Can You Take a Look at This? Shane Scott, DO Internal Medicine & Pediatrics The Objectives! Identify Common Presentations of Rashes in the Pediatric Patient! Decide if the rash is Communicable! Decide if the child should be sent home! Treatment/Advice to give teacher/parents 1
Classification! Infections! Infestations! Inflammation 2
Classic Exanthems 1. Measles : Rubeola 2. Scarlet Fever : Scarletina, Toxin Mediated 3. Rubella : German Measles 4. Duke s Disease 5. Fifth s Disease : Erythema infectiosum, Parvovirus 6. Roseola Infantum : Herpes 6 Measles -Fever (up to 104) -Runny Nose -Conjunctivitis -Splotcy, red, raised rash (day 5) -Koplik Spots (day 3) 3
Scarlet Fever! Strep throat! Can cause serious morbidity! Rheumatic Heart Disease! Arthritis! Renal dysfunction Scarlet Fever Centor Criteria strep rash 4
Rubella! Mild symptoms in children : fever, sore throat;! Rash may develop about 5 days after onset of symptoms! Adults : arthralgias, headache, conjunctivitis Rubella in pregnancy! Most dangerous during the first 12 weeks of pregnancy! Can cause intellectual disability, heart defects, liver/spleen problems, vision and hearing problems! Can cause miscarriage! Rubella titres standard during prenatal workup Rubella 5
Fifth s Disease! aka Slapped Cheek, parvovirus b19, erythema infectiosum! mild symptoms : fever, sore throat, runny nose! Rash may develop after initial symptoms - slapped check, then rest of body (lacy). Rash on bottom of feet may itch! May have some arthralgias Slapped Cheek Slapped Cheek and pregnancy! 50% of women are immune! 5% of non-immune women will obtain infection that may do harm to infant! Causes anemia and possible miscarriage in infant.! Blood test can identify those who are immune 6
Roseola! 6mos-2y/o! 3 days - sustained high fever (103-105)! Frequent febrile convulsions! Marked irritability! Evanescent pink discrete rash typically appears after defervescence! Edema of eyelids (droopy Roseola Dismals Canyons 7
Tinea! Scaly, well demarcated patch with sparse hair Tinea Capitis! Broken hairs (salt and pepper appearance)! May develop into a kerion! 95% KOH negative Tinea Capitis 8
Tinea Coporis! Fungal skin infection! Usually easily treated with over the counter athlete s foot cream! Use of topical steriod can change appearance Tinea Versicolor! Scaling, ovale, patchy! Upper trunk and proximal arms! Hyper or hypopigmented! Treat with selenium sulfide shampoo MRSA! It is everywhere!! Painful, spreads quicky! Exudative drainage! Drainage a Must! 9
MRSA Eradication! Bactroban ointment in nares! Hibiclens soap! Bleach baths Impetigo! Yellow Crusty Lesions! Typically caused by Strep or Stpah! Ointment is typically all that is needed 10
Mollusucum Contagiosum! Pox virus Family! Contagious! Pearly Papule with umibilicated center Molluscum Wart! Viral! Cryotherapy! Chemotherapy!?Tagmet! Salicylic Acid! Duck tape! 11
Acne! Bacterial infection! Bacterial overgrowth in pores of the skin! Herald patch! Puritic! Christmas tree distribution Pityrasis Rosea! Weeks duration! Reverse distribution in some kids 12
! Diagnosis requires 3 lesions : papule, vesicular, crusting lesion! Vaccinations have dramatically reduced disease burden! High Morbidity in Adolescents Varicella Varicella campbarnabas.org 13
Infestations Lice Lice! Typically behind the ears; occipital area! Transmitted via head to head contact! Not associated with poor hygiene or socioeconomic status! They don t transmit dz 14
Lice : Lifecycle! Must recognize life cycle:! Adult : must feed every 4-6 hours, can only survive for 24 hours away from host.! Egg : attach to the hair shaft; require 7-10 days to develop; nits are the empty eggs! Nymph : mature while feeding on the scalp. Adult in 1-2 weeks Lice : Diagnosis! Must see both adult and their eggs! Fine tooth coomb is used to examine the entire scalp! Nits do not constitute a diagnosis. Nits can be left behind for weeks after effective treatment Lice : Treatment! Application is always to dry hair! The louse shuts down its respiratory system when exposed to water (up to 4 hours)! Elimite, Nix, permethrin : repeat application in 1 week! Ulesfia : benzyl alcohol 5% lotion! No advantage to treat those who are not infected! 15
Scabies! Mites! Burrow under the skin! There excrement is left behind which causes the puritis! Elimite cream : head to toe! May itch for 1 week after treatment 16
Flea Bite Inflammation 17
Urticaria! Hives! Red, raised, puritic! Fades and moves around! Viral etiology most common in children Contact Dermatitis! Rhus Dermatitis! Urushiol Oil! the oil attaches to skin protein, then the body sees these proteins as foreign and attacks 18
Contact Dermatitis! Typically linear! Fluid Filled/vesicluar lesions! Treat : wash skin/ clotehs with soapy water! Cool compresses, steriods! Watch for secondary infections Nickel Allergy! Commonly found in snaps on pants and ear rings! Paint buttons with clear finger nail polish.! Place tape on button! Steriods to treat 19
Atopic Dermatitis! Can begin in infancy! Can be triggered by food/exposures! Can be seen in this with other allergic issues : Asthma Ketosis Pilaris! Rough, papular usually skin colored, but can be reddened! Located on upper arms, thighs, buttocks! Harmless; Difficult to treat - steriods, exfolliants Seborrhea! Erythematous plaques, greasy appearing, yellowish scale! Scalp, face, external ear!?fungal Component 20
Quiz Quiz #1 a. Tinea Coporis b. Atopic Dermatitis c. Urticaria 21
Quiz #1! (C) urticaria Quiz #2 a. Contact Dermatitis b. Varicella c. Molluscum Contagiosum Quiz #2! (C) Molluscum 22
Quiz #3 a. Strep b. Strep c. Strep Thanks! Questions? 23