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

2. Before we begin
Objectives
Learn to recognize common pediatric rashes

3. Remember your anatomy…

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

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

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

8. 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

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

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

11. 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

12. Roseola infantum

14. Pityriasis rosea

16. 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

17. Scarlet fever

19. impetigo

21. 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

22. Erythema infectiosum

24. Molluscum contagiosum

25. 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

26. Tinea infection

28. Atopic dermatitis

31. 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 dit_medp_emed&spon=45. Accessed August 06, 2013.
Rampal MD, Angelika. Pediatric Rashes to Worry About: Slideshow Accessed August 06, 2013.