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This article provides an overview of common paediatric rashes, including appearance, causes, relevant investigations and management.
Symptoms: fever > 5 days, conjunctivitis, polymorphous exanthem, fissuring of lips, strawberry tongue (Figure 4), diffuse erythema of oral and pharyngeal mucosa, periungual desquamation of fingers and toes, erythema of palms and soles
Other features: arthralgia, septic meningitis, coronary artery aneurysm, vasculitis and other cardiac conditions (congestive heart failure, myocarditis, arrhythmias, mitral insufficiency, acute MI)
Investigations: echocardiography (needs follow up 6 weeks later), inflammatory markers (ESR and CRP), alpha-1 antitrypsin
Management: high dose intravenous immunoglobulin, aspirin
Staphylococcal scalded skin syndrome
Staphylococcal scalded skin syndrome is a blistering skin disease caused by the exfoliate staphylococcal toxin.
Cause: exfoliative staphylococcal toxin
Appearance: blistering initially, then desquamation affecting flexural areas, buttocks, hands, or feet
Epidemiology: typically occurs in children under three years old
Associated symptoms: fever, irritability, diffuse blanching erythema around the mouth, desquamation as above, positive Nikolsky’s sign (the epidermal layer easily sloughs off when pressure is applied)
Management: hospital admission, supportive care, analgesia and intravenous antibiotics (flucloxacillin is first-line)
Eczema herpeticum is a complication of atopic eczema that occurs with infection of the herpes simplex virus (HSV).
Cause: type I HSV co-infection with active atopic eczema
Primary infection: in pre-school children, presenting with a sore throat, pyrexia, stomatitis, vesicles or ulceration in the oral cavity and face
Secondary infection: a cluster of itchy and painful blisters on the face and neck. New blisters have umbilication, old blisters crust and form sores.
Management: oral acyclovir, systemic antibiotics for secondary bacterial infection
Appearance: red or violet subcutaneous nodules located pretibially