rashes in infants and children
TRANSCRIPT
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
THANK YOU