Pediatric topic

.RASH :.
in infant and
children
R1 Natnicha Bunma , 13 July 2023
 .
QUIZ ?
 QUIZ
A 7 yr boy is brought in by parents for rash. Mom first notices the rash yesterday on his feet, and it has spread
up his leg to his buttock since then. He has also be complaining of intermittent abdominal pain,without
nausea/vomiting . The patient state the rash is painful , not pruritic. His ankle have had some swelling today, and he
states they are slightly painful with ambulation
Which of the following investigations are the MOST APPROPRIATE for this condition ??
QUIZ
Which of the following investigations are the MOST APPROPRIATE for this condition ??

A. complete blood count

B. Prothrombin time
C. Ultrasound ankle
D. Urinalysis
QUIZ
Which of the following investigations are the MOST APPROPRIATE for this condition ??

A. complete blood count

B. Prothrombin time
C. Ultrasound ankle
D. Urinalysis
 Introduction
Common
01 neonatal rash 04 Fungal infection

02 Viral infection 05 Spacific

03 Bacterial infection
 01
Common
neonatal rash
 ERYTHEMA TOXICUM
● self-limited rash
● Face ,trunk

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 TRANSIENT NEONATAL
PUSTULAR MELANOSIS
● most common in black infants
● Conservative treatment

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 NEONATAL ACNE
● 3rd wk of life
● Stimulated with maternal hormone
● Spontaneous resolve

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 SEBORRHEIC DERMATITIS
● 2-6 wk of life
● Greasy yellow / red scale
● Treat : oil followers washing
Salicylic acid-containing shampoo

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 ATOPIC DERMATITIS
● Unclear etiology
● Xerosis (dry skin) , erythematous papular and
plaques
● Identify trigger
, Vaseline

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 DIAPER DERMATITIS
● Irritate dermatitis
● Good hygiene , air-drying
Zinc oxide

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 02
Viral infection
 Erythematous Vesiculopustular rash
maculopapular rash
● Measles ● Varicella zoster

● Rubella ● Herpes simplex

● Infectious monocleosis ● Hand foot mouth disease

● Herpangina

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 MESLES
● Measles virus : RNA
● Incidence : > 6 yr
● Airbone transmission (4 day befor -> 5 day after onset rash)

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 MESLES
Fever
Prodome fever 2-4 day
+ 3 C Cough ,Coryza ,Conjuntivitis

Rash : erythenatous maculopapular rash

● Face -> sole in 72 hr
● Confluent maculopapular rash at trunk
● Koplik spots

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 MESLES
Supportive treatment + prevent spreading

Complication (post measles)

● Pneumonia
● Otitis media
● Menigoencephalitis
● Subacute sclerosing panenecphalitis

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 RUBELLA
● Rubella virus : RNA
● Acquired / congenital
● Airbone droplet (5 day befor -> 7 day after onset rash)

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 RUBELLA
Rash : Rose pink maculopapular rash
● Face to sole < 3 day
Prodromal period 1-5 day
● Fever ,malaise , conjunctivitis , cough
Lynphadenopathy (> 1.5 cm) at suboccipital/post auricular/posterior cervical
area

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 RUBELLA
Supportive treatment + prevent spreading
Immunization

Congenital rubella syndrome

Cataract , glaucoma , cardiac abnormalities , deafness , microcephaly,
blue berry muffin lesion

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 INFECTIOUS MONONUCLEOSIS
● Epstein-Barr virus
● Incidence : young children, adolescent
● Transmission : saliva

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 INFECTIOUS MONONUCLEOSIS
High grade fever + Sore throat(exudative) + Lymphadinitis
Maculopapular rash 5-15 %
Hogland sign (bilateral upper eyelid edema )

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 INFECTIOUS MONONUCLEOSIS
Supportive treatment +- corticosteroid (in high risk complication )

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 Varicella zoster
● Varicella zoster virus
● Incidence : 2-8 yr
● Transmission : airborne , direct contact , vertical transmission

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 Varicella zoster
Prodromal period 1-2 day
● Low grade fever ,malaise
Rash : various stage lesion (macule > papule > vesicle)
● Trunk to extremities

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 Varicella zoster
Supportive treatment (Do not give aspirin may develope Raye’s syndrome )
Acyclovir
Complication
● Neonate varicella
● Bacterial infection
● Immunocompromised children ● Encephalitis
● chicken pox with complication ● Reye’s syndrome
● Pneumonia

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 ENTEROVIRUS
● 68 serotype
● Transmission : fecal-oral route (usually)
● Clinical vary : upper/lower respi , GI >> menigitis , myocarditis

Hand-foot-and- mouth disease Herpangina

● enterovirus 71 , coxakievirus A16 ● Coxakievirus A

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

ENTEROVIRUSES
Hand-foot-and- mouth disease Herpangina
Fever, anorexia, malaise, and sore mouth
Vesicle at palm ,sole
 ENTEROVIRUSES
Supportive treatment +prevent transmission

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 03
Bacterial
infection
 Erythematous Vesiculopustular rash
maculopapular rash
● Scarlet fever ● SSSS

● Meningoccocemia

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 SCARLET FEVER
● Toxin prodicing B=hemolytic strep gr.A
● Incidence : school age (4-8 yr)
● Hx. tonsillitis ,pharyngitis

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 SCARLET FEVER
High fever ,sore throat
Rash :
Exanthem > Sand paper skin
Follow 1-2 day (many small papule on diffuse erythema)

Desquamation (hand,feet) 7-10 day later

White > strawberry tongue

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 SCARLET FEVER
Supportive treatment
Antibiotic
● Penicillin , Cephalosporin
● Erythromycin (penicillin allergy)

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 MENINGOCOCCAL INFECTION
● Neisseria meningitidis ,gram-negative diplococcus
● Incidence : 1 month - 15 yr (most common < 2 yr)
● Transmission : droplet

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 MENINGOCOCCAL INFECTION
● Clinical rapid progressive sepsis
● S/S :
- Petechiae rash (rapid progress to hemorrhagic over hour
, lower body ,trunk )
- Hemorrhage of soft palate ,ocular and palpebral conjunctiva
- Meningitis

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 MENINGOCOCCAL INFECTION
Treatment of shock in meningococcemia
Empirical Antibiotic
● Penicillin G (300,000 u/kg/d max 12 MU/d , q4-6 hr) or
● Ampicillin
● Cephalosporin

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

MENINGOCOCCAL INFECTION
Chemoprophylaxis
High risk contact (child care , expose secretion)

Azithromycin , not routinely. Equivalent to rifampin for eradicate of N. meningitidis from nasopharynx in one study
 STAPHYLOCOCCAL SCALDED
SKIN SYNDROME
● Staphylococcus aureus
- secret exfoliative toxin
- disruption of intercellular adhesion >> superficial blister

● Incidence : young children (most <2 years old)

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 STAPHYLOCOCCAL SCALDED
SKIN SYNDROME
● Fever
● Tender flaccid bullae with Nikolsky sign positive

Bullous impetigo : exfoliative toxin

restricted to area of infection

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 04
Fungal/Parasite
infection
 TINEA
● Tinea capitis , corporis : most common younger children
● Tinea pedis , curtis : seen in adolescent

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 TINEA

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 SCABIES
● Sarcoptes scabiei mite
● Borrow into the skin , deposit egg > larvage hatch
● Lesion show hand ,feet ,groin

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 SCABIES
Topical permethrin cream 8-12 hr before eash off
Lindane is contraindication in young children (neurotoxicity)

Linens and clothes > wash with hot water

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 05
Non infection
 KAWASAKI ’s DISEASE
● Unknown etiology
● Age < 5 yr (peak 18-24 mo)

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

KAWASAKI’s
DISEASE

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 KAWASAKI ’s DISEASE
Intravenous immunoglobulin (IVIG) 2 gm/kg in 12 hr
High dose Aspirin
80 to 100 mg/kg/d in x 2 wk
Then 3-5 mg/kg/d for 6 to 8 wks (in the absence of coronary aneurysms)

Complication
● Coronary aneurysm ,Myocarditis ,Pericarditis

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 HENOCH-SCHÖNLEIN PURPURA
most common vasculitis in childhood
Present with Tetrad
● Palpable purpura
● Arthalgia
● Abdominal pain
● Renal disease
Associated with upper respiratory infections, streptococcal infections, or medications
Deposition of immunoglobulin A, immunoglobulin C3, and other immune
complexes in the walls of the smaller vascular
● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th
 HENOCH-SCHÖNLEIN PURPURA
Rash :
- non blaching palpable purpura (predominate buttock ,leg ,arm )
(not pruritis)
- Lesion 2-10 mm

Diagnosis is usually readily made by bedside evaluation

Lab is unnecessary (except evaluate renal disease)

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 HENOCH-SCHÖNLEIN PURPURA
Self limitated 3-4 wk
At ED : most patient can discharge > FU 1 wk + UA
● Prednisolone 1 MKD x 2 wk then taper (GI,joint)
● NSAID (joint)
Treatment in severe nephritis is controversial

● Tintinallis Emergency Medicine A Comprehensive Study Guide_9th

 .
QUIZ ?
 QUIZ
A 9 mo baby girl present with a rash in groin area that the mother noticed while changing her diaper. What is the etiology of this
rash ??

A. Cutaneous candidiasis
B. Tinea cruris
C. Scabies
D. Seborrheic dermatitis
 QUIZ
A 9 mo baby girl present with a rash in groin area that the mother noticed while changing her diaper. What is the etiology of this
rash ??

A. Cutaneous candidiasis
B. Tinea cruris
C. Scabies
D. Seborrheic dermatitis
QUIZ
What the MOST APPROPRIATE treatment for the following condition ??

A. Doxycycline orally
B. Fluconazole topically
C. Griseofulvin orally
D. Hydrocortisone topically
QUIZ
What the MOST APPROPRIATE treatment for the following condition ??

A. Doxycycline orally
B. Fluconazole topically
C. Griseofulvin orally
D. Hydrocortisone topically
 QUIZ
A 19 yr olf male is brought to the ED by his friends with sign of fever and confusion. The patient is lethargic and warm to
touch. His friends state he was complaining of headache this morning and became increasingly confused later in the day. He has no
medical history and he was having no symtoms yesterday. On examination, you note that he is hypotensive and tachycardia and
spon fully undressing him , has skin findings illustrated here.
What is the next most appropriate management strategy at this time ??
QUIZ
What is the next most appropriate management strategy at this time ??

A. Administer acetaminophen and order a routine CT scan of head to evaluate his

headache
B. Obtain a dermatology consultation
C. place the patient in isolation, adminiter immediate antibiotic, and draw
appropriate culture
D. Order ECG,alcohol level,electrolyte and ammonia level to look for a source for
his confusion
E. Biopsy the skin lesion and send it to pathology
QUIZ
What is the next most appropriate management strategy at this time ??

A. Administer acetaminophen and order a routine CT scan of head to evaluate his

headache
B. Obtain a dermatology consultation
C. place the patient in isolation, adminiter immediate antibiotic, and draw
appropriate culture
D. Order ECG,alcohol level,electrolyte and ammonia level to look for a source for
his confusion
E. Biopsy the skin lesion and send it to pathology
Reference

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CREDITS: This presentation template was created by Slidesgo,

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