Rash causing diseases Flashcards
What is the classical tetrad of Henoch-Schonlein Purpura?
Purpuric rash
Kidney impairment
Abdominal pain
Arthritis
What are the 3 characteristics of Immune thrombocytopaenic purpura?
Platelets <100,000
Well child with no red flags
Otherwise normal FBE and film
What is the management of severe bleeding in ITP?
IVIG 1gm/kg
Methylprednisolone 30mg/kg
Platelet transfusion 20ml/kg
IV tranexamic acid 15mg/kg
What is the management of severe bleeding in haemophilia A?
75units/kg recombinant factor 8
DDAVP 0.3mcg/kg
IV tranexamic acid 15mg/kg or oral 25mg/kg
What is Kawasaki’s Disease?
- A medium vessel vasculitis potentially affecting any organ
-The second most common vasculitis in children (after HSP)
-The most common cause of acquired heart disease in children in high income areas - 25% of untreated cases will develop coronary artery aneurysms (CAA)
- More common in asian children but occurs worldwide
- Most common in age bracket 6months to 5yrs
Cardiac complications
- CA aneurysms, ischaemia, infarction
- carditis, effusions and tamponade
Non-cardiac
- Ileus, liver inflammation
- Pancreatitis
- Aseptic meningitis
- Facial nerve palsies
- seizures
What are the diagnostic criteria for Kawasaki’s disease?
Fever persisting for 5 days + 4/5
- Bilateral non-purulent conjuncitivis
- Symmetrical rash involving trunk and extremities (bullous or non-bullous)
- Mucosal involvement (cracked, dry, bleeding lips, strawberry tongue)
- Extremity changes (oedema, erythema, progresses to desquamating)
- Cervical lymphadenopathy (at least one node >1.5cm, usually unilateral and painful)
Mnemonic is CREAM
Conjunctivitis, Rash, oEdema, Adenopathy and Mucosal
Mnemonic CRASH
Conjunctvities, Rash, Adenopathy, Strawberry tongue, Hands and feet
What is incomplete Kawasakis?
More common in children outside the 6month to 5yr age range, actually have a higher risk of cardiac complications
Consider if prolonged fever +
- 2-3 of the typical symptoms
- aseptic meningitis
- infant with shock or unexplained irritability
- unexplained cervical lymphadenopathy
What is the treatment for Kawasakis?
2gm/Kg of IVIG at diagnosis single dose, 2nd dose considered if symptoms not resolving
3-5mg/kg of Aspirin daily for minimum 6 weeks (until normal echoes on follow up)
Corticosteroids
- Only in conjunction with specialist
- 2mg/kg PO Pred (max 60mg)
- Only for high risk patients ie Shock, cardiac involvement on presentation, <12 months, asian ethnicity, Alb <30, ALT > 100
What are the indications for steroids in HSP?
Moderate or worse abdo pain
Or
Moderate or worse joint pain
Doesn’t alter course of disease or help with the renal complications
How does Scarlet fever typically present?
“Sandpaper rash”
Fevers for several days
Sore throat
Lethargy
Cervical lymphadenppathy
What is the differential for Pupuric rash?
Meningococcal sepsis
Any sepsis with DIC
Trauma
- NAI, MVA, severe burns, coagulopathy of trauma
ITP/TTP
Acute leukaemia/lymphoma
VICC from snakebite
HSP
HUA
Coughing/vomiting if SVC distribution
How can you differentiate measles, kawasakis, scarlett fever and Chicken pox on history and type of rash?
What are the diagnostic tests for distinguishing scarlett fever, measles, chicken pox and kawasakis?
What are the complications of Kawasakis disease?
- Coronary artery aneurysms
- CHF
- AMI
- Arrhythmias
- Renal failure
- Multiorgan failure
- Sensorineural hearing loss
- Abdominal catastrophies
What are the differentials for a desquamating rash in paediatrics?
- Kawasakis disease
- SSSS
- SJS/TEN
- Other drug eruption (Pityriasiform)
- Traumatic burns (ie NAI)
- Gonococcal/Syphilis rashes
- Erysipelas
- Exfoliative dermatitis/Erythroderma
- Scarlet fever
- Desquamation post hand, foot and mouth disease
- Dermatophyte infections ie Tinea corporis
- Psoriasis (acute guttate form)
- Discoid lupus
- Seborrhoeic dermatitis
- Crusted scabies
- Cutaenous T cell lymphoma
- Dermatitis neglecta (lack of washing)
