This document provides information on different types of rashes in children and when parents should be concerned. It discusses common rashes like ringworm, fifth disease, chickenpox, impetigo, and warts. It also covers conditions such as contact dermatitis, hand-foot-mouth disease, eczema, hives, scarlet fever, roseola, rubella, Lyme disease, and diaper rash. The document emphasizes that while some rashes are minor, others can be life-threatening, so parents should see a doctor if concerned.

1. Rashes when to worry-----------?
D. TAREK SAYED
pediatric departement
MCH Buraydah
Rashes
When
To worry
Dr.Tarek Kotb
MCH
Buraydah

2. 
The differential diagnosis for febrile patients
with a rash is extensive.
The differential diagnosis for patient with rash is extensive

3. Rashes
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Macule: nonpalpable, circumscribed, flat lesion (<1 cm in diameter)
Papule: palpable , elevated lesion (<1 cm in diameter)
Maculopapular: combination of macular and popular lesions
Purpura: non-blanching papules or macules due to extravasation of RBCs
Vesicle: fluid-filled, elevated skin lesion (<1 cm in diameter)
Bulla: fluid-filled, elevated skin lesion (>1 cm in diameter)
Pustule: pus-containing vesicle
Ulcer: depressed skin lesion with missing epidermis and upper layer of
dermis

4. causes
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viruses
bacteria
infectious
Spirochetes
rickettsiae
Medications
rheumatologic diseases
Allergic
Non
infectios

5. 
Evaluating the
patient who
presents with fever
and a rash can be
challenging because
the differential
diagnosis is
extensive and
includes minor and
life-threatening
illnesses

6. Because the severity of
these illnesses can vary
from minor (roseola) to
life-threatening
(meningococcemia), the
physician must make
prompt management
decisions regarding
imperical theraby.

7. Age
Season
Geographic location
Exposures
Medications
immunization
Review for SLE
When started
Where started
Where spread
Review for IBD
Erythema nodosum
Pyderma gangrenosum
What was used
To treat ?
Podrome

8. 
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Ringworm
Worms don't cause ringworm.
It's caused by a fungus that
lives off dead skin, hair, and
nail tissue. It starts as a red,
scaly patch or bump. Then
comes the telltale itchy red ring.
The ring has raised, blistery, or
scaly borders. Ringworm is
passed on by skin-to-skin
contact with a person or animal.
Kids can also get it by sharing
things like towels or sports
gear. You may treat it with
antifungal creams.

9. 
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Fifth Disease
This contagious and usually mild
illness passes in a couple of
weeks. Fifth disease starts with
flu-like symptoms. A bright face
and body rash follow. It’s spread
by coughing and sneezing and
most contagious the week before
the rash appears. It's treated with
rest, fluids, and pain relievers (do
not give aspirin to children). If
your child has fifth disease and
you are pregnant, call your doctor.

10. 
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Chickenpox
This once-common rash isn't seen
as much in today's kids thanks to
the chickenpox vaccine. It’s very
contagious, spreads easily, and
leaves an itchy rash and red spots
or blisters all over the body. The
spots go through stages. They
blister, burst, dry, and crust over.
Chickenpox can be very serious.
All young kids should get a
chickenpox vaccine. So should
teens and adults who never had it
or the shot.

11. 
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Impetigo
Impetigo, caused by bacteria,
creates red sores or blisters.
These can break open, ooze, and
develop a yellow-brown crust.
Sores can show up all over the
body but mostly around the mouth
and nose. Impetigo can be spread
through close contact or by
sharing things like towels and
toys. Scratching can spread it to
other parts of the body. It's treated
with antibiotic ointment or pills.

12. 
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Warts
A virus causes these funky but
mostly harmless, painless skin
growths. Warts can spread easily
from person to person. They also
spread by touching an object used
by a person with the virus. They're
most often found on fingers and
hands. To prevent warts from
spreading, tell your child not to
pick them or bite nails. Cover
warts with bandages. Most warts
go away on their own.

13. 
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Contact Dermatitis
Some kids' skin reacts after
touching foods, soaps, or plants
like poison ivy, sumac, or oak. The
rash usually starts within 48 hours
after skin contact. Minor cases
may cause mild redness or a rash
of small red bumps. In severe
cases you may see swelling,
redness, and larger blisters. This
rash goes away after a week or
two or when contact ends.

14. 
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Hand-Foot-Mouth Disease
(Coxsackie)
Despite its scary name, this is a
common childhood illness. It starts
with a fever, followed by painful
mouth sores and a non-itchy rash.
The rash blisters on hands, feet,
and sometimes buttocks and legs.
It spreads through coughing,
sneezing, and used diapers. So
wash hands often. Coxsackie isn’t
serious and usually goes away on
its own in about a week.

15. 
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Eczema
Kids prone to eczema may have
other allergies and asthma. The
exact cause isn't clear. But kids
who get it tend to have a sensitive
immune system. Watch for a
raised rash with dry skin and
intense itching. Atopic dermatitis is
the most common type of eczema.
Some children outgrow it or have
milder cases as they get older.

16. 
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Hives
Many things can trigger these itchy or
burning welts. Medicines such as
aspirin (which kids should never take)
and penicillin can set off hives. Food
triggers include eggs, nuts, shellfish,
and food additives. Heat or cold and
strep throat can also cause hives.
Welts can show up anywhere on the
body and last minutes or days.
Sometimes an antihistamine can help.
Hives can be a sign of serious
problems, especially when they come
with breathing troubles or swelling in
the face. In those cases or if hives
don't go away, see your doctor.

17. 
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Scarlet Fever
Scarlet fever is strep throat with a
rash. Symptoms include sore
throat, fever, headache, belly
pain, and swollen neck glands.
After 1-2 days, a red rash with a
sandpaper texture shows up. After
7-14 days, the rash rubs
off. Scarlet fever is very
contagious, so wash hands often
to keep it from spreading. Call
your child's doctor if you think your
child has it. He'll probably be
treated with with antibiotics.

18. 
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Roseola (Sixth Disease)
Roseola, a mild illness, gets its
nickname from a list of six
common childhood rashes. Young
kids 6 months to 2 years are most
likely to get it. It's rare after age 4.
It starts with a cold, followed by a
few days of high fever (which can
trigger seizures). Then the fevers
end suddenly. They're followed by
a rash of small, pink, flat, or
slightly raised bumps. It shows up
first on the chest and back, then
hands and feet.

19. 
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Rubella (German Measles)
Rubella, also called German
measles, is a mild virus that
usually causes no serious
problems. However, it can harm
the fetus if a pregnant woman
becomes infected. The symptoms
are a low fever and rash that
spreads from the face to the rest
of the body. A standard childhood
vaccine called MMR protects
against measles, mumps, and
rubella.

20. 
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Lyme Disease
The hallmark of Lyme disease is a
target-shaped rash that appears
1-2 weeks after a tick bite, though
not everyone will develop the
distinctive rash. The rash may be
accompanied by a fever, chills,
and body aches. The culprit is a
type of bacterium carried by tiny
deer ticks. Without treatment,
Lyme disease can affect the joints,
nervous system, and heart.

21. 
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Molluscum Contagiosum
Signs: This contagious rash
shows up as one or more
flesh-colored, raised bumps
that are about the size of a
pimple. The center of each
bump has a tiny dimple. The
rash usually shows up on the
face, arms, and legs

22. 
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Diaper Rash With Yeast
Infection
Signs: This red, raised rash
shows up in the groin, around
the genitals, in the creases of
the hips, or on the buttocks. It
itches or irritates. Signs of an
accompanying yeast infection
are round, red spots separate
from but near the main rash.

25. 
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A young child presents to the
local ED with a fever, rash, and
lymphadenopathy. An
examination of his mouth
demonstrates a strawberry
tongue (shown here). You
suspect Kawasaki disease and
tell the parents that he is most
likely to suffer long-term
complications in which organ
system?
A. Cardiovascular
B. Neurologic
C. Gastrointestinal
D. Musculoskeletal
E. Pulmonary

26. 
The correct answer is A. Kawasaki
disease is an acute febrile vasculitis
of unknown etiology. Epidemics in
young children occur in the late
winter and spring, with the highest
incidence among individuals of
Japanese descent. There are 3
distinct stages. In the acute stage
(1-11 days), patients develop high
fevers (> 100 F), ocular changes
(conjunctivitis, anterior uveitis),
perianal erythema, acral edema and
erythema, oropharyngeal changes
(strawberry tongue, hyperemia,
fissuring), and lymphadenopathy. In
the subacute stage (11-30 days),
there may be persistent irritability,
anorexia, conjunctival injection,
thrombocytosis, acral
desquamation (shown), and
aneurysmal formation.

27. •
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A child is brought into his pediatrician's
office after developing a diffuse rash.
His parents do not believe in
vaccinations. You suspect that the
child has developed measles. All of the
following are true about measles
EXCEPT:
A. Measles is a leading cause of death
in young children worldwide
B. The classic triad is
cough, coryza, and conjunctivitis
C. Koplik spots are pathognomonic
white spots that appear on the buccal
cheeks
D. A major early complication is acute
sclerosing panencephalitis
E. Since the introduction of the
measles vaccine, the annual incidence
dramatically decreased.

28. 
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Measles is one of the most contagious
infectious diseases, with a secondary
infection rate of 90% in susceptible
individuals
it remains one of the leading causes of
death in young children worldwide,
with an estimated 197,000 deaths
yearly. After exposure, the incubation
period lasts for 7-14 days. Patients
then develop a prodrome of high
fevers, often > 104 F, with the classic
triad of cough, coryza, and
conjunctivitis. A couple of days later,
Koplik spots develop on the buccal
mucosa, appearing as white spots on
an erythematous base, as shown.

29. o
o
o
o
o
o
A 4-month-old girl presents to the
ED in extremis with rapidly
developing gangrene of the
extremities. All of the following are
true of meningococcemia
EXCEPT:
A. The mortality rate is 5%-10%
B. Meningitis is present in all
cases of septicemia
C. Empiric antibiotic treatment
should be initiated immediately
D. Transmission is person-toperson by direct contact via
respiratory droplets
E. Gangrene is caused by arterial
occlusion

30. 
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The correct answer is B
Meningococcemia is caused by the
gram-negative diplococcusNeisseria
meningitides. Transmission is personto-person via respiratory droplets,
often from an asymptomatic carrier.
Up to 30% of teenagers and 10% of
adults carry meningococci in the upper
respiratory tract. The clinical
presentation is variable, with 50% of
patients developing meningitis only,
10% developing septicemia only, and
40% developing both. Children with
meningitis are usually febrile and illappearing, with symptoms of lethargy,
vomiting, or nuchal rigidity. Septicemia
leads to capillary leak, coagulopathy,
profound acidosis, and myocardial
failure. Septic emboli cause arterial
occlusion in the distal extremities, as
shown in this infant.

31. 
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An 11-year-old girl presents with
raised violaceous plaques on her legs
and arms that developed over the last
few days. She has had a temperature
of 100-101 F at home but no other
complaints. Her current temperature is
100.2 F. The rest of her exam is
normal. You conclude that she has
Henoch-Schonlein purpura (HSP).
Which of the following tests are most
appropriate to perform at this point?
A. CBC, lumbar puncture
B. CBC, electrolytes, stool for occult
blood, urinalysis
C. CBC, electrolytes, stool for occult
blood, renal ultrasound
D. CBC, head CT, lumbar puncture,
abdominal ultrasound
E. CBC, abdominal ultrasound

32. 
The correct answer is B. The images
shown are purpuric lesions. In this
case of a healthy-appearing child with
this history and physical examination,
HSP is a reasonable diagnosis. HSP is
a vasculitis that can affect the skin,
joints, gastrointestinal tract, and
kidneys. In a well-appearing child,
HSP can be managed on an outpatient
basis. It is helpful to check blood
pressure, urine, and electrolytes to
look for a glomerulonephritis.
Urinalysis and blood pressure may be
followed for several months to monitor
kidney function. A fecal occult blood
test can help rule out significant gut
involvement, especially in children with
pain. Intussusception is the most
serious complication of HSP; if it is
suspected, the child should be
admitted and monitored.

33. A 3-year-old girl presents with a blistering
rash on her face and body. Her mouth is
pictured above. All of the following are true
statements regarding Stevens-Johnson
syndrome (SJS) EXCEPT:
A. Medications, including nonsteroidal
anti-inflammatory medications (NSAIDs),
sulfonamides, antiepileptics, and
allopurinol, are commonly accepted
triggers
B. Viruses, such as herpes simplex virus,
Epstein-Barr virus, enteroviruses, and
influenza, are accepted triggers
C. Malignancy can be associated with SJS
D. Bacterial etiologies include
mycoplasma and group A beta-hemolytic
streptococcus, among others
E. Idiopathic causes are unlikely

34. 
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The correct answer is E.
SJS may involve the mucous
membranes, including the eyes and
gastrointestinal tract. When more than
30% of the body surface area is
involved, cases are generally referred
to as toxic epidermal necrolysis.
Treatment is symptomatic, including
treatment of superinfection and pain
control. Patients with severe cases
should immediately be fluidresuscitated and treated as burn
victims. Offending agents should be
removed or treated. Use of steroids is
controversial. Involvement of
specialists, including ophthalmologists,
immunologists, and burn specialists,
may be indicated. Morbidity and
mortality are correlated with the
percentage of body surface area
involved

35. 
Staphylococcal scalded skin
syndrome (SSSS) is a disease
that usually affects infants and
young children who lack the
antibodies to Staphylococcus
aureus toxins that adults have. It
is caused by bacterial infection by
group II S. aureus that produces
toxins that cause
exfoliation, bullae (blister)
formation and redness of skin. In
children mortality is low, but can
be high in adults, who will usually
have a serious underlying disease
that makes them susceptible to
infection

36. Thank you