Rash

Question 1

The rash in an allergy will be… c.f. Eczema?

Answer 1

allergy - bumpy and itchy, may come and go. eczema - also itchy but will come with a longer history, and be associated with dry skin.

Question 2

T/F: In many cases there is simply a new rash with no obvious cause in a well child.

Answer 2

true

Question 3

The specific questions you need to ask for a rash if it is not from an obvious cause such as allergy?

Answer 3

• fever?
• irritable or lethargic?
• eating and drinking?
• Any other symptoms?

Plenty of open questions and allow the parents to talk

Question 4

The sort of things that might be picked up on Hx include cough and sore eyes in (1) or red eyes in (2) disease, abdominal pain in (3), a recent burn in (4), bleeding gums or nosebleeds and lethargy in (5)

Joint pains occur with a rash in several conditions, which include…(6)

Answer 4

1. measles
2. Kawasaki
3. Henoch-Schonlein Purpura
4. toxic shock syndrome
5. leukaemia
6. Meningococcal septicaemia, Henoch Schonlein purpura, juvenile onset arthritis and leukaemia.

Question 5

T/F: Headache and photophobia are key symptoms for diagnosing meningitis in a child under 5

Answer 5

false - not common complaints until a child is 6/ 7

Vomiting or seizures may be signs of meningitis. They won’t say they have a HA, but may be irritable/ inconsolable/ have an unusual cry.

In meningococcal septicaemia rigors or joint pains may occur before the rash and cardiovascular collapse a few hours later.

Question 6

There are 2 parts to the examination of a child with a rash

Answer 6

1. The first is a general assessment of how the child is;
2. look at the rash itself.

Question 7

Around 30% of children with meningococcal septicaemia have what kind of rash to begin with? (before the classic rash appears)

Answer 7

a blanching, erythematous rash

Question 8

What is thie describing: ‘usually innnocent and is the commonest type of mild viral rash’

Answer 8

Erythema (simply means redness)

Question 9

what is this describing: transient rash in babies < 1 week old and tends to have raised, blotchy areas.

Answer 9

erythema toxicum neonatorum

Question 10

macular vs papular rash?

Answer 10

• macular rash: splotchy and under the skin, so you can’t feel it
• papular rash: also splotchy with raised areas.

The two often happen together and are often described as maculo-papular. This happens in mild viral rashes, in rubella, measles, and also in Kawasaki’s disease.

Question 11

Vesicles are little blisters. Seen in what sort of conditions?

Answer 11

Chickenpox, Herpes simplex and shingles.

If the blisters are pus filled it may be a Streptococcus or Staphylococcus infection.

Question 12

Petechiae vs purpura?

Answer 12

• Petechiae: little pink/ purple dots ≤1mm, flat
• Purpura: purple areas ≥2mm, mean that blood has leaked from the vessels.

Question 13

what causes the characteristic rash in Meningococcal septicaemia? (a severe bacterial infection)

Answer 13

Neisseria meningitidis secretes a toxin which causes damage to blood vessels > blood leaks out into the skin > characteristic rash which doesn’t blanch when pressed

Looks more like a bruise than pinkness of the skin.

Question 14

• inflamed-looking, itchy, bumpy rash, usually all over the body.
• caused by allergy, and may occur in anaphylaxis.
• can come up and go back down quite quickly, and seem to affect different areas of the body within an hour or two.

Answer 14

urticaria

Question 15

a common skin condition which often runs in families and causes dry, itchy skin.

Answer 15

Eczema

(similar reaction can occur as an allergy - allergic dermatitis)

Question 16

eczema in younger vs older children?

Answer 16

• older children: will see scratch marks, and the ezcema is usually around the neck, elbows, knees, armpits and face. It can look quite inflamed, and secondary bacterial infection sometimes occurs, which tends to make it weepy with scabs.
• younger children: skin appears dry and bumpy with prominent follicles, and the appearance is more generalised.

Question 17

What is this describing: a variation of eczema, bumpy and usually happens on dry skin. Babies with this condition may have a flaky scalp condition called cradle cap.

Answer 17

seborrhoeic dermatitis.

Question 18

The bacterium ___ ___ is carried in the nose of a lot of people, but in some people it spreads through the bloods stream, leading to meningitis or meningococcal septicaemia

Answer 18

Neisseria meningitidis

Question 19

Meningococcal septicaemia is most common in what age groups?

Answer 19

<2 and 16-21

presents like any serious bacterial infection, although may cause joint pain. The rash can be non-specific, or petechial or purpuric.

Question 20

what is this describing: a disease which causes a rash and also affects the mouth and other mucous membranes.

Answer 20

Stevens-Johnson syndrome

Question 21

Characterstic rash in SJS?

Answer 21

very characteristic appearance of circles called target lesions. (red target with a pale centre)

Question 22

Cases of SJS where there is just the rash and no mucous membrane involvement are called what?

Answer 22

erythema multiforme. Children tend to be miserable, and often need hospital admission if they can’t drink. The disease may become quite severe.

Question 23

Toxic shock syndrome is caused by what?

Answer 23

• by a toxin secreting bacteria, either Streptococcus or sometimes Staphylococcus.
• may occur 2-3 days after a minor burn (burn itself tends to look normal, but the child has a fever, diarrhoea, appears unwell and has an erythematous rash).
• Can become unwell quickly, needs Abx as soon as the diagnosis is suspected

Question 24

what is this describing: a disease of childhood, most common in the under 2’s, which has serious complications involving the heart and coronary arteries.

Answer 24

Kawasaki disease

(With the right drug treatment, started early, these serious problems can be prevented)

Question 25

features of kawasaki disease?

Answer 25

rash usually maculo-papular.

Question 26

an immune disease which causes bleeding into the skin.

Answer 26

Henoch Schonlein purpura

Question 27

HSP vs meningococcal septicaemia?

Answer 27

causes a similar rash however in HSP the child is generally well, so your physiological assessment of the child will be normal.

Question 28

HSP typical distribution of the rash?

Answer 28

tends to be worst on the backs of the legs and the buttocks.

Question 29

Other features of HSP?

Answer 29

• Bleeing also occurs in the wall of the intestine, which causes pain, and can even cause intussusception.
• Bleeding can occur in the joints and cause quite severe joint pain.
• Kidney disease

Question 30

why is it important to diagnose HSP early?

Question 31

Anaphylaxis means a severe allergic reaction. What does the skin reaction tend to be?

Answer 31

widespread erythema and itchy flushing/ urticaria/ both

Question 32

Potential dangers of anaphylaxis?

Answer 32

• can affect the airway, in terms of lip or throat swelling
• can affect breathing by causing bronchospasm
• can affect circulation by causing peripheral vasodilation and hypotension
• can affect the gut, with diarrhoea

Question 33

In anaphalaxis if only the skin is affected > no cause for alarm. If it affects A, B or C are affected however, what treatment is needed?

Answer 33

urgent treatment with IM adrenaline can work within minutes and save lives.

Question 34

What is idiopathic thrombocytopaenic purpura (ITP)? Signs?

Answer 34

• an immune disease which affects the platelets and therefore the blood clotting
• causes petechiae in the skin. The child will be completely well other than the rash.

It is important to diagnose it with a full blood count and refer the child to a paediatrician, in case they need treatment with steroids.

Question 35

What kind of skin lesions can leukaemia sometimes present with?

Answer 35

petechiae or purpura. The child will usually appear clinically anaemic. In all children with petechiae it is important to do a full blood count, so you don’t miss leukaemia or ITP, one of the other red flag conditions.

Question 36

Petechiae vs purpura?

Answer 36

Petechiae: pink/ purple dots ≤1mm and flat.

Purpura: purple areas ≥2mm. Mean that blood has leaked from the vessels.

Question 37

What causes the rash in Meningococcal septicaemia?

Answer 37

Neisseria meningitidis secretes a toxin which causes damage to blood vessels > blood leaks out into the skin causing characteristic non-blanching rash

Appears more like a bruise than pinkness of the skin.