Pediatrics [INFECTIOUS RASHES]

Introduction
Children are prone to viruses. We prevent them with vaccines, but all it
takes is one suspicious parent to say no and suddenly these kids get
disease. Can adults get these diseases too? Of course. But it’s more likely
to see these viral exanthems in children. See the Derm-Infectious
Disease Adult Rashes for more rash disease. Learn the Pattern,
Development, and Timeline of the fever + rash to nail these on the test.

Erythema Infectiosum
Caused by parvovirus B19, there’s usually a nonspecific prodrome and
low grade fever that gives rise to an erythematous rash. It’s isolated to the
face bilaterally (slapped-cheek). This disease is benign on its own in a
normal healthy baby and resolves spontaneously. If there’s increased cell
turnover (hemolysis, especially sickle cell) or decreased production
(anemia, heavy metals) this infection may precipitate an aplastic crisis.
If baby gets sick and is near mom while she’s pregnant it can cause
hydrops fetalis in the new baby. Separate mom. Adults may also have
joint pain.

Measles
Caused by Rubeola, there’s an obvious prodrome of low grade fever and
the “four hard Cs” – cough, coryza (runny nose), conjunctivitis, and
Coplik Spots (Koplik Spots are small irregular spots with white centers
on buccal mucosa). After the spots, the fever and rash start together.
The rash spreads and clears from head to toe. Later in life a potentially
lethal complication (subacute sclerosing panencephalitis) can occur.
Vitamin A may improve outcomes of measles.

Rubella
Caused by Rubella, the rash itself looks just like measles. It starts on the
face, spreads to the toes, and is likewise macular. However, during the
rash these patients do not look as sick as measles. Also, the prodrome of
tender generalized (periorbital, postauricular) lymphadenitis precedes
the rash. Since Measles and Rubella look the same they’re in the same
vaccine. Congenital Rubella: heart defects, deafness, cataracts,
developmental delay, rash.

Roseola
Caused by HHV-6, there’s a prodrome of a high-fever (> 40 °C) that
breaks as the rash starts. The rash is a macular rash that begins on
trunk and spreads to the face. Febrile seizures may result from extreme
fever during the prodrome.

Varicella
Chickenpox are caused by Varicella Zoster. A vague, nonspecific viral
prodrome indicates contagion. What follows is a wide spread rash of
vesicles on an erythematous base that are in different phases (eruption,
ulceration, crusting). Contagion ends with a final crust. Scarring and
Shingles (reactivation) can be prevented with immunization.

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 Pediatrics [INFECTIOUS RASHES]

Varicella Zoster (Shingles)

Mumps
Mumps is a little inappropriate for this section as it doesn’t cause a rash.
Instead, it causes bilateral parotid swelling and orchitis in pubertal
males. Caused by paramyxovirus. Its prodrome is nonspecific. Inducing
salivation (Pickle Test) is painful and the parotid outlets may swollen.
Can lead to infertility.

Hand-Foot-Mouth
Caused by Coxsackie A virus, it also has a vague, nonspecific prodrome
but may present with oral pain. Like varicella, it has a vesicle on an
erythematous base, but will primarily involve only the hands, feet, and
mouth (thus the name). It can also involve the buttocks.

Molluscum Contagiosum *
Caused by a poxvirus that makes flesh colored, domed papules with Human herpesvirus (HHV)
central umbilication. Likes the trunk, arms, legs and diaper area. Benign
and clears on its own but can take 1-2 years.

Scarlet Fever
Caused by Group A strep. Begins with fever, sore throat and
desquamating “sandpaper” rash that begins on trunk and spreads
outwards. Look for a strawberry tongue. Penicillin will treat, prevent
rheumatic heart, but cannot prevent post-strep glomerulonephritis. exanthematous phase
Disease Bug Prodrome Rash Other
Erythema Parvovirus B19 Vague, Nonspecific Slapped Cheek appearance Aplastic Crisis
Infectiosum then to chest Hydrops Fetalis
Measles Rubeola Cough, Coryza, Erythematous Macular Rash SSPE
Conjunctivitis with Coplik Starts Head  Toes Vaccine
Spots Clear Head  Toes
4C
Rubella Rubella Tender, Generalized Erythematous Macular Rash TORCH
Lymphadenitis Starts Head  Toes Vaccine
Clear Head  Toes
Roseola *HHV-6 High Fever Truncal Rash Spreads to Face. Febrile Seizures
Starts when the fever breaks
Varicella Varicella Zoster Vague and Nonspecific Vesicles on an erythematous Shingles
(Chickenpox) base in different stages Vaccine
(eruption, ulceration, crusting)
Varicella Zoster Varicella Zoster Pain in a dermatome Vesicles on an erythematous Ø
(Shingles) Reactivation base in a single dermatome and
Herpes zoster
respects midline
Mumps Paramyxovirus Vague and Nonspecific Parotid Swelling + Orchitis Vaccine
Pickle Test or ↑ Amylase.
Hand Foot and Coxsackie A Vague and Nonspecific Vesicles on an erythematous
Mouth Disease May have oral pain base located on the hands, feet,
and mouth
Scarlet fever Group A strep Fever, sore throat Desquamating Sandpaper rash Penicillin
Strawberry Tongue on trunk that spreads out Rheumatic fever
Glomerulonephritis
Molluscum Poxvirus None Domed papules with central Clears
Contagiosum umbilication spontaneously
MMR
Shiny

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