rashes in infants and children
TRANSCRIPT
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Rashes in Infants and children
Dr. Mohammed Niyaz MEM Resident
MIMS -K
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Macule – < 1cm diameter area of color change, with no palpable substance
Patch – > 2cm diameter macule Papule – Palpable mass 1 cm diameter Nodule – Spherical enlargement of a papule >
5mm diameter Plaque – Flat-topped palpable lesion > 5mm
diameter, papule that is enlarged in 2 dimensions.
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Wheal – Edematous papule or plaque, transient Vesicle – Fluid-filled papule < 5mm diameter Bulla – > 5mm vesicle Pustule – Vesicle packed full of purulent material
(may or may not be sterile).
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General Approach
Fever & systemic symptoms Prior immunization Potential human or animal contacts Recent bites or stings Travel Drug administration Food & Environmental exposure
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Viruses Fungal Infections Bacterial Infections Infestations Common Neonatal Rashes Exanthems of unknown etiology
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Enteroviruses
Picornavirus group Poliovirus, Cock sackie , Echovirus Faeco-oral transmission Non specific febrile illness, Upper & Lower lip
infection, GI infections, Aseptic Meningitis Diffuse macular eruptions, Mobiliform rash , Roseola
like rash, Scarlatiniform eruptions
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Hand Foot and Mouth Disease
Enterovirus 19 Fever, Anorexia, Malaise, Soremouth4 to 8 mm size vesicles, painfulHeal in 7 to 10 days
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Herpangina
Cocksachie virus group AFever, Mouth pain, Oral Ulcers
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Symptomatic Therapy
Adequate hydration Antipyretics “Magic Mouthwash“ - Maalox and Diphenhydramine
liquids
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Measles
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Measles
Highly contagious , myxovirus infection IP- 10 days General Malaise, Systemic toxicity, fever, coryza,
conjuctivitis , photophobia and cough Centrifugal – head to feet Red copper to brownish hue Koplik spots- 1mm descrete spots with a red base
opposite lower molars
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Rubella (German Measles or Third disease)
IP- 12 to 25 days
Fever, Malaise , Headache, Sorethroat
Irregular pink macules and papules on face to neck, trunk , arms
Forcheimer spots- pinpoint petechia involving soft palate
Lymphadenopathy- suboccipital, post auricular
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Erythema Infectiosum ( Fifth disease)
Human Parvovirus B19
5 to 15 years
Slapped cheek appearance
Circum oral pallor
Fever, malaise , headache, sorethroat, cough , coryza
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Herpes
Gingivostomatitis
Disseminated, localized to CNS or mucocutaneous
HSV1 – Oral SecretionsHSV2 – Vaginal Secretions
IP- 2 to 14 days
Herpes labialis (cold sores) and Gingivostomatitis
Painful umbilicated vesicles
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Eczema herpeticum
Vesicular eruptions in areas affected by eczema
Life threatening
Treatment
Trimethoprim – sulfamethoxazole 10 mg/kg/d twice a dayClindamycin 24 mg /kg/d 3 times a day x 10 daysAcyclovir 80 mg /kg/d every 8 hours x 10 days
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Varicella Less than 10 years
Low grade fever, Malaise, Headache
Tear drop vesicles
Tzanck smear- Varicella giant cells
Complications- Encephalitis, Pneumonia, Hepatitis
Management :
AcetaminophenAntihistaminesAcyclovir
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Roseola Infantum (Exanthem subitum or 6th disease)
3 to 5 days febrile period
6 months to 3 years
High grade fever, cough, coryza, anorexia, abdominal discomfort
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Fungal Infections
Tinea CapitisKerion
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Tinea capitis (scalp)- in children < 10 years Tinea corporis – adolescent Kerion- severe form of capitis , exaggerated
inflammatory response producing painful boggy mass
Diagnosis- M/E- Hyphae Culture- Sabouraud dextrose sugar
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Treatment
Tinea capitis- Griseofulvin 20 to 25 mg /kg/ d or twice a daySelenium Sulfide 2.5%/ Ketaconazole shampooPainful Kerion – Cephalexin 40 mg/kg/d every 8 hours
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Bacterial Infections
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Impetigo
Staph aureus or Beta hemolytic streptococcus
At site of insect bite or cutaneous trauma
Face , neck and extremities
TreatmentMupirocin 2 % thrice dailyCephalexin 40 mg /kg /d TID x 7-10 daysClindamycin 24 mg/kg/d TID x 7-10 days
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Bullous ImpetigoEpidermolytic toxin – seperation of skin at granular layerNew born infants and childrenSuperficial , flaccid, thinwalled bullae 0.5 to 3 cm
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Staphylococcal Scalded skin syndrome
Fourth disease
Malaise, fever, irritablity, tenderness of the skin
Nikolsky sign – seperation of the epidermis when pressure is applied
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Treatment
Inpatient therapy, fluid resuscitation and parenteral antibiotics
Nafcillin 100 mg/kg/d every 6 hours IV Penicillin G procaine 300000 U/d IM for < 30 kg and
600000 U/d for > 30 kg
MRSA-Clindamycin 40 mg /kg/d Q6H Sulfamethoxazole-trimethoprim -10mg/kg/d BD for 7-
10 days Vancomycin 10 to 15 mg/kg/d BD
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Scarlet Fever
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Erysipelas
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Scabies
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Head lice
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Erythema Toxicum Neonatorum
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Neonatal Acne
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Seborrheic dermatitis
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Atopic Dermatitis
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Diaper rash
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Kawasaki Disease
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Henoch Shonlein Purpura
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Pityriasis rosea
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THANK YOU