1. PAEDIATRIC RASHES OSCE Dr S FISH

2. Terminology Macule – flat lesion,usually a circumscribed change of colour Papule – small, solid, elevated lesion Nodule – a large, solid, palpable and elevated lesion Plaque – a lesion slightly raised over a larger area Blister – an elevated lesion,fluid filled Ulcer – depressed lesion with loss of surface epithelium Atrophy – a depressed lesion with intact surface epithelium Crust – a mixture of scale and serum – yellowish accretions on the surface of a lesion Petechiae – non raised red-brown non blanchable lesions

3. Summary of Paediatric Skin Rashes: Adapted from Paediatric Handbook 6th Ed. Royal Children's Hospital, Melbourne

4. SLIDE 1

5. 1-Name condition and causative organism 2-Describe what you see 3-How would you treat it

6. SLIDE 2

7. 1-Name the condition 2-What are typical causative organism 3-describe typical features 4-How would you treat it

8. SLIDE 3

9. 1-Name the rash and the associated syndrome 2-name infective and drug causes 3-describe typical features

10. SLIDE 4

11. Name this disease,what is its cause. Name the features Name a major complication of this disease treatment

12. SLIDE 5

13. Name this condition What is the causative organism How do you treat it

14. SLIDE 6

15. What is this rash Describe features

16. SLIDE 7

17. What is this called What is the causative organism Describe features treatment

18. SLIDE 8

19. What is the broad term used to describe this condition Name the subset of conditions which cause it. How do you treat this condition ?

20. SLIDE 9

21. Name this condition What is the cause of it How do you treat it

22. SLIDE 10

23. What is this called What organism causes it treatment

24. SLIDE 11

25. Name the condition What causes this condition Describe the features How do you treat it

26. SLIDE 12

27. Name the rash What causes this condition Name 2 types of this condition How do you treat this condition

28. References Pictures – Derm atlas Oxford Handbook of Dermatology for primary care,Saxe,Jessop Topics in Paediatrics,Basson& Ginsberg

29. SLIDE 1 1-Chicken-pox, Varicella zoster virus 2-Crops of vesicles mainly on the trunk and head. -Pass through various stages of papule, vesicle, pustule and crust. 3-Symptomatic :analgesia – paracetamol for discomfort and pyrexia. -pruritis – antihistamine or calamine lotion - acyclovir only for those at risk of complications or immunocompromised.

30. SLIDE 2 1-Impetigo 2-staph areus and streptococcal pyogenes 3-Thin–roofed vesicles or bullae surrounded by narrow margin of erythema. The vesicles /bullae rupture to release thin cloudy yellow fluid. This fluid dries to form thick yellow crusts. 4-topical-bactroban(mupirocin) ointment/betadine cream - antibiotics – flucloxacillin or erythromycin

31. SLIDE 3 1-Erythema Multiforme Steven-Johnson Syndrome (mucous membrane involvement) 2-Drug most commonly associated-Allopurinol55 Recent drugs- Nevirapine, lamotrigine, sertraline, pantoprazole, tramadol Antibiotics- Sulphonamides, including co-trimoxazole, penicillin cephalosporins, fluoroquinolones, vancomycin NSAIDs- Piroxicam, fenbufen, ibuprofen, ketoprofen, naproxen, tenoxicam, diclofenac, sulindac Anti-TB- Rifampicin, ethambutol, isoniazid, pyrazinamide Anticonvulsants- Barbiturates, carbamazepine, phenytoin, valproate, lamotrigine - Infective herpes simplex 3-target lesion –round,erythematous papules contain central blister or darker area of necrosis

32. SLIDE 4 1-Kawasaki Disease, systemic vasculitis 2- Classical features of Kawasaki disease Fever lasting ≥5 days Marked irritability of the child Erythema, swelling and desquamation affecting the skin of the extremities Bilateral conjunctivitis Rash Inflammation of the lips, mouth and/or tongue Cervical lymphadenopathy 3- coronary artery aneurysms 4 -Intravenous Immune Globulin 2g/kg x1 Aspirin: –80-100 mg/kg/day until fever  x 14 day, then –3-5mg/kg/day x ≥ 6-8 weeks echocardiograms

33. SLIDE 5 1-Scabies 2-Mite –sarcoptes scabeii 3 -Clothes, towels, and bed linen should be machine-washed (at 50 degrees Celsius or above) to prevent re-infestation and transmission. Items that cannot be washed can be kept in plastic bags for at least 72 hours to contain the mites until they die. -benzyl benzoate lotion,apply for 24hours,may be repeated in 1 week -permethrin cream Antiscabial soap alone is not an effective treatment Babies <2 months -5% sulphur ointment

34. SLIDE 6 1-Measles 2-single stranded RNA Morbillivirus from the paramyxovirus family. 3- Symptoms Prodrome - lasts 2-4 days with fever, runny nose, mild conjunctivitis and diarrhoea. Koplik spots are pathognomic and appear on the buccal mucosa opposite the second molar teeth as small, red spots each with a bluish-white speck (sometimes compared to a grain of rice) in the centre.6 They occur in 60-70% of patients during the prodrome and for up to 2-3 days before the onset of the rash.6 Rash - (morbilliform = measles-like) first seen on forehead and neck and spreads, involves trunk and finally limbs over 3-4 days. It may become confluent in some areas. Rash then fades after 3-4 days in the order of its appearance. It leaves behind a brownish discoloration sometimes accompanied by fine desquamation. 4-Uncomplicated measles is usually self-limiting and treatment is mainly symptomatic with paracetamol or ibuprofen and plenty of fluids. Patients should remain at home to limit disease spread. It is a notifyable disease

35. SLIDE 7 1- erythema infectiosum, slapped cheek disease, slapped cheek syndrome, fifth disease, Parvovirus B19 (PV-B19), Sticker's disease 2- Parvovirus B19 3- After 3-7 days, the classic 'slapped cheek' rash appears as erythema on the cheeks, sparing the nose, peri-oral and peri-orbital regions.6 This disappears after 2-4 days.6 About 1-4 days after the facial rash appears, an erythematous macular/morbilliform rash develops on the extremities, mainly on the extensor surfaces.7 It is usually not itchy in young children, but may be itchy in older children and adults. This gradually fades over the next 3-21 days, but may recur in reaction to various stimuli such as exercise, heat and sunlight7 4- It is usually mild and self-limiting in healthy people. It may also cause fetal loss or fetal hydrops, reactive arthritis in adults, and severe anaemia in those with haematological conditions or immunocompromise.Detection in pregnancy is important for monitoring and possible treatment.

36. SLIDE 8 1-Napkin /Daiper dermatitis 2- Contact dermatitis prolonged exposure to urine and faeces, friction mild erythematous,glazed appearance -Seborrhoeic dermatitis salmon coloured greasy lesions and a predilection for intertriginous areas. -Candidiasis beefy red in colour with pin point pustulo-vesicular satellite lesion 3- frequent daiper changes barrier cream zinc and caster oil apply hydrocortisone 1% in aqueous cream bd if candidiasis suspected -10% steriod and nystatin 20% in zinc cream

37. SLIDE 9 1- tinea capitis 2- fungal infection by a group of organisms called dermatophytes 3-griseofulvin for 6 weeks,10mg/kg

38. SLIDE 10 Meningococcal meningitis Neisseria meningitidis Cefotaxime

39. SLIDE 11 1-Molluscum contagiosum 2-From direct innoculation of pox virus 3-tend to heal spontaneously within 6 months – 1 year -liquid nitrogen 2-3 weeks -express contents with sharp curette -benzoyl peroxide cream apply daily

40. SLIDE 12 1-Miliaria 2-Miliaria is a common disorder of the eccrine sweat glands that often occurs in conditions of increased heat and humidity. It is thought to be caused by blockage of the sweat ducts, which results in the leakage of eccrine sweat into the epidermis or dermis. 3-Two types -miliaria crystallina-clear superficial pinpoint vesicles -miliaria rubra –(prickly heat )-small discrete red papules,vesicles,papulovesicles 4-No compelling reason to treat miliaria crystallina exists because this condition is asymptomatic and self-limited. he prevention and treatment of miliaria primarily consists of controlling heat and humidity so that sweating is not stimulated. Measures may involve treating a febrile illness; removing occlusive clothing; limiting activity; providing air conditioning. Topical treatments that have been advocated involve lotions containing calamine