It's that time of year. The little ones are heading to school and inevitably exposed to much larger groups of children. With this also comes a higher risk of catching...

1. Childhood Exanthems
HELP! What's this rash...
It's that time of year. The little ones are heading to school and inevitably exposed to much larger groups of children.
With this also comes a higher risk of catching a virus or bacteria. One of the most challenging to both diagnose and
treat is 'the rash', or exanthem, as commonly referred to in the healthcare field. These infections are especially
common in childhood. Viral exanthems are the most common.
Pediatric and childhood exanthems do not always fit the 'classic' picture and can often be confused for each other. That
being said, they can generally be classified based on clinical features such as distribution, time course and other factors
of physical examination.
Measles, rubella, scarlet fever, fifth disease, roseola and chicken pox are some of the more well-known and common
skin conditions that affect children and will be discussed in this article.
Measles
Measles is an extremely contagious infection that affects children and is caused by the paramyxovirus. It has become
less common in the past 50 years thanks to vaccination, however it does still have a presence. Peak times for this virus
are between late winter and early spring. Upon infection, the measles will exist in the body for 2-4 says in a prodromal
period, which means it hasn’t shown symptoms on the skin yet. During this period, symptoms include a fever, cough
and runny nose, and an infection of the inner eyelid and outermost layer of the eye called conjunctivitis (pink eye).
Grey/white/blue papules found on the bucal membrane, the inside lining of the cheeks, are called Koplik's spots and
are a tell tale sign of measles. It should be noted that not all individuals who have the measles will have Koplik's spots.
After a few days, a 'rash' will generally appear at the hairline and spread downward over the following 3-4 days. The
lesions are dark red to purple in colour and will blanch, or turn white with pressure. Symptoms peaks at at about 4
days and lesions fade over the next one to two week period. Measles are contagious from approximately 3-4 days prior
to the rash developing to about four days after the rash has cleared. Measles can affect individuals of any age.
The MMR Vaccine
The MMR vaccine is a combination vaccine developed to prevent measles, mumps and rubella (German measles). It is
generally administered to children around the 1 year mark, with a second dose administered around the time that
children begin school. The second dose was introduced in the late 1980's, as approx. 2-5% of children were not
developing immunity with just one administration. Some healthcare professionals believe vaccination is essential, given
there is a lack of effective anti-viral treatment options.
There has been some controversy about the safety of combination vaccinations in general, as well as the MMR vaccine
in particular being related to autism. Perhaps because of this, over the past few years, more and more parents are
choosing against vaccination or choosing to follow a delayed schedule.
German Measles (Rubella) tends to be less severe than 'true measles', with very similar symptoms. Rubella is
caused by the Togavirus. One of the characteristics that distinguish Rubella from many of the other infections
mentioned here is that peak incidence tends to be in adolescence. Given the MMR vaccine is so standard, incidence of
Rubella has decreased dramatically. Again, the virus is spread through respiratory secretions and patients may be
contagious anywhere from one week prior to the rash outbreak to at least one week after its resolution. Low fever and
tender cervical-occipital lymphadenopathy are both characteristic of Rubella, along with general upper respiratory tract
infection symptoms. About half the cases are asymptomatic, meaning the infection is commonly overlooked or ignored.
Rubella lesions differ slightly from that of 'true measles' in that they are pink, gradually changing to light brown
macules that do not blanch (turn white when pressed). Complications of Rubella are rare, with the most serious being
associated with pregnancy, specifically maternal-fetal transmission in the first trimester. This can cause congenital
Rubella in the fetus, potentially causing cardiac abnormalities, deafness, blindness and even fetal death.
Chicken Pox (Varicella)
Chicken pox is perhaps one of the most well-known childhood exanthems. Although most adults can recall when they
were infected as children, varicella can affect individuals of any age. In 1995, a chicken pox vaccine was introduced,
although breakthrough infections do occur in 15-20% of vaccinated individuals. Some feel it unnecessary, as childhood
chicken pox infections tend to be very mild, although the itching can get annoying to say the least. Infections in
adulthood tend to be more severe in nature. Once again, contact with respiratory secretions, as well as the lesions
themselves can spread the varicella infection. There is a mild 2 day prodrome, which is characterized by a slight fever

2. and general malaise. The prodrome often goes unnoticed. Itchy, papular lesions develop on the face and scalp, moving
to the trunk and extremities. The lesions eventually become pustular and crust before healing over. There are often
lesions at varying stages of development on one individual. All of these lesions should heal within 1-2 weeks. The
infection is contagious from prodrome through the crusting stage. Individuals can have a reactivation of a latent
infection, often occurring in adulthood. This results in herpes zoster (shingles) or a primary chicken pox infection in
some. There are few, if any, complications of primary infection, usually limited to the extent to which the individual
scratches at the lesions (scarring, hypopigmentation, etc.). Congenital varicella can be fatal or cause severe
developmental consequences, but these complications are rare.
Erythema Infectiosum (Fifth Disease, or Slapped Cheek Disease)
'Slapped cheek disease' is characterized by a red facial exanthem, usually on the cheeks. Winter and Spring months are
the most common time for children ages 4-10 years old, to contract the viral infection. Erythema Infectiosum is caused
by the Parvo B19 virus. Exposure to this virus via respiratory droplets is common and many children will develop
antibodies to the virus. Outbreaks usually begin with a highly infectious prodromal period consisting of non-specific
symptoms such as low fever, runny nose and headache. A sudden onset macular facial rash, sparing both the nasal
bridge and the area around the eyes then develops. Once the rash is visible, the infectious period is over. In some
children, when the facial exanthems fade, maculopapular lesions appear over the trunk and extremities and can last up
to 6 weeks. This rash can be itchy with a lace-like appearance to the central area. Once again, Erythema Infectiosum is
relatively harmless to the childhood population, with very few children experiencing some arthralgia, which disappears
once the infection resolves. Pregnant women do need to be cautious around infected individuals, however, as
transmission of parvo B19 from mother to fetus can cause serious consequences for the fetus, including fetal anemia,
hydrops fetalis and in some cases death. These negative outcomes are most commonly associated with infection in the
first and second trimesters.
Scarlet Fever
Children between the ages of 2 – 10 years old are at the highest risk of Scarlet Fever infection. Scarlet fever, unlike
most of the other causative agents discussed above, is caused by a bacteria called Streptococcus pyogenes. Prior to the
typical Scarlet Fever rash, children will often experience tonsillitis or sore throat, along with pharyngitis. The duration of
this prodromal stage varies from child to child, eventually all ending with a pinpoint rash that starts centrally on the
trunk (and sometimes face) before moving to the extremities. This is one characteristic that makes scarlet fever easier
to distinguish from other exanthems such as those of rubeola and rubella. Erythema is often more noticeable in skin
folds and around the neck. Another distinguishing feature is that fever and sometimes vomiting and headache
accompany the breakout, instead of being part of the prodrome. One other key feature of scarlet fever is the typical
'strawberry tongue' , red and hypertrophic papilla on the tongue of those infected. This is often obscured by a thick
white tongue coating. The rash and other symptoms begin to resolve within 5-7 days. The benefit to a bacterial
infection is that Scarlet fever can be treated with antibiotics, which help to significantly reduce the chance of sequelae,
such as rheumatic fever, acute glomerulonephritis, middle ear infection, myocarditis, mastoiditis, and pneumonia.
Roseola Infantum
Roseola Infantum affects the youngest group thus far, with peak incidence at 6-7 months of age and most commonly
occurring in children less than 36 months. The human herpes virus 6 or 7 is responsible. Again, the virus is spread
through saliva and respiratory secretions. Unlike some of the other infections mentioned here, the virus remains
dormant initially following infection, it then has the potential to reactivate when the immune system is compromised.
Roseola has no prodrome. The first presenting symptom is a sudden high fever, usually last about four days. The fever
may be accompanied by vomiting, diarrhea and some lymphadenopathy. In about 30% of the cases, a rash will erupt
once the fever has subsided. The rose coloured lesions spread outwards, starting on the trunk. The rash is transient
and may last only a few hours to a few days. Due to very high fever and the younger age of this population, Roseola
infantum can be associated with febrile seizures.
Natural Treatment Options
In terms of natural treatments, keep in mind that most of these infections simply need to run their course. That being
said, there are some anti-virals that may speed up resolution of the systemic symptoms associated with the virus, such
as headache, nausea, vomiting, fever, etc. Elderberry and Olive leaf extract, either in combination, or used separately,
both have effective anti-viral properties. They have all been shown to slow or prevent the varicella virus from
replicating. Olive leaf is also anti-bacterial, meaning it will also be effective against Scarlet Fever. Echinacea has also
been shown to be helpful in many of these infections. Aloe vera gel can be applied topically to soothe the lesions
associated with any of the above. It is healing (anti-inflammatory) and soothing, decreasing itch and speeding
resolution. Colloidal silver can also be found in spray from and can be used to treat external eruptions associated with
these viral and bacterial infections. An oat bath can also help to soothe the itch and heal lesions. Put ½ cup to 1 cup
of oats in a cheese cloth (I also use old panty hose), tie it tightly and put it right in the bath water with you, squeezing
from time to time. Make sure to keep the bath warm, but not too hot, as hot water will further dry out the skin.
Decrease intake of refined sugar and increase vegetable and fruit intake. Soups are an excellent veggie rich meal, that
also help to hydrate. This brings me to my last point, be sure to increase fluid intake and with younger children, you
may want to consider an electrolyte replacement, to prevent dehydration.
What you can do to help maintain Childhood Exanthems :
 ANTI VIRALS CAN SPEED UP THE RESOLUTION
 ALOE VERA GEL CAN BE APPLIED TOPICALLY TO SOOTHE SKIN
 VEGETABLE RICH SOUP MAKES AN EXCELLENT MEAL!
CHILDHOOD EXANTHEMS QUICK FACTS
 THE MEASLES HAVE BEEN MUCH LESS COMMON IN THE LAST 50 YEARS, BUT STILL OCCOUR
 THE MMR VACCINE PROTECTS AGAINST MEASLES, MUMPS & RUBELLA

3.  IN 1995 THE CHICKEN POX VACCINE WAS INTRODUCED
Nutritional Information
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