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Pediatric Exanthems. Objectives. Be familiar with the terminology to describe rashes accurately to other providers Be able to identify the rashes of Measles, Rubella, Scarlet Fever, Erythema Infectiousum, and Roseola Infantum Know the general clinical features of each of the above rashes.

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objectives
Objectives
  • Be familiar with the terminology to describe rashes accurately to other providers
  • Be able to identify the rashes of Measles, Rubella, Scarlet Fever, Erythema Infectiousum, and Roseola Infantum
  • Know the general clinical features of each of the above rashes
the basics of rashes
The Basics of Rashes
  • Distribution
    • Localized vs. Systemic
    • Sun exposed areas?
  • Configuration
    • Round
    • Serpiginous
    • Coalesce
  • Description
    • Macular, Papular, Petechial
  • Evolution
    • Where it began and where it ended
  • Associated Findings
description of rashes
Description of Rashes
  • Macule – circumscribed color change in the skin that is flat
  • Papule – solid, elevated area < 1 cm in diameter
  • Plaque – solid, circumscribed area >1 cm in diameter
  • Vesicle – circumscribed, elevated < 1 cm with serous fluid
  • Bulla – circumscribed, elevated > 1 cm with serous fluid
  • Pustule – vesicle with purulent material
  • Nodule – mass with indistinct borders, elevates over epidermis
  • Wheal – circumscribed, flat topped, firm elevation of skin resulting from tense edema of papillary dermis
description of rashes6
Description of Rashes

PUSTULE

MACULE

NODULE

VESICLE

definitions
Definitions
  • Exanthem – a skin eruption occurring as a symptom of a general disease
  • Enanthem – eruptive lesions on the mucous membranes
classic childhood exanthems
Classic Childhood Exanthems
  • Measles (Rubeola)
  • Scarlet Fever
  • Rubella (German Measles)
  • Filatow-Dukes Disease
  • Erythem Infectiousum
  • Roseola Infantum
1 st disease measles
“1st Disease” - Measles
  • Paramyxovirus
  • At risk:
    • Preschool age children unvaccinated
    • School age children in whom vaccine failed
  • Season: late winter/spring
  • Incubation: 8-12 days
  • Infectious: 1-2 days before prodrome to 4 days after onset of rash
measles clinical features
Measles – clinical features
  • Prodrome
    • Day 7-11 after exposure
    • Fever, cough, coryza, conjunctivitis
  • Enanthem
    • Koplik’s spots appear 2 days before rash and lasts 2 days into rash
complications of measles
Complications of Measles
  • Otitis Media
  • Bronchopneumonia
  • Encephalitis
  • Pericarditis
  • Subacute sclerosing panencephalitis – late sequellae due to persistent infection of the CNS
2 nd disease scarlet fever
“2nd Disease” - Scarlet Fever
  • Due to erythrogenic exotoxin-producing group A beta-hemolytic streptococci
  • At risk:
    • <10 years old
    • Peak 4-8 years old
  • Season:
    • late fall, winter, spring
    • Likely due to close contact indoors in school
  • Incubation period: 2-4 days
  • Infectious period: during acute infection, gradually diminishes over weeks
scarlet fever clinical features
Scarlet Fever – Clinical Features
  • Abrupt onset fever, headache, vomiting, malaise, sore throat
  • Enanthem
    • Bright red oral mucosa
    • Palatal petechiae
    • Tongue changes
scarlet fever complications
Scarlet Fever - Complications
  • Purulent
    • Otitis media
    • Sinusitis
    • Peritonsillar/retropharyngeal abscesses
    • Cervical adenitis
  • Nonsuppurative sequalae
    • Rheumatic Fever
    • Acute glomerulonephritis
3 rd disease rubella
“3rd Disease” - Rubella
  • Togavirus
  • At risk: Unvaccinated adolescents
  • Season: late winter/early spring
  • Incubation: 14-21 days
  • Infectious period: 5-7 days before rash to 3 to 5 days after rash
rubella clinical features
Rubella – Clinical Features
  • Asymptomatic infection in up to 50%
  • Prodrome
    • Children: absent to mild
    • Adolescent & adult: fever, malaise, sore throat, nausea, anorexia, painful occipital LAD
  • Enanthem
    • Forschheimer’s spots  petechiae on the hard palate
rubella complications
Rubella - Complications
  • Arthralgias/arthritis in older patients
  • Peripheral neuritis, encephalitis, thrombocytopenic purpura (rare)
  • Congenital rubella syndrome
    • Infection during first trimester
    • IUGR, eye findings, deafness, cardiac defects, anemia, thrombcytopenia, skin nodules
4 th disease filatow dukes disease
“4th Disease” – Filatow Dukes Disease
  • Obsolete
  • Probably now better defined as another clinical entity
5 th disease erythema infectiosum
“5th Disease” – Erythema Infectiosum
  • Human Parvovirus B19
  • At risk: school age children
  • Season: sporadic
  • Incubation period: 4-14 days
  • Infectious period: up until onset of the rash
erythema infectiosum clinical features
Erythema Infectiosum Clinical Features
  • Over 50% of infections are asymptomatic
  • Prodrome:
    • Mild fever (15-30%)
    • Sore throat
    • Malaise
  • Adults: flu like symptoms, arthralgias/arthritis, rash in up to 40%
  • Hematological changes: proerythrocyte tropic virus – drop in RBC count
ei complications
EI: Complications
  • Immunocompromised:
    • Chronic infection with severe, persistent, relapsing and remitting anemia, prolonged viral shedding
  • Patients with decreased RBC survival time
    • Hemoglobinopathies, hemolytic disease
    • Aplastic crises
    • Prolonged viral shedding
  • Fetal infection – hydrops fetalis (1-9% risk of death)
6 th disease roseola infantum
“6th Disease” – Roseola Infantum
  • Human Herpes Virus 6 (and 7)
  • At risk: 6-36 months (peak 6-7 months)
  • Season: sporadic
  • Incubation: 9 days
  • Infectious period:
    • Virus is intermittently shed into saliva throughout life; asymptomatic persistent infection
roseola clinical features
Roseola – Clinical Features
  • High fever for 3-4 days
  • Abrupt defervescence with appearance of rash
  • Associated seizures likely due to infection of the meninges by the virus