Rashes in Infants and children

Dr. Mohammed Niyaz MEM Resident

MIMS -K

 Macule –  < 1cm diameter area of color change, with no palpable substance

 Patch –  > 2cm diameter macule  Papule – Palpable mass 1 cm diameter  Nodule – Spherical enlargement of a papule >

5mm diameter  Plaque – Flat-topped palpable lesion > 5mm

diameter, papule that is enlarged in 2 dimensions.

Wheal – Edematous papule or plaque, transient  Vesicle – Fluid-filled papule < 5mm diameter  Bulla –  > 5mm vesicle  Pustule – Vesicle packed full of purulent material

(may or may not be sterile).

General Approach

Fever & systemic symptoms Prior immunization Potential human or animal contacts Recent bites or stings Travel Drug administration Food & Environmental exposure

Viruses Fungal Infections Bacterial Infections Infestations Common Neonatal Rashes Exanthems of unknown etiology

Enteroviruses

Picornavirus group Poliovirus, Cock sackie , Echovirus Faeco-oral transmission Non specific febrile illness, Upper & Lower lip

infection, GI infections, Aseptic Meningitis Diffuse macular eruptions, Mobiliform rash , Roseola

like rash, Scarlatiniform eruptions

Hand Foot and Mouth Disease

Enterovirus 19 Fever, Anorexia, Malaise, Soremouth4 to 8 mm size vesicles, painfulHeal in 7 to 10 days

Herpangina

Cocksachie virus group AFever, Mouth pain, Oral Ulcers

Symptomatic Therapy

Adequate hydration Antipyretics “Magic Mouthwash“ - Maalox and Diphenhydramine

liquids

Measles

Measles

Highly contagious , myxovirus infection IP- 10 days General Malaise, Systemic toxicity, fever, coryza,

conjuctivitis , photophobia and cough Centrifugal – head to feet Red copper to brownish hue Koplik spots- 1mm descrete spots with a red base

opposite lower molars

Rubella (German Measles or Third disease)

IP- 12 to 25 days

Fever, Malaise , Headache, Sorethroat

Irregular pink macules and papules on face to neck, trunk , arms

Forcheimer spots- pinpoint petechia involving soft palate

Lymphadenopathy- suboccipital, post auricular

Erythema Infectiosum ( Fifth disease)

Human Parvovirus B19

5 to 15 years

Slapped cheek appearance

Circum oral pallor

Fever, malaise , headache, sorethroat, cough , coryza

Herpes

Gingivostomatitis

Disseminated, localized to CNS or mucocutaneous

HSV1 – Oral SecretionsHSV2 – Vaginal Secretions

IP- 2 to 14 days

Herpes labialis (cold sores) and Gingivostomatitis

Painful umbilicated vesicles

Eczema herpeticum

Vesicular eruptions in areas affected by eczema

Life threatening

Treatment

Trimethoprim – sulfamethoxazole 10 mg/kg/d twice a dayClindamycin 24 mg /kg/d 3 times a day x 10 daysAcyclovir 80 mg /kg/d every 8 hours x 10 days

Varicella Less than 10 years

Low grade fever, Malaise, Headache

Tear drop vesicles

Tzanck smear- Varicella giant cells

Complications- Encephalitis, Pneumonia, Hepatitis

Management :

AcetaminophenAntihistaminesAcyclovir

Roseola Infantum (Exanthem subitum or 6th disease)

3 to 5 days febrile period

6 months to 3 years

High grade fever, cough, coryza, anorexia, abdominal discomfort

Fungal Infections

Tinea CapitisKerion

Tinea capitis (scalp)- in children < 10 years Tinea corporis – adolescent Kerion- severe form of capitis , exaggerated

inflammatory response producing painful boggy mass

Diagnosis- M/E- Hyphae Culture- Sabouraud dextrose sugar

Treatment

Tinea capitis- Griseofulvin 20 to 25 mg /kg/ d or twice a daySelenium Sulfide 2.5%/ Ketaconazole shampooPainful Kerion – Cephalexin 40 mg/kg/d every 8 hours

Bacterial Infections

Impetigo

Staph aureus or Beta hemolytic streptococcus

At site of insect bite or cutaneous trauma

Face , neck and extremities

TreatmentMupirocin 2 % thrice dailyCephalexin 40 mg /kg /d TID x 7-10 daysClindamycin 24 mg/kg/d TID x 7-10 days

Bullous ImpetigoEpidermolytic toxin – seperation of skin at granular layerNew born infants and childrenSuperficial , flaccid, thinwalled bullae 0.5 to 3 cm

Staphylococcal Scalded skin syndrome

Fourth disease

Malaise, fever, irritablity, tenderness of the skin

Nikolsky sign – seperation of the epidermis when pressure is applied

Treatment

Inpatient therapy, fluid resuscitation and parenteral antibiotics

Nafcillin 100 mg/kg/d every 6 hours IV Penicillin G procaine 300000 U/d IM for < 30 kg and

600000 U/d for > 30 kg

MRSA-Clindamycin 40 mg /kg/d Q6H Sulfamethoxazole-trimethoprim -10mg/kg/d BD for 7-

10 days Vancomycin 10 to 15 mg/kg/d BD

Scarlet Fever

Erysipelas

Scabies

Head lice

Erythema Toxicum Neonatorum

Neonatal Acne

Seborrheic dermatitis

Atopic Dermatitis

Diaper rash

Kawasaki Disease

Henoch Shonlein Purpura

Pityriasis rosea

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