Paediatric

rashes
C A RA H E PPE LL
 Dermatological terminology

Macule Patch Papule Plaque Nodule Vesicle Bullae Pustule

Flat lesion Flat lesion Elevated lesion Elevated lesion Elevated, solid Elevated, fluid- Elevated, fluid- Elevated, pus-
<1cm <1cm <1cm <1cm lesion >1cm filled lesion filled lesion filled lesion
No elevation/ No elevation/ <1cm >1cm <1cm
depression depression

Figures taken from MDS Manuals, 2022; Academic Dermatology of Nervada, 2019; Dermatology Times 2018.
Henoch-Schonlein Purpura
Pathophysio-
Features DDx Diagnosis Criteria Management
logy
•IgA vasculitis •Purpura •Meningococc •FBC and •Palpable •Supportive
•IgA deposits •Joint pain al blood film purpura + •analgesia,
in blood •arthralgia septicaemia •Renal profile •diffuse rest,
vessels mostly of knees •Leukaemia abdominal hydration
and ankles
•Serum
•Inflammatio •ITP albumin pai •Monitoring
n in skin, •Abdominal •arthritis or
pain •HUS •CRP •urine dip
kidneys, GI •in severe cases •NAI •Blood arthralgia •BP
system can get GI cultures •IgA
•Often haemorrhage, •Urine deposits on •Recovery 4-6
triggered by intussusception, histology
bowel infarction dipstick wks w/out
URTI/ •proteinuria
•Renal •Urine PCR renal inv
gastroenteriti or
s involvement •BP •Recurrence
•IgA nephritis
haematuria w/in 6m in
•Most
common
•can develop 33%
nephrotic
<10y syndrome •ESRF in
minority
Kawasaki’s disease

Presentation Features Investigations Management

•Systemic, medium •Persistent high fever •FBC •High dose aspirin

sized vessel vasculitis >39 for >5d •anaemia •IV immunoglobulins
•Typically affects under •Widespread •leukocytosis, •FU with echos Disease course Symptoms Duration
5s erythematous •thrombocytosis
•More common in Asian maculopapular rash Acute phase Fever 1-2w
•LFT
children •Desquamation of Rash
•hypoalbuminaemia
•Key complication – hands and feet Lymphadenopathy
•elevated liver
coronary artery •Strawberry tongue
aneurysm enzymes Subacute phase Desquamation 2-4w
•Cracked lips
•Raised ESR Arthralgia
•Cervical
lymphadenopathy •Urinalysis Coronary artery
•raised WCC aneurysm
•Bilateral conjunctivitis
•Echocardiogram
Convalescent Symptoms settle 2-4w
•coronary a. pathology
phase
Viral exanthems
First disease – Measles

Second disease – Scarlet fever

Third disease – Rubella

Fourth disease – Dukes’ disease

Fifth disease – Parvovirus B19

Sixth disease – Roseola infantum

 Cause

•Measles RNA paramyxovirus

•Aerosol transmission

Incubation period

•10-14 days

Infectious period

•Prodrome until 4 days after rash starts

Symptoms

•Fever
•Coryzal symptoms
•Conjunctivitis
•Koplik spots (2 days post fever)

Measles
•Erythematous, macular rash
•Starts on face, behind ears
•Desquamation sparing palms and soles

Management

•Supportive
•Notifiable disease
•Stay off school for at least 4 days
•Contacts should be given MMR if not immunized within 72 hr

Complications

•Otitis media (hearing loss)

•Pneumonia
•Diarrhoea
•Dehydration
•Myocarditis
•Encephalitis
•Subacute sclerosing panencephalitis
•Meningitis
•Vision loss
Taken from PCDS •Death
 Cause

•Group A strep
•More common in children 2-6y

Incubation period

•2-5 days

Infectious period

•Up to 6 days before symptoms and until 24 hours after 1st dose of antibiotic

Symptoms

•Fine punctate erythematous macular rash with sandpaper skin

•Starts on trunk and spreads outwards, more obvious in flexures
Taken from PCDS •Desquamation later particularly around fingers and toes
•Fever – lasts 24-48 hours

Scarlet fever
•Lethargy
•Flushed face with circumoral pallor
•Sore throat
•Strawberry tongue
•Cervical lymphadenopathy

Diagnosis

•Throat swab (don’t wait to treat)

Management

•Pencillin V for 10 days, azithromycin if pen allergic

•Notifiable disease
•Stay off school for 24 hours

Complications

•Otitis media
•Rheumatic fever
•Acute post streptococcal glomerulonephritis
Taken from PCDS •Meningitis
 Cause

•Rubella togavirus

Incubation period

•14-21 days

Infectious period

•7 days before symptoms to 4 days after

Symptoms

•Low-grade fever - prodrome

•Erythematous, macular rash
•Starts on face then spreads to rest of body

Rubella
•Joint pain
•Sore throat
•Lymphadenopathy
•Suboccipital
•postauricular

Management

•Supportive
•Notifiable disease
•Stay off school for at least 5 days
•Avoid pregnant women

Complications

•Arthritis
•Thrombocytopenia
•Encephalitis
•Myocarditis
•Congenital rubella syndrome – triad of deafness, blindness and congenital heart disease
Taken from PCDS
 Terms
Taken from PCDS •Fifth disease
•Slapped cheek
•Erythema infectiosum

Cause

•Parvovirus B19/HHV-6

Incubation period

•4-14 days

Infectious period

•Until rash appears

Slapped
Symptoms

•Mild fever
•Coryza

cheek •Muscle aches and lethargy

•Diffuse bright red rash on both cheeks after 2-5 days
•Reticular mildy erythematous rash on trunk and limbs

Inestigations

•Serology testing and FBC in vuolnerable patients

Management

•Supportive

Complications

•Aplastic anaemia (haemoglobinopathies)

•Pancytopenia (immunosuppressed)
•Encephalitis or meningitis
•Pregnancy complications – hydrops foetalis and foetal death
•Hepatitis
Taken from PCDS •Myocarditis
•Nephritis
 Cause

•HHV-6
•Typically in 2-6y

Incubation period

•5-15 days

Infectious period

•Until 24h after the fever has gone

Symptoms

Roseola •High fever (up to 40)

•After 1-2wks, lasts for 3-5 days then disappears
infantum •Coryzal symptoms
•Sore throat
•Lymphadenopathy
•Mild erythematous macular rash on arms, legs, trunk and face – lasts 1-2d
•Nagayama spots – papular enanthem on uvula and palate

Management

•Supportive

Complication

•Febrile convulsions
•Myocariditis
•Thrombocytopenia
Taken from PCDS •GBS
 Cause

•VZV

Incubation period

•10-21 days

Infectious period

•Droplet infection/direct contact

•1-2d before rash, until all lesions are crusted over

Symptoms

•Vesicular rash
•Starts on trunk/face and spreads outwards affecting whole body over 2-5d
Taken from PCDS •Fever often first symptom

Chicken pox
•Itch
•General fatigue and malaise

Management

•Supportive
•Aciclovir in IC, adults and adolescents over 14y presenting w/in 24h, neonates or those at risk
of complications
•Calamine lotion/chlorphenamine for itching
•Stay off school until lesions crusted over
•VZIG in vulnerable contacts

Complications

•Bacterial superinfection (NSAIDs increase risk)

•Dehydration
•Conjunctival lesions
•Pneumonia
•Encephalitis
•Disseminated haemorrhagic chickenpox
Taken from PCDS
•Shingles/RHS later in life
 Cause
Taken from PCDS

•Coxsackie A virus
•Enterovirus 71

Incubation period

•3-6 days

Infectious period

•Most contagious for the first week of symptoms

Hand, foot Symptoms

and mouth •URTI

•After 1-2 days small mouth ulcers appear, followed by itchy, red,
vesicular rash across body, especially on hands, feet and around
mouth

Management

•Supportive

Complications

•Dehydration
•Bacterial superinfection
Taken from PCDS
•Encephalitis
 Cause

•Staphylococcus aureus
•Less commonly Streptococcus pyogenes
•Golden crust
•Contagious – keep of school until lesions have healed/treated with abx for 48
hours

Non-bullous impetigo

•Typically around nose or mouth

•1st line - Hydrogen peroxide 1% cream
•2nd line - Topical fusidic acid or topical mupirocin if MRSA suspected
•Oral flucloxacillin (erythromycin if pen allergic) if more widespread/severe

Impetigo Bullous impetigo

•Epidermolytic toxins produces by S. aureus break down protein in skin

•1-2cm vesicles, which brust forming golden crust
•Severe infection – staphylococcus scaldec skin syndrome
•Swabs to confirm diagnosis
•Flucloxacillin
•Isolate where posssible

Complications

•Cellulitis
•Sepsis
•Scarring
•Post streptococcal glomerulonephritis
•Staphylococcus scalded skin syndrome
Taken from passmed •Scarlet fever
 Causes

•Molluscum contagiosum virus (poxvirus)

•Transmitted by DC or indirectly via fomites on
contaminated surfaces
•Most commonly seen in 1-4y

Features

•Papules with central dimple

Molluscum •Appear in crops

•Spread through DC/sharing items like towels or
contagiosum bedsheets

Management

•Self-resolving – can take up to 18m

•Education on hygiene measures
•May require abx if bacterial superinfection
•If IC/extensive lesions/lesions around orbit/genital
regions may require referral to specialist
•Topical potassium hydroxide, benzoyl peroxide,
podophyllotoxin, imiquimod or tretinoin
Taken from PCDS •Surgical removal or cryotherapy (can lead to scarring)
References
Zero to finals

https://www.msdmanuals.com/en-gb/professional/dermatologic-disorders/approach-to-the-
dermatologic-patient/description-of-skin-lesions

https://acadderm.com/pityriasis-rosea-it-starts-with-a-herald-patch/

https://www.dermatologytimes.com/view/image-iq-smooth-nodule-leads-distal-numbness

https://sketchymedicine.com/2012/07/kawasaki-disease/

https://www.osmosis.org/learn/Kawasaki_disease

https://www.pcds.org.uk