Pediatric rashes By : ALI alwaily/MD G.S.M MEDICAL EDUCATION

Before we begin Objectives Learn to recognize common pediatric rashes

Remember your anatomy…

Epidermis Rashes involving the Epidermis Eczematous Scaling Vesicular Papular Pustular Hypopigmented Rashes not involving the epidermis Erythema Purpura Induration

Macule / Patch:- circumscribed area without elevation Papule / Plaque :- solid raised lesion <1cm its papule if elevated will be plaque >1. cm

Nodule: solid raised lesion Vesicle: circumscribed area fluid filled Nodule: solid raised lesion

Bulla : circumscribed area fluid filled >1cm Vesicle : circumscribed area fluid filled <1cm Pustule : circumscribed area. Containing pus Wheal:an area of the skin which is temporarily raised, typically reddened, and usually accompanied by itching Wheal

Petechiae / Purpura / Ecchymosess : small red/brown macule <1 cm that does not blanche

Distinguish characteristic of common childhood rashes will depend on 1- condition 2- location 3- appearance 4-duration 5-deffrential diagnosis

1-Roseola infantum 2- Pityriasis rosea -condition : Roseola infantum (exanthema subitum) -location : Trunk, spreads peripherally -appearance : Macular to maculopapular -duration : 1-2 days - deferential diagnosis : Can be confused with measles; measles rash begins on the face, and the child is usually ill-appearing 2- Pityriasis rosea Condition : pituriasis rosea Location : Trunk, bilateral and symmetric, Christmas tree distribution Appearance : oval-shaped, rose-colored patches with slight scale Duration :2-12 weeks Deferential diagnosis: Often confused with tinea corporis; pityriasis rosea is typically widespread, whereas tinea corporis usually causes a single lesion

Roseola infantum

Pityriasis rosea

3- Scarlet fever 4- Impetigo Condition :impetigo Condition : scarlet fever Location : Upper trunk, spreads throughout body, spares palms and soles Appearance : Erythematous, blanching, fine macules, resembling a sunburn; sandpaper-like papules Duration :several weeks Deferential diagnosis: Petechiae on palate; white strawberry tongue; test positive for streptococcal infection Condition :impetigo Location :Anywhere; face and extremities are most common. Appearance :Vesicles or pustules that form a thick, yellow crust. Duration :7-10 days Deferential diagnosis : May be a primary or secondary infection; bullous form is typical in neonates, and nonbullous form is more common in preschool- and school-aged children 4- Impetigo

Scarlet fever

impetigo

5- Erythema infectiosum (fifth disease) Condition :Erythema infectiosum (fifth disease) Location :Face and thighs Appearance :Erythematous “slapped cheek” rash followed by pink papules and macules in a lacy, reticular pattern Duration :facial rash lasts 2 to 4 days; lacy, reticular rash may last 1 to 6 weeks Deferential diagnosis :May be confused with scarlet fever; the slapped cheek rash can differentiate erythema infectiosum 6- Molluscum contagiosum Condition : Molluscum contagiosum Location : Anywhere; rarely on oral mucosa Appearance : Flesh-colored or pearly white, small papules with central umbilication Duration : Months or up to 2 to 4 years Deferential diagnosis: no

Erythema infectiosum

Molluscum contagiosum

7- Tinea infection 8- Atopic dermatitis Condition :Tinea infection Location :Anywhere Appearance :Alopecia or broken hair follicles on the scalp (tinea capitis), erythematous annular patch or plaque with a raised border and central clearing on the body (tinea corporis) Duration :2-4 weeks Deferential diagnosis:Often confused with pityriasis rosea; potassium hydroxide microscopy can help confirm diagnosis 8- Atopic dermatitis Condition : Atopic dermatitis Location :Extensor surfaces of extremities, cheeks, and scalp in infants and younger children; flexor surfaces in older children Appearance :Erythematous plaques, excoriation, severely dry skin, scaling, vesicular lesions Duration :Chronic, relapsing Deferential diagnosis : no

Tinea infection

Atopic dermatitis

References Cydulka RK, Garber B. Dermatologic Presentations. In Marx J, ed. Rosen’s Emergency Medicine. Philadelphia, PA: Elsevier; 2010. Habif MD, Thomas P. Clinical Dermatology, 4th Edition – A Color Guide to Diagnosis and Therapy. Philadelphia, PA: Mosby; 2004. Murray OMSII, Alexandra. Deadly Rashes Not to Miss in the ED. American Academy of Emergency Medicine. http://www.medscape.com/viewarticle/804255?nlid=31985_541&src=wnl_e dit_medp_emed&spon=45. Accessed August 06, 2013. Rampal MD, Angelika. Pediatric Rashes to Worry About: Slideshow. http://reference.medscape.com/features/slideshow/pediatric-rashes. Accessed August 06, 2013.