Rashes in children

TERMINOLOGY
Macule Vesicle Hemorrhagic rash Lichenification itching
<1cm Clear fluid (non-blanching) rash
Not palpable Small Petechiae Excoriation/Desquamation
Flat Bullae Pin point Scaly
Large patch Clear fluid Purpura Crust scab
Papule Big < 1cm Wheal
<1cm Pustule Ecchymosis
Palpable Pus > 1cm
Raised
Large plaque

Short case
Rash
- Multiple
- Site
- Size (range of size if multiple)
- Shape
- Colour
- Margin
- Types (
macula/popular/maculapapular)
- Blanching/not
Skin
- Scratch mark
- Scaly
- Colour change
Rashes in children

Diseases Description
Meningococcemia - Can kill within hours
- Found in child with fever & purpuric rash. Can have gross edema d/t
capillary leakage.
- Rash:
o Purpuric, start anywhere and spread, non-blanching, irregular
size and have necrotic area
Impetigo - By staph/ strep
- Pre-existing skin ds is more prone to get it
- Rash: usually at face, neck & hand
o Erythematous macules vesicular/pustular bullous
ruptured and confluent honey-coloured crusted lesion
Chicken pox - Spread by resp droplet
( primary VZ) - Incubation : 10 23 days
- Present with fever + rash + itchy and scratch
- Rash
o 200 500 lesion
o Start at head and trunk progress to digit
o Papule vesicle pustule crust ( all stages present at the
same time)
Shingles - Uncommon in child
(secondary VZ) - Dermatome distribution
HFMD - By enterovirus, coxsackie virus, feco-oral transmission
- In <10 y old child, starts with fever and painful mouth sore
- Rash:
o Painful vesicular at hand, foot and mouth + buttocks and leg
- Subsided within few days
Measles - Has declined d/t immunization
- Presented with - fever, cough, runny nose, conjunctivitis,malaiseand
koplik spots.
- Rash dev at day 4 of fever.
o Maculapapular, spread behind ears downward whole body
o Discrete maculapapular blotchy + confluent

Rubella - Mild ds in childhood

- Severe damage to fetus
- Precaution of risk of exposure to non immune pregnant mom
- mild fever, lymphadenopathy
- Incubation perios: 15-20 d
- Prevention: immunization
- Rash
o Maculapapular rash, 1st at face spread to whole body
o Not itchy
Kawasaki ds - Acute febrile vasculitic syndrome
- Criteria : 5 days hx of fever + either 4 features below
o Changes in the peripheral extremities: Initial reddening or
edema of the palms and soles, followed by membranous
desquamation of the finger and toe tips or transverse grooves
across the fingernails and toenails (Beau lines)
o Polymorphous rash (not vesicular): Usually generalized but
may be limited to the groin or lower extremities
Rashes in children

o Oropharyngeal changes: Erythema, fissuring, and crusting of

the lips; strawberry tongue; diffuse mucosal injection of the
oropharynx
o Bilateral, nonexudative, painless bulbar conjunctival injection
o Acute nonpurulent cervical lymphadenopathy with lymph
node diameter greater than 1.5 cm, usually unilateral
- Other presentations
o BCG flare
o Jaundice
o Arthritis
- Acute cx (must rule out early)
o Myocarditis, pericarditis, pancarditis, pericardial effusion,
arrhythmia, MI
- Other cx
o CVS: coronary artery aneurysms, coronary artery ectasia
o CNS: aseptic meningitis
o GIT: hydrops gallbladder
- Ix: transaminase , ESR, LDH, bilirubin, sterile pyuria
- Mx: IVIG, Aspirin
Atopic dermatitis - Dry skin + itchy + raised rash
- Most common type of eczema
- hx of allergy + asthma +rhinitis
- common in 1st y of life, but less common in <2m
- Rash
o Itchy +++
Scratching erythematous, crusted
Skin dry lichenification
Itchy-scratch-itchy cycle
o Distribution defer with age
>2m: face + trunk
Older child: skin fold
Seborrheic - Common in <2m
dermatitis - Organism: pitysporum ovale
- Starts on scalp formation of erythematous scaly eruption thick
yellow adherent layer ( called cradle dap)
- Rash not itchy
o Scaly, spread from scalp face behind ear flexures
napkin
- risk to dev atopic dermatitis
Contact dermatitis - D/t food, soup, plant oil
- Starts 48 h after contact
- Subsided after 1-2 w of removal of irritants
- Reaction: swelling, redness + large blister
- Minor reaction: mild redness + rash of small bumps
Scarlet fever - Strep pyogenes, d/t exotoxin production
- Systemic manifestation
- Common in 3-12 y old
- Rash: scarlatiniform rash, dev 12-48 of fever
o Erythematous (blanches with pressure ) patches below the
ears, chest, and axilla
trunk and extremities exanthem (fine erythematous
Rashes in children

punctate eruption) eruption like coarse sandpaper

desquamation of face,palm,finger
o Typically, the rash consists of scarlet macules over generalized
erythema (boiled lobster appearance).
- Other presentation: red exudative tonsillitis, strawberry tongue,
erythematous lips, , exudative conjunctivitis
Henoch Scholein - More common in male, 3-10 y/o
Purpura - Preceded after URTI sx
- Triad of
o Purpuric rash (non blanching) on the extensor surface of arm
and leg, and also buttock
Trunk spared
o Symmetrical Arthritis
o Abdominal pain or nephritis ( hematuria, HT)
- No confirmatory test available, but ix is necessary to exclude the ddx
(ITP,DF, meningocemia)
- Self limiting ds, only give steroid if pt develop severe abdominal pain
Raseola infantum - HHV 6
- Affect infant + young children
- Initially day 3-5 days of high grade fever, then during afebrile dev
rashes
(rashes during afebrile phase)
Differ from measles rashes during febrile phase
- Rash:
o small rose pink macule/papule at trunk and face
Erythema - Major characteristic of Rheumatic Fever
marginatum - Rash
o Erythematous macular component, raised edge, non-[ruritic,
not painful, pink margin
o May reappear intermittently over weeks
Erythema - HSV, mycoplasma
multiforme (EM) - Erythematous macules or plaque at extensor surfaces of UL
- Dx by lesion
- Rash
o Doughnut shaped, erythematous outer ring, pale inner ring +
necrotic centre pruritic
o Lesion fixed in position, symmetrical bilat
o Fades over 10d
- Oral lesion may occur but other mucosal surfaces are spared
Erythema - Parvovirus B19
infectiosum - Presentation: slapped cheeks (intense erythemaover malar areas,
sunburn like) reticulated macular erythema over the limbs
- Ass with arthralgia
Steven-johnson ds - Ddx of EM
- 2/more mucosal surfaces are involved
- Widespread lesion
- Bullae formation + hemorrhagic crusting
- Mucosal +genitalia ulceration (painful)
Urticaria - Raised, well-circumscribed areas of erythema and edema involving the
(Hives) dermis and epidermis that are very pruritic
- Rash
Rashes in children

o Blanching, raised, palpable wheal ( linear,circular, or arcuate

(serpiginous); can occur on any skin area
- Ass with difficulty in breathing + facial swelling
- Precipitants
o Drugs aspirin, penicillin
o Foods eggs, nuts, shellfish, food additives
o Infection: strep sore throat
o New perfumes, hair dyes, detergents, lotions, creams, or
clothes
o Exposure to new pets (dander), dust, mold, chemicals, or
plants
o Contact with nickel, rubber, latex, industrial chemicals, and
nail polish
o Sun or cold exposure
o Exercise
SLE - Malar rash : fixed erythema, flat/raised over malar eminence, spare
nasolabialfold
- Discoid rash) erythematous raised patches with keratotic sclerae
- 3 stages of rash
o Erythema Pigmented hyperkeratotic edematous papules
atrophic depressed lesion (located at ear, cheek, scalp,
forehead, chest)
Dengue fever - Incubation period 4-7d
- Presentation: fever, retroorbital pain, myalgia, arthralgia, URTI
- Hemorrhagic manifestation
o Petecchiea islands of white in a sea of red
o Gum/nose bleeding
o Hematuria
Typhoid fever - Salmonella typhi
- Feco-oral transmission
- Hx of eating outside n hygiene
- Presentation: stepladder fever,malaise, influenza like, poorly localise
abd pain, hepatosplenomegally
- Rash: Rose spot on abdomen and chest
Thrombocytopenia - ITP
- Preceeded after URTI sx ( in child with 2w of infection)
- Bleeding manifestation
o Purpura, epistaxis, gum bleeding, easy bruising
- Commonest cause of thrombocytopenia in 2-10y old
- Rapid onset of purpura
- Normal blood count, except platelet
Leukemia - Presentation: prolonged fever +bleeding tendencies + pallor
- Other ss: hepatosplenomegally, lymphadenopathy
- Bleeding manifestation: petecchiae and purpura
- Ix: platelet, hb, /normal WBC with blast cell. ( blast cell not
mature, so the child prone to get infection)