Mimi Lu, MDClinical Assistant Professor

University of Maryland

mlu@em.umaryland.edu

DEADLY PEDIATRIC RASHES

DISCLOSURES

• None

OBJECTIVES

• Review pearls to recognize life threatening rashes

• Discuss treatment of life threatening pediatric rashes

TAKE HOME

• Viral exanthem

• Supportive care

• Follow up with your pediatrician

THANK YOU!!!

DEADLY RASHES

• Characteristics

• Altered LOC

• Mucous membrane involvement

• Multiorgan involvement

• Extensive blisters or desquamation

• Pain out of proportion to exam

• Petechiae or purpura

DEADLY RASHES

1. Palms/ Soles

• MRS TECK

2. Blistering/ mucosal involvement

3. Purpura/ Petechiae

“PALMS AND SOLES”

MRS TECK

• Meningiococcemia

• Rocky Mountain Spotted Fever

• Syphillis, Stevens-Johnson Syndrome, SSSS

• Toxic shock syndrome, Toxic Epidermal Necrolysis

• Erythema Multiforme

• Coxsackie

• Kawasaki

KAWASAKI DISEASE

KAWASAKI DISEASE

• Fever plus 4 of 5 characteristics

1. Bilateral conjunctival injection without exudate

2. Rash

• maculopapular, erythema multiforme, scarlatiniform

3. Unilateral cervical adenopathy, ≥ 1.5 cm

4. Strawberry tongue, erythema of oral & pharyngeal mucosa, dry/cracked lips

5. Edema & erythema of hands & feet

C

R

A

S

H

SSS

• photos

Nikolsky’s

Sign

STAPHYLOCOCCAL SCALDED SKIN SYNDROME

• Malaise

• Fever

• Paradoxical irritability

• Sunburn rash

• Intense around neck, intertriginous areas, perioral

• Nikolsky’s sign

• No mucous membrane involvement

• Mucous membranes

• Adverse med reaction

• NSAIDS

• Penicillins

• Sulfonamides

• Anticonvulsants

• Rx: IVF

• Burn center

• ?IVIG

STEVENS JOHNSON SYNDROME

ERYTHEMA MULTIFORME

Etiology: 90% infectious (60% HSV)

meds, malignancy, autoimmune diseases

Supportive:

Topical emollients, antihistamines, NSAIDs

Recurrent: prophylactic oral acyclovir

Lesions typically resolve in 2 weeks

COXSACKIE (HAND-FOOT-MOUTH)

Vesicular lesions on the anterior mouth and an

exanthem on the hands and feet (and buttocks) in

association with fever

Peak incidence in the summer and fall

Infants and children younger than 5 years

Tx: supportive

HENOCH-SCHONLEIN PURPURA

• Vasculitis of small vessels

• Non-thrombocytopenic purpura

• “palpable purpura”

• Edema in dependent regions

• Arthritis

• Abdominal pain/ GI bleed

• Intussusception

• Renal involvement

IDIOPATHIC THROMBOCYTOPENIC PURPURA

• Fever + petechial rash + headache

• Tick-borne illness

• Clinical diagnosis

• Spreads inwards

• Rx: Doxycycline or chloramphenicol

ROCKY MOUNTAIN SPOTTED FEVER

• Fever + petechial rash

• Rapid progression to purpura

• Transmission in close quarters

• URI prodrome

• Fulminant shock

MENINGOCOCCEMIA

DEADLY RASHES

1. Palms/ Soles

• MRS TECK

2. Blistering/ mucosal involvement

3. Purpura/ Petechiae