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Pediatric Rashes Presentation For Medical Students
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James Lamberg, MS-III
PediatricSkin Conditions
2 / 50
Terminology
Macule < 1cm => Patch > 1cmPapule < 1cm => Plaque > 1cmNodule small/deep => Tumor bigPetechiae < 3mm => Purpura > 3mmVesicle < 1cm => Bullae > 1cmPustule = pusWheel = comes and goesEnanthem = MM + Exanthema
3 / 50
Viral Exanthem
• Erythematous, Blanches, No Pruritus, Seen Post-Infection
• Hx: Cold, URI• Rx: Supportive
Red SpotsWhite Halo
Adenovirus: Rash + Pharyngitis+ Non-Purulent Conjunctivitis
4 / 50
Rubella (German Measles)
• Discrete Pink/Red Fine Maculopapular, Starts on Face, Spreads Caudad
• Hx: 1-5d Fever, Malaise, Adenopathy, Sore Throat, Sick Contacts
• Rx: Supportive. Immunize.
Forchheimer Spots Scattered Rash
5 / 50
Rubeola (Measles)
• Tiny Bluish/White Dots, Red Halos, Blotchy, Erythematous, Blanching, Maculopapular
• Hx: Fever, Malaise, Dry Cough, Coryza, Conjunctivitis/Photophobia
• Rx: Supportive. Immunize.
Koplik SpotsBuccal Mucosa
1-2d aftersymptoms start
6 / 50
Varicella (Chickenpox)
• Appear Rapidly In Crops, Tiny Erythematous Papules => Vesicles With Red Halos, Pruritic
• Hx: Fever, URI Symptoms, Malaise• Rx: Supportive. Antihistamines. Avoid
Aspirin (Reye), IVAcyclovir If Immuno-Compromised. Immunize.
Different “Stages”
7 / 50
Hand-Foot-Mouth (Coxsackie)
• Shallow Yellow Ulcers,Red Halos,
• Hx: Fever, Malaise,Sore Mouth, Anorexia.
• Rx: Supportive. Can Cause AsepticMeningitis, Myoperi-
carditis.
Palate Ulcers
Ulcers Near Gums
Erythematous MaculesHands & Feet
8 / 50
Erythema Infectiosum (Fifth)
• Warm, Erythematous, Nontender, Circum-scribed Patches On Cheeks (“Slapped”). Lacy Rash On Extensor Surfaces.
• Hx: PrimarilyRash. Can HaveFever, Myalgias,Headache.
• Rx: Supportive.
Parvovirus B19
9 / 50
Roseola Infantum
• Discrete Rose/Pink Macules ≈3d Post Fever• Hx: 6-36 Months, Rapid Temp Elevation,
Anorexia, Irritability.• Rx: Supportive.
HSV-6
10 / 50
Infective Mononucleosis
• Diffuse Maculopapular,4+ Tonsils, PalatalPetechiae.
• Hx: Fatigue, Malaise,Headache, Sweats, Chills,Eyelid Edema, Pharyngitis.
• Rx: Supportive.Protect Airway, Steroids.Avoid Sports (Spleen).
11 / 50
Kawasaki Disease
• Diffuse Maculopapular Erythematous Rash.• Hx: Fever (5d), Conjunctivitis, Dry Lips,
Strawberry Tongue, Rash.• Rx: IVIG, Aspirin? Steroids?
PeriungualDesquamation(2w Later)
12 / 50
Strep Scarlet Fever
• Flushed Face, PerioralPallor. Diffuse, Blanching,Erythematous, SandpaperRash. Strawberry Tongue.
• Hx: Abrupt Fever, Chills,Malaise, Sore Throat
• Rx: Antibiotics?
ErythrogenicToxin
1st… …2nd
Follow-Up:GlomerlulonephritisRheumatic Fever
13 / 50
Staph Scalded Skin
• Epidermal Separation.• Hx: Impetigo. Infected
Umbilicus/Circumcision.• Rx: Treat Staph.
Exchange TransfusionIn Premies/Severe SSSS.
PositiveNikolsky
Sign
14 / 50
Meningococcemia
• Purpuric/Petechial Rash, Scrape + Gram.• Hx: Age 6-12mo, Dorm. Fever, Lethargy, URI
Symptoms, Headache, Chills.• Rx: Antibiotics. Steroids If
Adrenal Insufficiency. Vaccinate.
15 / 50
Henoch-Schönlein Purpura
• Palpable Purpura On Buttocks,Upper Thighs, Feet/Ankles.
• Hx: Fever, Malaise, Arthritis,Abdominal Pain, Hematochezia.
• Rx: Supportive. Replace Blood& Fluid Loss.
16 / 50
Lyme Disease
• Erythematous Rash With Central Clearing.• Hx: Hiking/Woods. Flu-Like Symptoms.
Arthritis. Bell Palsy.• Rx: Antibiotics.
Ixodes Tick
Erythema Migrans
Watch For:AV Block
17 / 50
Rocky Mountain Spotted Fever
• Starts Distal Hands/Soles. Petechial Or Erythematous Blanching Maculopapular.
• Hx: Hiking/Woods. Fever. Chills, Headache, Conjunctivitis, Cough, Myalgias.
• Rx: Antibiotics.2-6d Later
18 / 50
Impetigo
• Strep: Papule => Vesicle, Red Halo.• Staph: Vesicle => Honey Colored Crusts.• Hx: Skin Lesion: Insect Bite, Injury,
Dermatitis. Usually Staph.• Rx: Topical
Antibiotics If Local,Oral Antibiotics IfExtensive.
Both Staph & Strep Can Cause Honey-Colored Crusts
19 / 50
Acne Vulgaris
• Comedones, Papules, Pustules In Sebaceous Gland Distribution.
• Hx: Mild Pain, Tenderness.• Rx: Topical
Retinoids If Mild.Oral Retinoids& AntibioticsIf Severe.
20 / 50
Abscess
• Localized, Pus-Filled, Erythematous.• Hx: Skin Lesion: Insect Bite, Injury,
Dermatitis. Usually Staph.• Rx: Incision & Drainage +
Antibiotics (Staph).Consider MRSA.
Draining =>
21 / 50
Erysipelas & Cellulitis
• Painful Raised Purple/Red Plaque.• Hx: Skin Lesion: Insect Bite, Injury,
Dermatitis. Group A Beta-Hemolytic Strep. Fever, Chills, Headache, Nausea.
• Rx: Antibiotics.Saline WetDressings IfNecrotic.
22 / 50
Necrotizing Fasciitis
• Cellulitis + Black Tissue Necrosis.Hx: Deep Traumatic/Surgical Wounds, Diabetes. Fever, Edema, Wound Induration.
• Rx: Surgical Debridement.Antibiotics,BroadSpectrum.
23 / 50
Congenital Rubella
• Thrombotic Petechiae + Jaundice = Blueberry Muffin.
• Hx: Maternal Rubella (TORCH). CMV Too.• Rx: Contact Precautions x 1yr.
Supportive.Vaccinate.
24 / 50
Mongolian Spot
• Flat Slate-Gray/Bluish-Black Poorly Circumscribed Macules.
• Hx: 90% African American, 80% Asian, 10% Caucasian
• Rx: None.Fades ByAge 7.
25 / 50
Bruises (In Child Abuse)
• Bruises At Different Stages Of Healing On Flexor Surfaces.
• Hx: Story Does Not MatchInjury Or Child Activity Level.
• Rx: Mandatory Reporting.Treat Injuries.
26 / 50
Erythema Toxicum Neonatorum
• Yellow Papules/Pustules,Erythematous Rings,Appears On Trunk,“fleabite” dermatosis.
• Hx: Occurs In Up To 50%.• Rx: None. Fades
Within 5-7 Days.
27 / 50
Neonatal Pustular Melanosis
• 1-2mm Vesiculopustules => Pigmented Macules With A Scale.
• Hx: Presents At Birth, Changes In 24-28h.• Rx: None. Fades
In 3wk – 3mo.
28 / 50
Cutis Marmorata
• Netlike Red/Blue Mottling.• Hx: Normal Response To
Chilling.• Rx: None. Resolves
By 6 Months.
29 / 50
Scald Burns (In Child Abuse)
• Blistering Burns On Hands/Feet/Buttocks.• Hx: Story Does Not Match
Injury Or Child Activity Level.• Rx: Mandatory Reporting.
Treat Injuries
30 / 50
Milia
• Tiny White/Yellow Firm Papules.• Hx: Arise Spontaneously, Usually Face.• Rx: None. Resolves In Months To Years.
31 / 50
Hemangiomas
• Bright Red Elevated “Strawberry” Plaque.• Hx: Grow For 6 Months, Slowly Resolve.• Rx: Watchful Waiting. Intervene If Interfering
With A Vital Function.
32 / 50
Port-Wine Stain
• Purple/Red Lesion, Usually Covering Face.• Hx: Venous Malformation.• Rx: R/O Klippel-Weber (hemihypertrophy).
R/O Struge-Weber (seizures, mental retardation, glaucoma,hemiplegia).
33 / 50
Salmon Patch (Stork Bite)
• Light Red Splotchy Area, May Redden With Crying Or Exertion.
• Hx: Capillary Malformation, Neck, Glabella, Forehead.
• Rx: None. FadeIn First Year.
34 / 50
Acanthosis Nigricans
• Hyperpigmentation + Hyperkeratosis.• Hx: Benign (Common,
Obesity Related),Endocrine (InsulinResistance Related).
• Rx: R/O Diabetes
Malignancy-RelatedAcanthosis Does NotOccur In Childhood.
35 / 50
Psoriasis
• Pruritic Red Silvery/White Scaly Rash.• Hx: Pain, Pruritis, Family History, No Fever.• Rx: Topical Steroids, UV/Solar Light Therapy.
<= Auspitz Sign
36 / 50
Atopic Dermatitis (Eczema)
• Pruritic Red Papules/Plaques, Ooze/Crust.• Hx: Asthma, Allergy, Family History.• Rx: Topical Steroids.
37 / 50
Seborrheic Dermatitis
• Red Scaling Hair-Bearing Areas, Flaking.• Hx: More In Winter. Non-Pruritic.• Rx: Topical Steroids.
Dandruff Shampoo.
38 / 50
Pityriasis Rosea
• Oval Scaly Rings Running Parallel With Skin Lines, “Christmas Tree” Pattern, Starts With Herald Patch
• Hx: Malaise, Headache,Constitutional Symptoms.
• Rx: Supportive.
Herald Patch
39 / 50
Contact Dermatitis
• Well-Demarcated Erythema, Crusting +/- Blistering.
• Hx: Allergic Contact,Poison Ivy (Shown), Nickel.
• Rx: Topical Steroids.Cool Compress, OatmealBath, Oral Antihistamines.
40 / 50
Urticaria (Hive)
• Edematous Erythematous Raised Plaques.• Hx: Allergen, Medications,
Foods, Chemicals.• Rx: Supportive.
Antihistamines.
Dermatographia =>(common)
41 / 50
Tinea Corporis & Capitis
• Vesicular Red Border With Central Clearing.• Hx: Pruritic. Pets.• Rx: Topical Antifungal.
Oral Antifungal ForTinea Capitis.
WoodLamp
42 / 50
Tinea Versicolor
• Small Oval Scaly Patches, Raindrop Pattern On Upper Chest, Back, Proximal Arms.
• Hx: Warm Climates,Pregnancy.
• Rx: SeleniumSulfide Or AzoleAntifungals.
43 / 50
Candidal Diaper Dermatitis
• Bright Red, Sharp Borders, Pinpoint Satellite Papules/Pustules
• Hx: Recent Antibiotic Use. Recent Diarrhea.• Rx: Topical
Antifungals.PetroleumJelly + ImprovedDiaper ChangingPractices.
44 / 50
Erythema Multiforme
• Symmetric Dusky Red Target Macules On Palms, Soles, Extensor Surfaces.
• Hx: Medications, Viruses, Bacteria, Foods.Prodrome: Fever, Cough, Discomfort.
• Rx: StopCausative Agent.
Can Be Associated With Kawasaki
Disease
45 / 50
Drug Eruption
• Erythematous Macules/Papules, Fine/Blotchy, Like-Measles/Viral Exanthems.
• Hx: Erupt On Face/Trunk5-14d After Medication.
• Rx: Stop Causative Agent.Supportive, Antihistamines,Topical Steroids.
46 / 50
Hymenoptera Stings
• Pain Erythema Edema < 2h Of Sting.• Hx: Bee, Wasp, Hornet, Yellow Jacket Sting.• Rx: Supportive. Manage Airway,
If AnaphylaxisAdministerEpinephrine
47 / 50
Scabies
• Pruritic Papules, Vesicles, Pustules, Linear Burrows On Finger/Toe Webs, Axilla, Flexor Surfaces, Nipples.
• Hx: 4-6wk Post-Exposure. Worse At Night.• Rx: Topical Permethrin. Household Cleaning.
48 / 50
Lice
• Urticarial Papules (Bites), White Eggs (Nits)• Hx: Pruritis. Sharing Hats, Brushes.• Rx: Address School-Wide To Prevent
Re-Infestation.Metal Nit Comb.Nit-RemovalChemicals.Pediculicides.
49 / 50
Warts
• Hyperkeratonic Papule With Rough Irregular Surface On Fingers/Hands/Feet.
• Hx: Local Trauma, Barefoot, Nail Biting.• Rx: Removal If Symptomatic.
50 / 50
Molluscum Contagiosum
• Sharply Circumscribed Single/Multiple Dome-Shaped Papules With Waxy Surfaces, Usually With Umbilicated Centers.
• Hx: Spread By Scratching.• Rx: Removal
If Symptomatic.Resolve In2-3 Years.
Poxvirus