Visual Diagnosis: A Review of Pediatric Rashes

Transcription

1 Visual Diagnosis: A Review of Pediatric Rashes Frank J. Sloan, MD FAAP Emergency Services Department Thank you to VisualDX for allowing the use of their images for educational purposes. 1

2 Modern Medicine 2

3 Rashes Dermatology Terminology Morbilliform Morbilli Latin for what we now call measles. It comes from Morbus which means disease and illus which is the diminutive form in Latin. Together it means little disease. form meaning in the shape of. So a Morbilliform Rash is any rash that resembles Measles Rash. SO any large red rash can be described as a Morbilliform Rash. 3

4 Morbilliform Rashes Many diseases can be described as having a red rash. Some can be deadly (RUBEOLA) others are not (ROSEOLA) Many of these disease came as waves or epidemics, so physicians may only see them a once or just few times in their lifetime. Western Medicine tried to describe these epidemics to help try and tell them apart. (English Measles vs German Measles) Physical Symptoms and the characteristic of the rash help tell them apart. Classically they were classified as the 6 Erythematous Exanthems of Childhood They are numbered 1 6. They can also be called Morbilliform Rashes Rubeola Rube-one-la The king of the Red Rashes. Highest Mortality of any of the Erythematous Exanthems, Thus it s the first of the erythematous exanthems In an unvaccinated patient, the rash starts at the top of the head and drips down the body like a can of paint dumped on the top of his head. 4

5 Rubeola In unvaccinated patients, it has 3 physical findings that start with C and a fourth with a pseudo C Cough Coryza Conjunctivitis Koplik Spots Enanthem 5

6 Dermatology Terminology Macular Rash is any rash that is completely flat Macular papular Rash is a rash that has some lesions that are flat and other lesions that are raised. Scarlatina Is the second classical Morbilliform rash seen in children. Starts as a Red rash on the neck or groin. On the body it has a fine papular feel. Described as fine sandpaper or macular papular. Caused by Group A Strep Pharyngitis. Not all Strep Pharyngitis will develop into Scarlatina. Difference between Scarlet Fever and Scarlatina? Common on the face, neck, axilla, and the groin 6

7 Scarlatina Patients will have strep Pharyngitis symptoms such as headache, sore throat of abdominal pain/vomiting The face usually appears more flushed than raised. You should see circumoral pallor in patients with Scarlatina Circumoral Pallor Scarlatina The body has raised feel to it. Macular papular In patients with melanin, the skin wont appear red. Cutis Anserina Goose Flesh 7

8 Scarlatina Before the rash occurs you can sometimes seen Pastia Lines in the flexural folds, especially in the antecubital area Pastia Lines Scarlatina First few days a white membrane forms with red papilla coming thru creating a White Strawberry Tongue After day 4 5 of the illness the membrane will slough off forming a shinny red tongue or a Red Strawberry tongue 8

9 Scarlatina The enanthem found in Scarlatina is Palatal petechia, however only some patients will have this on exam. Dermatology Terminology Desquamation from the Latin word desquamare, meaning 'to scrape the scales off a fish. It s the Dermatological word for peeling skin. It can be seen in many disease so is not pathognomonic for any one disease 9

10 Scarlatina Scarlatina? You have a patient with fever, sore throat, a large cervical Lymph node, a Morbilliform rash. However the Rapid Strep test is negative Treat for strep pharyngitis or Wait for the culture? 10

11 Dermatology Terminology Scarlatiniform A rash that presents as tiny macules(<1mm) coalescing rapidly to form areas of erythema with rare patches of normal skin in between, particularly in the skin folds. It can be caused by numerous things including Arcanobacterium haemolyticum, EBV, numerous other viruses, and even drug reactions. 11

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13 Rubella The rash starts on face and then spreads to the rest of the body. The exanthem lasts only three days, hence the name 3 day Measles. May have a fine skin desquamation. Has full body swollen Lymph nodes with post auricular being prominent. There is an Enanthem of macules to petechia of the soft palate and Uvula called Forchheimer spots Rubeola Scarlatina Rubella They all have enanthems They can all present on the face and spread all over the body All three can be confluent in places The major difference is in size of the lesions 13

14 Dermatological Terminology Morbilliform rash A red macular rash with lesions in the 3 5mm range Rubelliform Lesions that are more pink than red like Morbilliform and the lesion tend to range 1 3mm with more space between lesions Scarlatiniform rash Lesions that start at <1mm before coalescing. There may be a papular component to the lesions 14

15 Dermatological Terminology Non blanching Rashes i.e. blood is in the skin Petechia Lesions less than 0.3 cm Purpura Lesions 0.3 cm to 1cm Ecchymosis Lesions >1cm 15

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17 Traumatic purpura Disease? 17

18 Q U ES T IO N S? 18