Rashes
Classification of rashes
Note: Petechiae generally means vascular/ platelet issues
Distinguishing Features
Chicken pox: Rash on scalp
Roseola (6th disease): Rash on trunk
Slapped cheek (5th disease): Rash not on trunk
Measles: Koplik spots + 3Cs
Rubella: Swollen glands
DDx
Infectious causes [7]
Inflammatory causes [4]
C onjuctivitis (non exudative)
R ashes
E dema
A denopathy
M ucosal involvement
Treatment
SOAPBRAINMD:
S erositis (pleuritis or pericarditis)
O ral (Ulcers)
A rthritis (Non-erosive, any joint, polyarticular)
P hotosensitive rash
B lood dyscrasia (anemia, leukopenia, lymphopenia or thrombocytopenia)
R enal Nephritis
A NA
I mmunoreactive (anti-Ds DNA, Anti-Rho, Anti-Sm, Anti-La, antiphospholipid)
N eurological (Sz, Chorea, Psychosis)
M alar rash
D iscoid rash
Associates with two rashes characteristically:
Source
http://julieyumi.tumblr.com/post/409401181/a-handy-guide-on-how-to-differentiate-between-common
www.learnpediatrics.com
- Macule: Flat lesion (<1 cm in diameter)/ Plaque >1cm
- Papule: Elevated lesion (<1 cm in diameter)/ Nodule >1cm
- Vesicle: fluid-filled (<1 cm in diameter)
- Bulla: fluid-filled (>1 cm in diameter)
- Pustule: pus-containing vesicle
- Ulcer: break in epidermis and upper dermis
- Purpura: non-blanching papules or macules due to extravasation of RBCs
Note: Petechiae generally means vascular/ platelet issues
Distinguishing Features
Chicken pox: Rash on scalp
Roseola (6th disease): Rash on trunk
Slapped cheek (5th disease): Rash not on trunk
Measles: Koplik spots + 3Cs
Rubella: Swollen glands
DDx
Infectious causes [7]
- Measles:
- Blanching erythematous maculopapular rash (Morbilliform rash)
- Begins in head and neck à spreads centrifugally to trunk and exrtremities
- Associated symptoms: fever, cough, coryza and conjunctivitis (3 Cs)
- Rubella:
- Rash resembles measles, but patient is not ill looking
- Prominent postauricular, posterior cervical +/- suboccipital adenopathy
- Forschemier spots: small, red spots (petechiae) on soft palate in 20% of rubella patients
- Chickenpox:
- Vesicular lesions on erythematous base
- Lesions appear in crops
- “dew drops on rose petals” appearance
- Lesions are present in different stages: papules, vesicles, crusting
- Erythema infectiosum (fifth disease) – human parvovirus B19
- Characteristic rash that resembles “slapped cheeks”
- Roseola infantum or exanthema subitum
- Human herpesvirus 6 or 7 infection
- High fever for 3-4 days
- Followed by seizures
- Generalized rash (trunk to extremities, face spared)
- Scarlet fever
- Exotoxin-mediated diffuse erythematous rash
- Pharyngitis due to group A streptococcus
- Coarse, sandpaper-like, erythematous, blanching rash and desquamation
- Circumoral pallor and strawberry tongue
- Non-polio enteroviruses (coxsackievirus, echovirus)
- Cause variety of different rashes
Inflammatory causes [4]
- Acute rheumatic fever
- Potential sequela of group A streptococcal pharyngitis (strep pyogenes)
- Erythema marginatum – transient macular lesions with central clearing usually found on extensor surfaces of proximal extremities and trunk
- Subcutaneous nodules over bony prominences
- Kawasaki Vasculitis
- Usually in kids <4 years old
- Fever >5 days + ≥4 of the following:
C onjuctivitis (non exudative)
R ashes
E dema
A denopathy
M ucosal involvement
Treatment
- IVIg
- Aspirin (potential Reyes syndrome
- Glucocorticoids
- Systemic Lupus Erythromatosis
SOAPBRAINMD:
S erositis (pleuritis or pericarditis)
O ral (Ulcers)
A rthritis (Non-erosive, any joint, polyarticular)
P hotosensitive rash
B lood dyscrasia (anemia, leukopenia, lymphopenia or thrombocytopenia)
R enal Nephritis
A NA
I mmunoreactive (anti-Ds DNA, Anti-Rho, Anti-Sm, Anti-La, antiphospholipid)
N eurological (Sz, Chorea, Psychosis)
M alar rash
D iscoid rash
- Inflammatory Bowel Disease
Associates with two rashes characteristically:
Source
http://julieyumi.tumblr.com/post/409401181/a-handy-guide-on-how-to-differentiate-between-common
www.learnpediatrics.com