Pediatric Dermatology: Rash and Fever + Other Rashes

high fever, resolves, rash, herpesvirus 6, young, 7-13

Roseola Infantum: Background

-Characterized by 3-5 days of _____ ______ that ________ and is followed by a _____

-Etiology → human ___________ _ is the most common cause. Can also be caused by coxsackievirus, adenovirus, and parainfluenza virus type 1

-Epidemiology → ______ children, 90% of cases occur < 2 years old, peak incidence between __-__ months, and can occur at any time of year

fever, >, macular, neck, face, 1-2, lymphadenopathy, cough, vomiting

Roseola Infantum: Symptoms

-High _____ for 3-5 days (often _ 103 F)

-Rash after fever resolves

• Blanching, ________ or maculopapular rash that is rose-pink

• Starts on _____ and trunk and spreads to the ____ and extremities 

• Lasts __-__ days on average 

-Cervical, postauricular, and/or occipital ________________ (very common)

-Cold symptoms like _____ and rhinorrhea are possible, as are ________/diarrhea 

benign, supportive

Roseola Infantum: Diagnosis and Treatment

-Diagnosis → clinical

-Treatment → ______, self limiting disease. Provide _______ therapy like fluids and rest.

parvovirus B19, school, RBC, erythroid, benign, aplastic, anemia

Erythema Infectiosum: Background

-Etiology → human _____________ ___

-Epidemiology → ______ aged children

-Pathogenesis → affinity for ___ progenitor cells. Replicates in _______ stem cells → cell death → erythroid aplasia and anemia

-Healthy children → _______ viral exanthem

-Children with shortened erythrocyte life span → could lead to transient ________ crisis

-Immunocompromised children → could lead to severe ________

fever, malar rash, 2-5, symmetric, reticulated, 1-4

Erythema Infectiosum: Symptoms

-Prodromal period (low grade ______, malaise, headache, and myalgias)

-Erythematous _____ _____ “slapped cheek” that appears __-__ days after prodromal period

-Erythematous __________, maculopapular, truncal rash described as lacy and _____________

• Presents __-__ days after malar rash

• Lasts on average 11 days

• Can wax and wane

clinical, antibodies, without, transfusions, pregnant, hydrops

Erythema Infectiosum: Diagnosis and Treatment

-Diagnosis 

• _________ (classic presentation in immunocompetent children) 

• Atypical presentation or significant risk factors calls for Parvovirus B12 IgM and IgG __________ test and CBC

-Treatment 

• Typically resolves __________ complications 

• Supportive care 

• ____________ if aplastic crisis or severe anemia 

-Keep away from _________ women due to risk of fetal anemia and _______ fetalis 

Coxsackievirus, 5, GI

Hand Foot Mouth Disease: Background

-Etiology → _____________ or enterovirus

-Epidemiology

• Infants and children (<_ y/o most common)

• Can occur in older children and adults (rare)

• Shed through respiratory and __ tract

fever, tongue, mucosa, ulcers, red, hand, feet, macular

Hand Food Mouth Disease: Symptoms

-Low grade _____ (< 101), not always present

-Oral lesions (painful)

• _______ and buccal ________ are the most common locations

• Erythematous macules → vesicles → _______ with greyish-yellow base and ____ rim

-Skin lesions

• _____ and ______ are most common. Can also see on buttocks, upper thighs, and arms

• ______, maculopapular, vesicular, or mix

clinical, self limiting, hydration

Hand Foot Mouth Disease: Diagnosis and Treatment

-Diagnosis → _______

• If necessary, throat/stool/vesicle culture or PCR can be performed 

-Treatment → mild and ____ _________ 

• Supportive care (__________, pain relief) 

Paramyxovirus, 8-12, conjunctivitis, koplik, fever, rash, hairline, downward

Measles: Background

-Etiology → ________________

-Phases

• (1) Incubation → __-___ days from exposure to onset of symptoms

• (2) Prodromal → cough, coryza, _____________, ______ spots

• (3) Exanthematous → high _____ (104-105), macular ____ beginning on head/_________ and progresses _________ over 24 hours

• (4) Recovery

-Koplik spots → small, bluish white lesions with a red halo that appear inside the mouth, typically on the inner lining of the cheeks opposite the molars

IgM, 1-2, PCR, before, supportive, vitamin A, otitis media, 5

Measles: Diagnosis, Treatment, and Complications

-Diagnosis

• ___ antibodies that appear _-_ days after rash and last for _-_ months

• Reverse transcriptase ___ → detects measles RNA up to 5 days ______ symptoms

-Treatment

• _________ care (resolves within 7-10 days)

• High dose ________ _ in infants

• Prevent with MMR vaccine

-Complications

• _______ _______ is MC

• Pneumonia

• Myocarditis

• Encephalitis

-High risk individuals are immunocompromised and children < _ y/o

Togavirus, lymphadenopathy, maculopapular, face, body, soft palate, IgM, unborn fetuses 

Rubella (German Measles)

-Etiology → __________ family 

-Symptoms 

• Mild prodromal phase (may go unnoticed) 

• Postauricular, posterior cervical, occipital _____________

• Erythematous, _____________ rash that begins on ____ and spread to ____. Lasts about 3 days 

• Forscheimer spots → rose colored spots on ____ _______ 

-Diagnosis 

• ___ antibodies (positive 5 days after symptoms onset) 

-Treatment 

• Supportive care

• MMR vaccine for prevention 

-Complications 

• Greatest risk to ____ _________ due to congenital rubella syndrome 

Varicella zoster, fever, pruritic, trunk, head, extremities, papules, vesicles, crusts, different

Varicella: Background and Symptoms

-Etiology → ________ _______ virus

-Symptoms

• Prodromal period (_____, malaise, anorexia)

• Rash (_______) → starts on the _____, followed by ____/face then extremities

• Small red _________ → nonumbilicated, oval, “teardrop” _________ on erythematous base → ulcerates → _______ → heals

• New crop of lesions for 3-4 days (lesions in __________ stages of healing)

PCR, supportive, oral, IV

Varicella (Chickenpox): Diagnosis and Treatment

-Diagnosis → clinical, ____ is the method of choice

-Treatment

• Children < 12 y/o → _______ measures (not including neonates)

• High risk for complications (immunocompetent) → ____ antiviral

• High risk for complications (immunocompromised) → __ antiviral

-Vaccine is available

herald, clearing, thigh, torso, oval, macules, Christmas tree

Pityriasis Rosea

-Etiology → viral

-Epidemiology → peak incidence in adolescence 

-Symptoms 

• ______ patch → solitary, 2-5 cm, pink, oval patch with central _________ usually on the trunk or proximal ______

• Generalized rash → follows herald patch in 1-2 weeks, occurs on ______ and proximal extremities, 0.5-2 cm _____ to oblong ________ that are red or tan with fine scale 

• “__________ ______ pattern”

-Treatment → benign, self limited 

sebum, Malassezia, scalp, eyebrows, cradle cap, first, 1, thick, crusting

Seborrheic Dermatitis: Background and Infant Presentation

-Common, chronic inflammatory disease accompanied by overproduction of _____

-Pathogenesis

• Unknown but thought to be an abnormal inflammatory response to _________ species in sebum rich areas

• Common areas affected are _____, _________, eyelids, nasolabial folds, external auditory canal, and posterior auricular folds

-Infants (______ ___)

• Begins during ______ month of life

• Resolves around _ year

• Most often on vertex of scalp

• ______, greasy/waxy, yellow-white scaling and __________ of scalp

• Asymptomatic

dandruff, scaling, oil, ketoconazole, shampoo

Seborrheic Dermatitis: Presentation, Diagnosis, Treatment

-Adolescents (________)

• Scalp most often affected

• Fine, white, dry ________ of the scalp

• May have minor itching

-Diagnosis → clinical

-Treatment

• Frequent shampooing can help remove scale

• Cradle cap → can apply ____ (mineral or olive), allow to sit for a few minutes then gently brush and shampoo

• Adolescents → ____________, selenium sulfate, or salicylic acid _________

pruritic, stress, allergens, early, 5

Eczema/Atopic Dermatitis: Background

-Chronic, _________, relapsing inflammatory skin condition

-Pathogenesis

• Genetics, immunologic abnormalities, impaired skin barrier function, and environmental interactions 

-Triggers 

• _____/anxiety, climate, irritants/_________, and sweating 

-Epidemiology 

• Often starts in ______ infancy, most cases before _ y/o

erythematous, ill, scale, allergic, face, extremities, antecubital, neck

Eczema/Atopic Dermatitis: Symptoms

-Symptoms

• ____________ papules/plaques with ____-defined borders and overlying _____ or hyperkeratosis

• Pruritic

• May weep

• Skin fissures

• Excoriations

-Tend to have other _______ diseases like asthma and allergic rhinitis

-Location of Rash

• Infants → _____, scalp, extensor surfaces of ___________

• Older children → __________ and popliteal fossae, head, ____

hydration, corticosteroid, tacrolimus, triggers

Eczema/Atopic Dermatitis: Treatment

-Skin ____________ → fragrance free ointment or cream, avoid lotions

-Decrease itching/inflammation/flares → ____________ ointment with the lowest potency effective

-Immunomodulating topicals (________) → second line in patients unresponsive to other treatments

-Avoid ________