Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Paediatric rashes

202 views

Published on

Paediatric rashes

Published in: Health & Medicine
  • New E-book Reveals Unique Holistic Strategies to Cure candida. Discover How To Quickly And Easily Cure yeast infection Permanently...Even If Everything Else You Tried had Failed...Without Drugs, Without Over The Counters, and Without Nasty Side Effects � Guaranteed! ♣♣♣ https://tinyurl.com/y4uu6uch
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • About 2 years ago, I developed a severe case of vaginal yeast infection that would not let up. The itching, burning and swelling of my labia were simply unbearable. I have purchased several over-the-counter treatments, including Monistat cream to subside the symptoms. While it worked initially, eventually things wore off and left me with an even worse infection than before. The same goes for the antibiotics I took with the advice of my doctor. I felt horrible. After doing some research online, I guessed I had a yeast infection and purchased your program. The results were almost instantaneous. In less than 7 hours, I felt a tremendous relief. Two weeks later and I became completely free from the unbearable vaginal itching, burning, swelling and discharge. Using your methods, I have kept my chronic yeast infection at bay ever since. No more drugs or OTC�s for me. ♥♥♥ http://ishbv.com/index7/pdf
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • About 2 years ago, I developed a severe case of vaginal yeast infection that would not let up. The itching, burning and swelling of my labia were simply unbearable. I have purchased several over-the-counter treatments, including Monistat cream to subside the symptoms. While it worked initially, eventually things wore off and left me with an even worse infection than before. The same goes for the antibiotics I took with the advice of my doctor. I felt horrible. After doing some research online, I guessed I had a yeast infection and purchased your program. The results were almost instantaneous. In less than 7 hours, I felt a tremendous relief. Two weeks later and I became completely free from the unbearable vaginal itching, burning, swelling and discharge. Using your methods, I have kept my chronic yeast infection at bay ever since. No more drugs or OTC�s for me. ▲▲▲ http://scamcb.com/index7/pdf
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • I am so thankful and thrilled to know that someone had found a solution to such a disturbing problem in this country! There are too many women and men that are suffering from this horrendous disease! Before I ordered your program, I used to itch and scratch constantly sometimes all night long. Above all the annoyance it was very embarrassing, especially at work. Since I started your system, I don't use drugs or creams anymore to bring me through the nightmare of yeast infections that was my reality for too long! The constant itching and rashes that sometimes continued for mouths are completely gone. Additionally, the lack of energy and heartburn which I now know were caused by candida overgrowth have also disappeared in a matter of weeks. I feel so rejuvenated and lucky to have found your system. I am also amazed and thankful that your product worked so fast and well. ★★★ http://scamcb.com/index7/pdf
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Great book! I'm on the second week and seeing definite improvement on my yeast infection symptoms. I must also note that the texture of my skin became very soft and consistent. I completely agree with many of your arguments in the book especially those about conventional methods for treating Yeast Infection. I wanted to let you know that I feel so fine you have no idea. I am not so tired all the time and I feel very energetic. The rashes on my neck and on the right side of my nose have also cleared up. I wish you all the health and happiness in the world and thanks so much for helping me. I really appreciate your time and efforts to assist me. ◆◆◆ http://scamcb.com/index7/pdf
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Paediatric rashes

  1. 1. Paediatric Rashes Dan Pixley 2018
  2. 2.  How to describe a rash  Recognise the visual diagnoses for paediatric rash presentations  Patterns, distribution, special features  Broaden differentials for rash and identify the commonly misdiagnosed presentations  Treatments for rash  Recognise the critical rash Objectives
  3. 3. Anatomy Epidermis - Protective barrier - melanin and immune Dermis - sweat: - Nerves - Sebaceous: - blood vessels Hypodermis (Subcut fat) - Attaching the dermis to your muscles and bones: - blood vessels and nerve cells: - Controlling your body temperature: - Storing your fat
  4. 4.  Macule –  Circumscribed are of change <1cm  Patch –  Large area of skin change  Papule –  solid raised lesion <1cm  Nodule –  solid raised lesion >1cm  Plaque –  circumscribed confluent area of nodules  Vesicle –  fluid filled are <1cm  Bulla –  fluid filled area >1cm  Pustule –  circumscribed area containing pus  Furuncle –  skin abscess (usually from staph)  Carbuncle –  collection of furuncles connected Describing a rash
  5. 5.  Viral  Bacterial  Fungi  Drug Reactions  Allergic  Autoimmune  mites Aetiologies
  6. 6.  4 year old child brought in by parents. Itching vigorously. Common Rashes
  7. 7.  Highly contagious skin infestation by the mite Sarcoptes scabiei  itchiness and a pimple-like rash  1st infection: symptoms in between two and six weeks  Second infection: Sxs develop in 24 hours  Symptoms secondary to an allergic reaction (Type IV)  zigzag or S pattern of the burrow will appear across the skin  Rx: Permethrin 1. Scabies
  8. 8. 2. ACNEPropionibacterium acnes
  9. 9. 2. Acne Comedomes Pustules, nodules
  10. 10. 2. Acne
  11. 11. Common Rashes 3. Contact Dermatitis
  12. 12.  Irritant dermatitis  Allergic Dermatitis  Treat with removal of exposure, protective barrier and/or steroids 3. Contact Dermatitis
  13. 13. 4. Atopic Dermatitis (Eczema)
  14. 14.  Infant  4months to 5 years  Cheeks  Extensor surfaces  Diaper area 4. Atopic Dermatitis (Eczema)  3 year old - adult  Flexor surfaces  Neck  Face  Upper chest Rx: steroids and moisturisers Cotton clothing Dry well after bathing Antibiotics for superimposed infection
  15. 15. Common Rashes 5. Impetigo
  16. 16.  Staphylococcus aureus or Streptococcus pyogenes  Highly contagious  Treated with mupirocin ointment or POABs  E.g Flucloxacillin  Isolate from day care  Occasionally admit  Risk of leading to Osteomyeltisis and PSGN 5. Impetigo
  17. 17. Tinea
  18. 18. Tinea Tineas Capitis Tinea Versicolour
  19. 19.  Treatment  Corporis: Topical antifungals e.g Clotrimazole, Terbnafine  Versioclour: Topical antifungals plus Selenium sulfide shampoo  Capitis: Griseofulvin for 6 weeks plus Selenium shampoo Tinea
  20. 20. Non specific Viral Rash (exanthomata)
  21. 21.  The majority of Exanthems are nonspecific and difficult to categorise  Associated with non specific sxs like headache, lethargy, mayalgia and GI complaints  Most resolve in less than a week  Cause  Thought to be from enteroviruses and adenovirus/rhinovirus/parainfluenza Non specific Viral Rash (exanthomata)
  22. 22.  First Disease  Measles  Second Disease  Scarlet Fever  Third Disease  Rubella  Fourth Disease  Dukes -Controversial (possibly a misdiagnosis)  Fifth Disease  Erythema Infectiosum (Parvovirus B19)  Sixth Disease  Roseola (HHV6) Specific Exanthems
  23. 23. Exanthems First Disease -Measles
  24. 24.  Incubation: 7-14 d  Prodrome: 4 -5 d before rash fever, malaise, rhinorrohea, cough, Koplik spots 1-3 d before rash  Rash: day 4-7 of illness starts behind ears, forehead, around mouth dusky red, florid maculopapular rash spreads over trunk and limbs. Lasts 5 d.  Infectivity: prodrome to 4 d after the rash  Transmission: respiratory droplet or direct contact  Complications: ears & OM, lungs & pneumonia conjunctivitis CNS encephalitis at d 10, SSPE after several years Measles
  25. 25. Exanthems Rubella – 3rd Disease
  26. 26.  Also called German Measels  often mild with half of people not realizing that they are infected  A rash may start around two weeks after exposure and last for three days  starts on the face and spreads to the rest of the body  Infection during early pregnancy (below 20 weeks) may result in a child born with congenital rubella syndrome (CRS) or miscarriage.  Once recovered, people are immune to future infections.  Vaccine preventable Rubella
  27. 27. Exanthems Scarlett Fever 2nd disease Pastia’s lines
  28. 28.  Can occur as a result of a group A streptococcus (group A strep) infection  It most commonly affects children between five and 15 years of age  Complications:  Suppurative: peritonsillar or retropharyngeal abscesses, cellulitis, mastoiditis or sinusitis  Non-suppurative: Rheumatic fever, RHD, PSGN, Reactive Arthritis Scarlett fever
  29. 29. Exanthems 5th Disease – Parvovirus B19
  30. 30. Roseola (6th disease) - 3 year old child presents with 3 day history of fevers, cough and runny nose - Fevers stopped yesterday but suddenly patient woke up with this rash.
  31. 31. Emergent Rashes Pyotr Nikolsky (1858–1940)
  32. 32. Erythema Multiforme
  33. 33. Immune dysfunction  Causes: Viral (HSV)  Drugs  antibiotics (including, sulphonamides, penicillin)  anticonvulsants (phenytoin, barbiturates)  aspirin, antituberculoids, and allopurinol and many others.  Infections: Viral (HSV), bacterail and fungal  Other: Mutliple myeoloma, Lymphoma, Vasculitis Erythema Multiforme
  34. 34. SJS/TEN
  35. 35.  Spectrum of disease  Widespread blisters predominant on the trunk and face, mucous membrane erosions;  SJS: epidermal detachment is less than 10% TBSA  TEN: epidermal detachment is more than 30% TBSA  Cross over between 10-30% SJS/TENS
  36. 36.  Often start with fever, sore throat, cough, and burning eyes for 1 to 3 days  Type IV hypersensitivity reaction – secondary to immune system being triggered by drugs/infections  Ulcers and other lesions begin to appear in the mucous membranes  - almost always in the mouth and lips, but also in the genital and anal regions.  Problems eating and drinking due to pain of ulcers  Conjunctivitis occurs in about 30%  Rash of round small lesions arise on the face, trunk, arms and legs, but usually not the scalp SJS/TENS
  37. 37.  Mortality rate:  5% for SJS  30-40% for TENS  Treatment  discontinuation of the causative factor – most important  Move to a burns unit  Supportive cares and IVH  IV anti-biotics  Immunomodulatory: steroids, cyclophosphamide, plasmapheresis, acetylcysteine, infliximab SJS/TENS
  38. 38. Meningitis
  39. 39.  Characterizing Viral Exanthems – Medscape  Nguyen T, Freedman J. Dermatologic emergencies: diagnosing and managing life- threatening rashes. Emerg Med Pract. 2002;4(9):1-28.  Emergent Diagnoisis of the unknown rash. Jounral Emergency Medicine 2010. Heather Murphy-Lavoie, MD, FAAEM, andTracy Leigh LeGros, MD, PhD, FACEP, FAAEM  Morens DM, Katz AR. The "fourth disease" of childhood: reevaluation of a nonexistent disease. Am J Epidemiol. 1991 Sep 15;134(6):628-40.  Powell KR. Filatow-Dukes' disease. Epidermolytic toxin-producing staphylococci as the etiologic agent of the fourth childhood exanthem. Am J Dis Child. 1979 Jan;133(1):88- 91.  3Weisse ME. The fourth disease, 1900-2000. Lancet. 2001 Jan 27;357(9252):299-301.  Maverakis, Emanual; Wang, Elizabeth A.; Shinkai, Kanade; Mahasirimongkol, Surakameth; Margolis, David J.; Avigan, Mark; Chung, Wen-Hung; Goldman, Jennifer; Grenade, Lois La. "Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Standard Reporting and Evaluation Guidelines" JAMA Dermatology. doi:10.1001/jamadermatol.2017.0160. References

×