Rash Flashcards

Question

Rubella (German Measles) Management?

Answer 1

School exclusion – 5 days from onset of rash Check pregnant contacts Symptomatic & supportive management Diagnosis - Serology

Answer 2

Firm, pearly dome-shaped lesions Central umbilication May last months

Answer 3

Eczema may develop in surrounding skin – usually this prompts presentation Eczema can obliterate the primary lesions Can become secondarily infected (bacterial)

Answer 4

Education – very common, caused by a virus, benign, they may develop a few or more and they can last months (will not resolve until full immune system developed) – Don’t share towels but no other restrictions Treatment of surrounding eczema Uncomplicated lesions should be left alone Bothersome, isolate lesions – cryotherapy Larger areas – immune stimulation agents, 5% benzyl peroxide

Answer 5

Polymorphus rash 1. Measles like (red, blotchy, raised) 2. Maculopapular 3. Generalised erythema 4. Target-like Desquamation may occur later

Answer 6

Predominantly affects <5 years More common in boys Diagnosis often delayed as presentation similar to many other viral Exanthems Complications – coronary artery dilation or aneurysm formation Clinical features can occur sequentially or may not be all present at the same time – infants less than 12 mths often have incomplete symptoms to meet diagnosis Clinical diagnosis Fever > 5 days AND 4/5: polymorphous rash, bilateral conjunctivitis, mucus membrane changes, peripheral changes or cervical LAD Fever – needs to last at least 5 days for diagnosis Head & Neck Bilateral ‘dry’ conjunctivitis – no exudate (differentiates from other viral causes) Mucus membrane changes - strawberry tongue, dry cracked lips, redness of oropharyngeal mucosa Cervical LAD – usually unilateral, single, painful Peripheries Non-pitting, uncomfortable oedema in feet and hands – reluctance to walk Arthralgia in hip and knee Palmar erythema – no pattern to redness, may be fluctuate in intensity Erythema of soles

Answer 7

Exclude other DDx – staphylococcal infection (scaled skin syndrome, TSS), streptococcal (scarlet fever), measles, Steven’s Johnson syndrome, drug reaction, rheumatoid/juvenile arthritis Investigations – all patients must have: a. ASOT/Anti-DNAase B – exclude strep infection b. Platelet count – marked thrombocytosis in 2nd week of illness c. ECHO – at least 2; one initially and at 6-8weeks later 3. IV immunoglobulin – preferably within 10days of illness 4. Aspirin daily for 6-8 weeks

Answer 8

Petechial and purpuric rash Non-blanching Late sign – can appear 12-36 hrs later)

Answer 9

Peak < 2 years and adolescence Preceding viral infection or a blanching rash does not exclude meningococcal disease Sudden onset of symptoms; often deteriorate rapidly General viral type – fever, malaise, arthralgia, myalgia, headache, vomiting Lethargy, reduced conscious state Suggestive of meningococcal disease - Leg pain - Confusion - Photophobia – late sign > 12 hrs - Neck pain/stiffness – late sign > 12 hrs May present with signs of shock May present with pneumonia, URTI or occult bacteraemia

Answer 10

Commence empirical IV antibiotics as soon as meningococcal disease suspected a. Ceftriaxone or Cefotaxime b. Penicillin if cephalosporin’s unavailable c. IM can be used if IV access can’t be obtained within 15 minutes Dexamethasone ABCD a. Fluid bolus – careful with fluids if suspect meningitis as often increased ADH secretion Blood cultures Other investigations within first hour a. Meningococcal PCR if blood cultures obtained after antibiotic administration b. FBE c. U&Es d. Glucose e. Coagulation screen – if appropriate (DIC complication) f. LP – usually not in acute management, consider if suspect meningitis Infection control a. Contact precautions b. Treatment of contacts

Answer 11

Infection of the epidermis Causes GABHS, S. aureus Lesions are rounded, well demarcated and are grouped & asymmetrical Areas of ooze + crusts Commonly on face, trunk or limbs Can be bullous lesions Painless Progressive – rapidly spread/increase

Answer 12

Highly contagious Common particularly in young children and in hotter months Clear up in a few days, but may need to be treated again May be associated with fever If strep – monitor for post-strep glomerulonephritis

Answer 13

Localised, uncomplicated a. Wash crusts off b. Saline baths – dry lesions c. Topical mupirocin 2% ointment Extensive a. Swabs - MCS b. May require antibiotics flucloxacillin or cephalexin Infection precaution a. Excluded from school until treatment is started and the sores are completely covered with watertight dressing

Answer 14

Diffuse red flushing Torso and skin folds Blanching Circumoral pallor (pale around mouth) ‘Sand-paper’ like feel

Answer 15

Peak age = 5 – 10 yrs; extremely uncommon <5yrs Prodrome – sudden onset high fever +/- headache, abdo pain, vomiting, malaise +/- strawberry tongue (initially may be white) Cervical + submandibular LAD Pharyngo-tonsillitis – usually starts as this Rash appears within ~2hrs of prodrome Complications – Post-strep GN, quinsy, acute rheumatic fever

Answer 16

1. Clinical diagnosis may be confirmed with: a. Throat swab – less useful as many school-aged children are normal carriers b. ASOT + anti-DNAase B more specific 2. Penicillin

Answer 17

Widespread blistering rash caused by toxin Distribution – umbilicus (neonates), nose, nasopharynx or throat, conjunctiva Starts with macular erythema initially on face & major flexures – becomes more generalised Flaccid bullae develop 2 days later, skin wrinkles and shears off – most marked in groin, neck fold Mucosae uninvolved Skin is exquisitely tender

Answer 18

Primarily affects neonates and young children Usually febrile Fluid loss rarely significant Heal over 4-8 days with no sequelae

Answer 19

1. Cultures a. Obvious sites of infection or nasopharynx and throat 2. Supportive a. Nursed naked on non-stick material with minimal handling b. Avoid topical agents in early stages c. Analgesia 3. Flucloxacillin is treatment of choice a. Emollients once skin dries and desquamation commences

Answer 20

Appears 3-4 days later Red, blotchy, raised Starts in hairline and moves down the body Becomes confluent and later may become desquamate – the more confluent, the more severe Lasts 4-7 days

Answer 21

Prodrome – Fever, coryza, conjunctivitis, Koplick spots – white spots on red buccal mucosa Infectious from 2 days before illness to 5-days after rash onset

Answer 22

Diagnosis – serology (IgM positive after rash), PCR (nasopharyngeal aspirate) Symptomatic & supportive Rx Consider Vitamin A supplement in immunocompromised and young infants with severe disease Complications – otitis media, pneumonia, encephalitis & sclerosing panencephalitis Can be fatal (bacterial complications most commonly)

Answer 23

Pruritic elevated skin lesions, surrounded by erythematous base (wheal) Due to extravasation of plasma into dermis May be local or generalised Well circumscribed but often coalesce May see excoriation Vary in size Transience of indivudal lesions

Answer 24

Common condition May be idiopathic or associated with preceding cause Possible causes – medications, infections, foods (infrequently), bites/stings, physical (pressure, cold, exercise) Observe for dyspnoea or dysphagia in first few hours (anaphylaxis) Most common DDx = erythema multiforme – not itchy, not transient, target lesions, often mucosal involvement

Answer 25

1. Remove identifiable causes if any 2. Cool compress 3. Education – explanation, information, reassurance 4. Anti-histamines – itching a. Promethazine (Phenergan) if >2 yrs b. Cetirizine (Zyrtec) if >1 yr c. Steroid creams and diet manipulation not indicated/effective

Answer 26

Rash Dry, itchy, inflammatory chronic skin disease Remitting, relapsing course

Answer 27

Typically begins in childhood Affects ~30% children Onset usually before 12 months Most ‘grow out of it’ before age 5

Answer 28

1. Itch 2. AND 3 or more of: a. Hx of involvement in skin creases b. Personal hx of asthma or hayfever c. Hx dry skin in last year d. Onset < 3 yrs e. Visible flexural eczema

Answer 29

1. Education a. Triggers b. Avoid irritants i.e. soaps, overheating, pets, prickly/woolly clothing 2. Moisturiser a. Prevent dryness of skin 3. Daily cool bath 4. Control itch a. Distract child if scratching 5. Consider Vitamin D supplement

Answer 30

Used if acute deterioration (flare) increased erythema and itch 1. Topical steroids a. Hydrocortisone 1% 2. Tar creams (lichenification) 3. If secondary infection a. Antibiotics or antivirals b. Cool bath with added salt, 4% bleach and bath oil 4. Wet dressings 5. Cold compressing relief of itch 6. Consider referrals a. Eczema workshop b. Allergy testing and advice Outpatient clinic