Child with

rashesFaris mohd nasir

1314597
outlines
×Definitions
×Types of rash
×Causes of fever and rash
×Approach to child with rash
definitio
n
Change of the human skin which may affects its colour,
appearance or texture
Types of
rashes
 Macule
Flat, non-palpable, Papule Nodule
alteration in normal Raised solid lesion, < Raised solid lesion,
skin colour, <1cm. If 1 cm >1 cm
>1cm called patch
 Pustule
Vesicle/Bullae
Plaque Raised lesion,
Raised, clear fluid
Solid, plateau-like elevated, fluid-filled
filled lesions. (<0.5
elevation, large lesions, containing
cm @ >0.5 cm
surface area WBCs + Debris +/-
diameter)
Bacteria
 Urticaria/Hives
Elevated lesion with
flat top and pale
centre. Pruritic.
rash

Petechiae
Pinpoint rashes, Purpura Ecchymoses
punctate bleeding > 5 mm > 1 cm
into dermis < 5 mm
Causes of fever and rash
Vesicular, bullous,
Maculopapular Petechial, purpuric
pustular

• HHV6/7 (Roseola
Infantum) <2 y.o • Varicella-zoster virus
• Enteroviral rash (chicken pox, shingles)
Viral • Parvovirus (slapped • HSV
• Enterovirus
cheek) • Coxsackie (HFMD)
• Measles, rubella

• Impetigo (crusting)
• Scarlet fever • Boils (hair follicles
• Meningococcal or
• Erythema marginatum infection)
other bacterial
Bacterial (rheumatic fever) • Staph bullous impetigo or
sepsis
• Salmonella typhi scalded skin
• IE
• Lyme disease • TEN

• HSP
• Kawasaki disease • Erythema multiforme • Thrombocytopenia
Others • JIA • SJS • Vasculitis
• Malaria
Maculopap
ular rash
measles
× Features: Enanthem - prodromal upper
respiratory symptoms and cough, Koplik
spots (look like grains of sugar on buccal mucosa)
× Exanthem: rash beginning at face, spread
cephalocaudally & centrifugally.
× Infectivity: from 4 days before to 4 days
after the rash appears
× Managements: supportive, report
Scarlet fever
× Erythematous rash that occur with
streptococcal pharyngitis.
× Prodrome: infection is spread via
respiratory secretions. Child may have
fever, vomiting, abdominal pain
× Exanthem: sandpaper-like diffuse rash in
the neck and chest area. Perioral pallor.
× Erythematous pharynx, strawberry tongue
× Mx: penicillin V x 10 days, isolation
Rubella (3 day measle
s)
× Prodrome: mild illness with low-grade fever
× Exanthem: MP rash starting at face, spread to
whole body.
× Tender sub-occipital and post-auricular
lymphadenopathy.
× Mx: supportive, vaccine
Erythema infectiosum th
(5 dis
× Infection by parvovirus B19 induces immune complex ease)
formations that deposits in joints and the skin.
× Low-grade fever, headache, and coryza 7 days after
exposure.
× Rash appears in 3 stages
× Erythematous slapped cheek rash appearance
with circumoral pallor
× Erythematous symmetric maculopapular truncal
rash appears 1 to 4 days later
× Later fades as central clearing takes place, giving
a distinctive lacy, reticulated rash
× Managements: supportive, anti-pyretics for fever
Roseola infantum (6th
disease)
× HHV6 infection is benign, self-limiting
× Prodrome: high-spiking fever (>40ºC)
lasting
for up to 4 days. Fever stop when rash
appears
× Exanthem: rose-coloured maculopapular
rash, start from trunk spreading
peripherally.
× Mx: supportive, anti-pyretic for fever
exanthems
• Rash start from face, spread cephalocaudally
Measles • Koplik spot
• Rash appear with fever

Scarlet
• Sore-throat, sand-paper like rash
fever

Rubella • 3 days rash

Parvovirus • Slapped-cheek appearance, circumoral pallor

HHV 6 • Very high fever, rash appear as fever disappear

Kawasaki disease
× Systemic vascular disease.
× Diagnostic criteria: Fever for at least 5 days, in the
presence of at least 4 of the 5 following criteria:
1. Conjunctivitis (non-purulent)
2. Rash (polymorphous)
3. Erythema of palm and soles (80%), oedema (67%)
4. Adenoid (cervical lymphadenopathy)
5. Mucosal membrane changes (lips fissure, strawberry
tongue)
Vesicular,
bullous &
pustular
rashes
Chicken pox (varicella zoster)
× Prodrome: spread by respiratory droplets or direct
contact
× Infectious period: 2 days before vesicles appear. Ends
when the last vesicle crusts over.
× Rash: usually start at head, then the rest of body.
Different stages present at one time.
× Heals completely in 2 weeks.
× Mx: symptomatic relief, school exclusion.
Anti-viral in severe varicella,
encephalitis and immuno-supressed
Hand, foot, mouth disease
× Infection by Coxsackie virus A16, B and enterovirus 71
× Often associated with outbreak and highly infectious
× Spread via faecal-oral, oral-oral and respiratory
droplets.
× Prodrome: sore mouth, anorexia, low-grade fever,
malaise
× Inflamed oropharynx, scattered vesicles on tongue,
buccal mucosa, palate  may ulcerate
× Maculopapular, vesicular @ pustular lesion on the
hand (tender)
× Mx: supportive, hydration, topical viscous lidocaine
(analgesic)
Petechiae/purp
uric
Henoch-schonlein pur
× Small vessels IgA mediated vasculitis
pu ra
× Rash: palpable purpura over buttocks and L/L. severe
skin vasculitis can lead to oedema ( dorsum hand,
scrotal, peri-orbital)
× Arthritis: large joints
× GIT: colicky abdominal pain. May have melena,
haematemesis
× Renal: dipstick hematuria & proteinuria
× Mx: resolves spontaneously, NSAID for arthritis.
meningococcaemia
× Infection by Neisseria Meningitidis
× Prodrome: cough, sore throat
× Acute meningococcaemia: high-grade
fever, chills,
ill-looking, tachycardia, tachypnoea, mild
hypotension
× Rash initially maculopapular, become
petechiae-purpuric within hours
× Signs of meningeal irritation
× Mx: Antibiotics, supportive (may need
inotropes in shock)
Pruritic rash

Urticaria Atopic dermatitis

Rapidly developing Acute  Erythematous, weeping
erythematous eruption eczema
with raised central white Chronic  lichenified and dry
wheals and local purpura,
very itchy Post-inflammatory
hyper/hypopigmentation
Pruritic rash

Contact dermatitis Seborrheic dermatitis

Erythema and weeping at Dry, scaly and erythematous
contact site with irritant Red plaque may be present
History taking
× Demographic data – age, gender
× Rash
× Characteristic
× Pattern of distribution
× Progression pattern
× Timing & onset
× Changes in morphology
× Associated symptoms
× Fever – in relation to the onset of rash
× Ill-looking? - meningococcaemia
× Sore-throat – scarlet fever
× Itchiness - Allergy rxn, chicken pox
× Tenderness – shingles, HFMD
× Conjunctivitis – Kawasaki, measles
× Joint swelling – HSP
× Swelling behind ear – Lymphadenopathy in rubella
× Past medical history
× Previous chicken pox, measles
× Immunization history
× Receive MMR vaccination or not
× Drug history
× Any drug allergy, SJS-inducing drugs (acetaminophen,
Zithromax, ibuprofen, phenytoin)

× Family history
× Family history of skin disease or atopy
× Social history
× Hygiene, contact with anyone with any skin lesion
× History of travelling to pandemic area
Physical examinations
 General appearance  hemodynamic and
respiratory status, consciousness level
 Full examination of skin and mucosa  assess
rash
 Others:
× lymphadenopathy
× oral, genital or conjunctival lesions
× evidence of excoriations or tenderness
Thank
you!
references
1. Oxford handbook of Paediatrics
2. Nelson textbook of Paediatrics
3. Compilation of Notes: Paediatrics