Rashes

Question 1

Immunisation schedule

Answer 1

UK Health Security Agency

-8 weeks

Question 2

Erythema Marginatum

Answer 2

-10% kids; rare adults
-Trunk, UL and LL not face
-Flat rash, spreads circular fashion, centre fades. Irregular border
-Non itchy
-Last hours/ weeks/ months

-Group A strep
-Polyarthritis, carditis, Sydenham chorea
-Subcut nodules

-Short incubation

-Clinical diagnosis: cultures, ASOT (titre of antibody against strep), cardiological tests

-Treatment: penicillin (10 days)/ co-amoxiclav less frequently in liquid

Question 3

M(ongolian) Blue Spots

Answer 3

-Dermal melanocytosis (can be congenital)
-Looks like ecchymoses/ bruise, fade by adolescence, irregular, flat, normal texture usually 2-8cm
-Less common in paler skins
-Base of buttock

-Document them in health record

Question 4

Mottled skin/ cutis mamrorata

Answer 4

-Alternating constricted and dilated blood vessels, common
?

Question 5

Erythema multiforme

Answer 5

-Hypersensitivity
-Target lesion; mucous membrane involvement
-peripheral then spread centrally within 24 hours
-Centre of rash darkens; itchy
-Evolve over 72 hours; polymorphous
-Kobner phenomenon
-No swelling of face mucosal lesions after few days

-Fever child, painful joints
-HS: 2-14 days before. Mycoplasma, VZ, HIV

Question 6

SJS and toxic epidermal necrolysis

Answer 6

-Prpbably variants of same condition
-Rare, acute, serious and poetntially fatal
-Skin and mucosal loss
-Vast majority caused by medicine
-SJSl: 1-2/million per year: TEN 0.4-1.2/million

Question 7

Causes

Answer 7

-Antibiotics

Question 8

Presentation of TEN

Answer 8

-Prodrome
=Fever, high, constant
=Cough, sore throat
=Runny nose, diff swallowing
=Aches and pains

-Rash
=Abrupt onset trunk face and limbs, macules red or purple, targets in EM, blisters merge to sheets which detach exposing leaking dermis

Question 9

Diagnosis of SJS vs TEN

Answer 9

SJS:
-Skin detachment <10% BSA
=Erythema

Question 10

Management of TEN

Answer 10

-Stop using drug ASAP
-Treat like burns patient
-Meticulous control of temperature, fluid and nutrition
-Pain relief
-Skin care )antisepctics, leave blisters, dressings)
-Urinary catheter
-Physio
-Eye: daily opthalamost assessment

Question 11

Erythema nodosum

Answer 11

-Red lumps LL>UL, 6:1 women, hot red tender turns purple 2nd week
-Erupt for 10 days

-Joint aches (knees) last months
-Fever, unwell at time of rash
-Conjunctivitis

-Often preceded by sore throat 7-14 days before
-Infections: strep viral

Question 12

Erythema infectiosum: Parvovirus B19

Answer 12

-Facial +/- circumoral pallor
-Macular papular lace like on trunk, itchy
-Moves to limbs

-Fever, headache, malaise

Question 13

Hand Foot and Mouth disease

Answer 13

-Macules, papules- turn to grey vesicles surrounded by red halo; resolve spontaneously 7-10 daus; n scarring

-Oral lesions anyway hard palate)
-Papules and vesicles and ulcers; heal 5-10 days
-Skin lesions alongside or after

-2-5 days oral/ direct contact

Question 14

HSV

Answer 14

-1: gingivostomatitis, oral ulceration vesicles
-2: genital (usually)
-2-14 days incubation
-Culture, PCR diagnosis
-Aciclovir, valaciclovir treatment
-Latent for life, conjunctivitis, men, enceph, CN palsies
-No immunisation, beware if HSV infants (SEM)

Question 15

Larva migrans

Answer 15

-Anyone, at site of larvae penetration tingling: can lie dormant for months or progress. Creeping, itchy rash feet, knees, buttocks
-Parasite eggs in faeces of animals- soil- few days to few months

Question 16

Scabies

Answer 16

-Red, itchy bumps, limbs, trunk
-Nodules (may persist for months)
-Acropustulosis in infants

Question 17

Tinea Corporis

Answer 17

-Face, trunk or limbs; well demarcated with scaly, vesicular or pustular border
-Itch, may be hypersensitivity to fungus
-Unknown incubation

Question 18

Measles

Answer 18

?

Question 19

Chicken pox