeand shapes

Fine pink maculopapular rash on

face then trunk & limbs

Generalised maculopapular rash

for 7-10 days

- lace-like

**Dx

features

rash appears once fever settles **Koplics spots : multiple red spots with white

dots in the centre resting on inflamed mucous

membrane of the hard palate opposite to the

upper second molar tooth

**Diffuse erythematous patch

on the cheeks with circumoral

pallor giving slapped cheek

appearance

Managemt Treat symptomatically

Reassurance

Supportive

Symptoms usually last 10 days

Supportive Supportive

Complications:

- Otitis media

- Bronchopneumonia

- Encephalitis (1/1000)- Myocarditis/pericarditis

- SSPE (rare)

- 30% mortality in developing countries

DDx of maculopapular rash (see above)

Complications :

- Arthritis (esp. adolescents)

- Thrombocytopenia (rare)

- Encephalitis- Peripheral neuritis

- Birth defects in 1st

trimester

* Hence importance of vaccinating

girls!

DDx of slapped cheek:

- Cushing syndrome

- Malar flush (SLE)

- Scarlet fever- Corticosteroid (drug)



Roseola Infantum Measles Koplik’s spot Erythema Infectiousm Rubella (German measles)

Rubella (German measles) Follicular tonsillitis Scarlet fever Strawberry tongue Chicken Pox



BACTERIAL MACULOPAPULAR RASH VIRAL VESICULAR RASH

Scarlet Fever Chickenpox

Cause Group A beta-haemolytic Streptococcus

(toxigenic stains)

Varicella zoster virus

General feature IP = 2-4 days

Bright red blanching rash (sandpaper)

First in axila/groins, then widespreadRed face with circumoral pallor

Strawberry tongue (white then red)

Hx of strep. Tonsillitis

IP = 14-21 days

Very commonProdrome mild fever & malaise

Infectious for 1-2 days before rash & 5 days afterwards

Rash ** rash is pinpoint, red fine granular macules, Bright

red blanching rash (sandpaper) mainly on the trunk

giving the appearance of goose skin

Vesicles on erythematous base

- Change to macule→ papule→vesicle→crust

- Last 3-4 days

- Mainly on trunk

- Can appear in mouth/genital region

- Usually no scarring

**Dx features **tongue is swallowen, edematous, hyperemic, with

prominent papilla with circumoral pallor giving the

appearance of red strawberry tongue

- multiple vesicles centripetal in distribution mainly found on the face and trunk

and scattered on the extremities.

- oval in shape, resting on erythematous base, filled with clear fluid, about 0.5

cm in diameter.

- Some vesicles erupted and show crustation

Management Symptomatic relief

Penicillin V 7-10 days

Supportive – fluids/paracetamol/calamine lotion

Admit if complications suspected

Dx of streptococcal tonsillitis:

(2 out 3)- diffuse erythematous tonsils

- pus on top of tonsil

- enlarged tender lymphadenopathy

DDx of congested tonsil with white spots:

- diphtheria - infectious mononucleosis

- thrush - milk

Complications:

- Always look carefully at child if fever persists > 5 days after appearance rash secondary bacterial infection

- Pneumonitis

- Encephalitis

- Cerebellar ataxia

- Eczema herpeticum

- Risk to neonates & pregnant women 1st trimester especially

DDx of vesicular vesicular rash (see above)



#Common Childhood Rashes in General Practice.docx

Documents