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6/12/2015
1
Pediatric Rashes
Darwin M. Koller, MD, MSCE
Medical Director, Pediatric Emergency Department
Assistant Professor, Department of Pediatrics and Department of
Emergency Medicine
Goal
Review some common, non life-threatening
pediatric skin conditions
Scarlet Fever Scarlet Fever
All ages, most 1-10 yo, M = F, GABHS
More common late fall early spring
Rash appears 2-3 days after symptoms
Carrier states
Scarlet Fever
Fine punctate red papules
Pastia’s lines
Face flushed w/ peri-oral pallor
Sandpaper texture
Chest Ext, groin, axillae
Strep throat, palatal petechiae
Fever, malaise, HA, LAD, sore throat
Scarlet Fever
Can lead to ARF, PSGN
Benzathine PCN IM, Amoxicillin, Keflex
Zithromax or Biaxin in PCN-allergic patient
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Fifth’s Disease Fifth’s Disease
Erythema infectiosum
Parvovirus B19
Most 3-12yo, F > M
Late winter, early spring
Respiratory droplets
Begins 1-2 weeks after exposure
Prodrome – HA, malaise, fever, arthralgias
Rash appears day 3 or 4
Fifth’s Disease
Edematous plaques, macules, papules
“Slapped-cheek” appearance
Pink to red
Round to oval
Lacy reticulating appearance of lesions
Extensor surfaces, trunk, cheeks
No MM involvement
Roseola Infantum
Roseola
Exanthem subitum
HSV-6
6mo-3yo, M = F
Fever for 3-5 days Rash for 1-2 days
Well-appearing!!
Roseola
Maculopapular, 2-3mm
Rose pink
Trunk, spreads to neck and extremities
Rapid defervescence as rash appears
Self-limited
Symptomatic care
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Hand-Foot-Mouth Disease Hand-Foot-Mouth Disease
Children < 10 yo, M = F
Seasonal patterns in warmer months
Coxsackie A 16, Enterovirus 71
Highly contagious
Hand-Foot-Mouth Disease
Macules/papules vesicles
Pink to red, round/oval
Size 2 to 8 mm
Hands, feet, mouth
Fever, malaise, pain
Refusal to drink Dehydration
Hand-Foot-Mouth Disease
Self-limited 5-7 day course
Symptomatic treatment
– Miracle mouthwash
– Fluids
– Narcotic analgesia
Herpetic Whitlow Herpetic Whitlow
Any age, M = F, common
HSV – 1
Occurs 2 to 8 days post-exposure
Systemic symptoms rare (fever, LAD)
Lesions resolve over 1 to 2 weeks
Recurrences possible
Fingernail biters, thumb suckers, etc
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Herpetic Whitlow
Grouped 2-4 mm vesicles on red base
Distal fingers
Painful
Tzank smear
Self-limited
Symptomatic care
– Analgesics
– Acyclovir in severe or immunosuppressed
– Bactroban if signs of bacterial super-infection
Scabies (“Seven-Year-Itch”)
Scabies
Age < 5yo, young adults, M = F
Sarcoptes scabei
Transmitted by close proximity
Mites remain alive for 1-2 days off skin
Increased in crowded living conditions, low
SES, and immunosuppressed
Skin sensitization to mite
Scabies
Intraepidermal burrows and papulovesicles
Flesh-colored w/ surrounding erythema
Web spaces, wrists, elbows, genitals, feet
Spares face and neck
Widespread in infants
Severe pruritis!
Often close contacts with infestation/sx
Scabies
Persists for weeks even after treatment
Nodular lesions can last months
Permethrin 5% cream (Elimite)
– Apply neck to toes x 8h rinse
– Treat all close contacts & family members
– Repeat treatment in one week
– Bedding and clothes washed in hot water
Topical steroids for severe itching
Chicken Pox (Varicella)
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Chicken Pox (Varicella)
90% < 10 years old, M = F
Incidence declining due to VZV vaccine
Spread by direct contact & air droplets
Rash appears 2-3 days after exposure
Chicken Pox (Varicella)
Superficial thin vesicles, 2-5 mm
Watery yellow, crusts brown-red
Few to > 100 lesions
Face/scalp trunk/ext
Can appear on palate
Low-grade fever
Chicken Pox (Varicella)
Symptoms last 1-3 weeks
Self-limited
Severe in immunocompromised
Itching, pain and superinfection
Aveeno baths, topical antipruritics
Acyclovir if rash < 24 h old
Impetigo
Impetigo
All ages, M = F
Streptococcus
Systemic symptoms rare
Carriers are predisposed
Recurrence common
Contagious
Impetigo
Erythematous macules thin-roofed
vesicles crusts/erosions
Honey-colored yellow “stuck-on” crusts
Round or geographic
Scattered or confluent
Face, arms, legs, buttocks, digits
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Impetigo
Antibacterial soaps/washes
Topical antibacterials – uncomplicated
Oral antibiotics – complicated, face
Treat for 7 days
Treat close contacts
Ringworm
Ringworm (Tinea Corporis)
All ages, M = F, common
Exposure to kittens & puppies
Scaling, sharply marginated plaques
Size 1 to 10 cm
Pinkish red
Peripheral enlargement w/ central clearing
KOF prep or Fungal culture
Topical vs. oral treatment
Treat affected household members / pets
Tinea Capitis
Tinea Capitis
Children 1 to 10y yo, M > F, 5:1, AAF
Affects 3 to 8% of pediatric population
Trichophyton tonsurans 90% of U.S. cases
Scaly, pruritic patches on scalp w/ hair loss
LAD, low-grade fever
Endothrix
Karyon
KOH prep or fungal culture
Tinea Capitis
Trash all hair care utensils, wash pillows
Children may attend school once on meds
Antifungal shampoos decrease shedding
Need systemic therapy
– Griseofulvin (15mg/k/day) x 6 to 8 weeks
– Higher doses in refractory cases
– Newer agents: Itraconazole, Terbenafine
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Molluscum Contagiosum Molluscum Contagiosum
Children 2 to 16 yo, M > F, common
Transmitted by skin-to-skin contact
Increased incidence in young children,
swimmers, and kids who bath together
Can appear 14d to 6mo post-exposure!
Asymptomatic or mildly pruritic
Clinical diagnosis
Molluscum Contagiosum
Small (<5mm) shiny papules with central
umbilcation
Pearly white to flesh-colored, round
Isolated or multiple scattered lesions
Predilection for axillae, folds
Most self-resolve
Dermatology referral if removal desired
Pityriasis Rosea
Pityriasis Rosea
Benign, self-limited
Most common in adolescence
Viral-like prodrome
“Christmas Tree” pattern
Small round papules 1-2 cm scaly, oval
Fades over 2-3 months
Treatment – supportive, UV light
Questions?
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