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Pediatric Rashes

Pediatric rashes are a common complaint, and knowing the difference between them can save time, stress, and agony. Here are a series of resources to help you differentiate between the rashes most commonly seen.

DISEASE SEASON PROGRESSION MORPHOLOGY DISTRIBUTION ASSOCIATED FINDINGS TREATMENT

Measles/Rubeola

paramyxovirus

Winter to Spring

Incubation: 1-2 weeks

Communicability:
4 days before and after the rash

Rash appears 3 days after symptoms

Erythematous, confluent, maculopapular

Begins at the hairline and spreads inferiorly

Koplik Spots

Koplik spots in mouth

High Fever

Cough, Coryza, and Conjunctivitis

Forchheimer spots

-Infected: Supportive care
-Unimmunized contacts: Measles vaccine within 72 hours of exposure or IgG within 6 days of exposure
-Prevention: MMR vaccine

Scarlet Fever

Streptococcus pyrogenes

Fall to Spring

Incubation: 2-4 days

Hypersensitivity reaction to Group A hemolytic Strep

Generalized erythema with a sandpaper texture

Begins on the face and upper part of the trunk and spreads inferiorly

-Pastia lines
-Forcheimer spots
-Strawberry tongue
-Sandpaper rash
-Exudative pharyngitis
-Abdominal Pain
Rheumatic Fever

Throat Swab, oral Penicillin V, Azithromycin if allergic
Can return to school 24 hours after antibiotic started

Rubella

Rubivirus

Late Winter and Early Spring

Incubation: 2-3 weeks

Communicability:
7 days before and after the eruptions

Rash appears 1-5 days after symptoms

Rose-pink, maculopapular

Rubella
Spreads inferiorly -Lymphadenopathy
-Arthralgias
-Forcheimer Spots
Infected: Supportive care
Prevention: MMR vaccine

Erythema Infectiousum

Parvovirus B19

Winter and Spring  

“Slapped cheek” appearance, lacy reticular rash

Erythema Infectiosum
-Erythematous cheeks
-Reticular Extremities
-Rash waxes and wanes over weeks
-Arthritis
-Aplastic Crisis
 

Roseola 

human herpesvirus 6 and 7

Spring

Incubation: 5-15 days

Communicability:
unknown

Rash appears once fever subsides

Rose-pink, maculopapular

Neck and trunk -Lymphadenopathy
-Febrile seizures
-Aplastic Crisis
Infected: Supportive care
Prevention: No known vaccine

Varicella

herpes zoster virus

Late Winter and Early Spring

Incubation: 0-3 weeks

Communicability:
2 days before and 5 after the eruptions

Rash appears 3-4 days after symptoms

Vesicles on an erythematous base, crusts, various stages of healing

Varicella Zoster
Begins on the face and trunk and spreads centripetally -Pruritis
-Varicella-Zoster
Treatment: Supportive Care
Prevention: Varicella vaccine

Hand-foot-and-mouth disease

 Coxsackie A virus

Late Summer or early Fall   Elliptical vesicles on an erythematous base
Oral vesicles
Erosions
Mouth, hands and feet Vesicles on the hands and feet and in the mouth  

Herpes simplex

Variable   -Grouped vesicles on an erythematous base (e.g. anterior oral cavity – buccal mucosa, tongue, lips, around mouth)
-Herpetic whitlow, painful fingers with vesicles
-Genital herpes: HSV2, shaft of penis, vagina, vulva, anus
-Keratitis
    Infected: Topical or Oral Acyclovir

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