Dr.Muhammad Rashid The rash and mucous membrane lesions shown in the photograph develop in an infant 5 days into the course of an upper respiratory infection with otitis media, being treated with amoxicillin. The child’s condition is likely a. Urticaria b. Rubeola c. Stevens-Johnson syndrome d. Kawasaki disease e. Scarlet fever Definition A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. Viral Infection eg. Measels Bacterial Infection such as Scarlet fever Food Allergy Other Allergies: ◦ for example: dyes, medicines, insect stings, metals such as zinc or nickel (such rashes are often called hives) Skin contact with an irritant Fungal infection Reaction to vaccination Skin diseases such as eczema or acne Exposure to sun (sunburn) or heat Ricketial disease eg Rocky mountain spotted fever Coagulopathy as patachae or perpura eg. ITP Vasculities eg kawasaki disease or feet. or "bulls-eye“ May have vesicles and blisters of various sizes (bulla) Are located on the upper body. with a pink-red ring around a pale center. symmetrically arranged and starting on the extremities. It often takes on the classical "target lesion" appearance. also called "iris". legs.Penicillins Sulfonamides . palms.phenytoin Infections include: Herpes simplex . It is a mild. or illness Pink-red blotches. Fungi . self-limited rash E M is a type of hypsersensitivity reaction. infections. arms. May involve the face or lips Resolution within 7–10 days is the norm Medications that can cause this reaction include: Barbiturates . It occurs in response to medicines. leprosy . Mycoplasma. hands. Symptoms Fever Malaise Itching of the skin Joint aches Multiple skin lesions Eye burning. and discharge Mouth sores Tests include: Nikolsky sign. skin lesion biopsy and Examination of skin tissue . itching. . Target lesions . Stevens–Johnson syndrome (SJS) is a milder form of toxic epidermal necrolysis (TEN) with less than 10% body surface area detachment This Inflammatory disorder is triggered by an allergic reaction to certain drugs including antibiotics. It is an immune-complex–mediated hypersensitivity disorder that typically involves the skin and the mucous membranes.penicillin and amoxicillin. velproate. tetracycline. histolpasmosis. such as sulfonamides.diptheria Gp A strepto cocci. influenza. Nonsteroidal anti-inflammatory medications and anticonvulsants such as carbamezapine.mycoplasma. mumps. .diclofenac have also been implicated Occurs up to 1-3 wks after drug exposure common infections are.HIV. phenobarbital.EB virus.Herpes simplex virus. Ulcers in the mouth and lips but also in the genital and anal regions. arthralgia. Mouth ulcers are usually extremely painful and reduce the patient's ability to eat or drink. urticarial plaques. bullae. fatigue. headache. these lesions have only 2 zones of color .Signs and symptoms : Productive cough. Conjunctivitis of the eyes occurs in about 30% of children who develop SJS. this is considered pathognomonic In contrast to the typical lesions of erythema multiforme. sore throat. or confluent erythema The typical lesion has the appearance of a target. vesicles. The rash can begin as macules that develop into papules. Targer lesion in SJS . topical anesthetics for pain relief Areas of denuded skin must be covered with compresses of saline or Burow solution Tetanus prophylaxis must be addressed Treatment is similar to that for patients with thermal burns.Mainly clinical Diagnosis It is a Dermatological emergency. intravenous fluids and nasogastric or parenteral feeding) and symptomatic Consider Iv IG . mortality rate is 5% Withdrawal of any agent suspected of causing the condition is critically important Oral lesions are managed with mouthwashes.g. and continued care can only be supportive (e. . It is a life threatening dermatologic disorder Widespread erythema. ocular abnormalities. respiratory failure. necrosis. and genitourinary complications. and bullous detachment of the epidermis and mucous membranes Resulting in exfoliation and sepsis and/or death Mucous membrane involvement can result in gastrointestinal hemorrhage. whereas SJS involves less than 10% . TEN involves more than 30% of the body surface. death . epithelial erosions of trachea. corneal scarring.buccal mucosal is possible Extremities with face > trunk Involvement of palms and soles Generalized with prominent face and trunk involvement Palms and soles may be spared Generalized Nails may also shed Other Complications Burning and stinging Recurrences Secondary bacterial infection Scarring. tongue. and blistering "Atypical lesions": 50% have no target lesions Diffuse erythema then necrosis and sheet-like epidermal detachment in > 30% Sites Dorsa of hands and forearms Mucous membrane involvement (lips. phimosis and Tubular necrosis and acute kidney injury. blindness. eruptive nevomelanocytic nevi. contractures.Erythema Multiforme Stevens Johnson Syndrome Toxic Epidermal Necrolysis Lesion Macules/papules with central vesicles Classic bull's·eye pattern of concentric light and dark rings (typical target lesionsl Bilateral and symmetric All lesions appear within 72 h May show dermal edema Lesion "fixed" for at least 7 d Cutaneous blistering with mucous membrane involvement "Atypical lesions": red circular patch with dark purple centre (aka targetoid) "Sicker" (high fever) Sheet-like epidermal detachment in < 10% (Nikolsky sign ) Severe mucous membrane involvement. chlorumphenicol. paraneoplastic pemphigus Scarlet fever. or Mycoplasma pneumoniae Frequently drug· related (NSAlDs. GVHD. exfoliative dermatitis . granuloma annulare. exfoliative dermatitis. Kawasaki disease. penicillins) Occurs up to 1 ·3 wks after drug exposure with more rapid onset upon rechallenge Frequently drug related. eruption. phototoxic. phototoxic eruption.allopurinol etc < 5% are due to viral infection. mycosis fungoides Scarlet fever.Erythema Multiforme Stevens Johnson Syndrome Toxic Epidermal Necrolysis Constitutional Symptoms Weakness. penicillin. anticonvulsants. sulphonamide. GVHD. sulfonamides. SSSS. malaise Prodrome 1 -14d prior to eruption with fever and flu·like illness High fever > 38°C Etiology Infection: HSV. immunization Differential Diagnosis Giant urticaria. SSSS. Erythema Multiforme Stevens Johnson Syndrome Toxic Epidermal Necrolysis Course and Prognosis Lesions last 2 wks and heal without complications 4·6 wks course 5% mortality 30% mortality due to fluid loss. regrowth of epidermis by 3 wks. secondary infection Management Symptomatic treatment (oral antihistamines. oral antacids) Corticosteroids in severely ill (controversial) Prophylactic oral acyclovir for 6·1 2 months for HSV·associated EM with frequent Prolonged hospitalization Withdraw suspect drug Intravenous fluids Infection prophylaxis Consider IVIG As for Stevens·Johnso n syndrome Admit to burn unit Debride frankly necrotic tissue Consider IVIG . . electrolyte. . Healing begins about 10 days after treatment. which spreads to cover most of the body Skin slips off with gentle pressure. Skin biopsy (in rare cases) Hospitalization . young children and individuals with a depressed immune system or renal insufficiency Sign and Symptoms: Blisters Fever Large areas of skin peel or fall away Painful skin Redness of the skin. Cultures of the skin and throat. rehydration & IV antibiotics are mainstay of treatment. leaving wet red areas (Nikolsky's sign) Fluid loss Tests may include: CBC. The syndrome is induced by epidermolytic exotoxin released by S. aureus and cause detachment within the epidermal layer and peeling of skin affects infants. . arms Associated with arthralgia. It is an inflamation of the fat cells under the skin (panniculitis)characterized by round. tender. drugs: sulfonamides. poorly demarcated nodules Sites: asymmetrically arranged on extensor lower legs. TB. Hodgkin's lymphoma Chest x-ray (to rule out chest infection and sarcoidosis) and throat culture. (PPD) skin test EN is self limiting and usually resolves itself within 3–6 weeks. Bed rest. knees. red. analgesics. Crohn's > UC Malignancy: acute leukemia. fever. wet dressings. Yersinia. antistreptolysin (ASO) titre. oral contraceptives. histoplasmosis. hepatitis C mycoplasma Inflammation: sarcoidosis. NSAIDs and treat underlying cause . compressive bandages. retinoic acid Infections: GAS. malaise 40% are idiopathic. . The child’s condition is likely a. being treated with amoxicillin. Rubeola c. Kawasaki disease e.The rash and mucous membrane lesions shown in the photograph develop in an infant 5 days into the course of an upper respiratory infection with otitis media. Stevens-Johnson syndrome d. Urticaria b. Scarlet fever . and urinary retention caused by dysuria. the mortality rate can approach 10%. and. dehydration due to severe stomatitis. anus. poor fluid intake. The combination of erythema multiforme and vesicular. ulcerated lesions of the mucous membranes of the eyes. and urethra defines the Stevens-Johnson syndrome (erythema multiforme major). subsequently. and penicillin) and infection with a variety of organisms including Mycoplasma pneumoniae or herpes type 1 . sulfonamides. Fever is common. Among the known causes of the Stevens-Johnson syndrome are allergy to various drugs (including phenytoin. The answer is c. Common complications include corneal ulceration. barbiturates. and even pulmonary involvement occasionally is noted. mouth. mouth. and nose. The previously healthy 4-year-old child pictured presents to the emergency room with a 2-day history of a brightly erythematous rash and temperature of 40°C (104°F). Epidermolysis bullosa b. Staphylococcal scalded skin syndrome c. The desquamation of skin shown occurs with gentle traction. The child is admitted and over the next day develops crusting and fissuring around the eyes. Scarlet fever . Drug eruption e. The exquisitely tender. This child most likely has a. generalized rash is worse in the flexural and perioral areas. Erythema multiforme d. The answer is b. Also known as Ritter disease. crusting of the eyes. The rash is preceded by fever. and extraordinary tenderness of the skin. including infection and fluid and electrolyte imbalance. Cultures of the bullae are negative. Recovery without scarring can be expected. mouth. erythema. Peeling of the epidermis in response to mild shearing forces (Nikolsky sign) leaves the patient susceptible to problems similar to those of a burn injury. irritability. Circumoral erythema. but the source site is often positive. Treatment includes antibiotics (to cover resistant Staphylococcus aureus) and localized skin care. and blisters on the skin can develop. and nose. . Intraoral mucosal surfaces are not affected. staphylococcal scalded skin disease is seen most commonly in children less than 5 years of age. During the next 24 h. The most likely diagnosis of this girl’s condition is a. Erythema multiforme . A 14-year-old girl awakens with a mild sore throat.and a diffuse maculopapular rash. Four days after the onset of her illness. she develops tender swelling of her wrists and redness of her eyes. her physician notes mild tenderness and marked swelling of her posterior cervical and occipital lymph nodes. low-grade fever. the rash has vanished. Rubella b. Rubeola c. In addition. Erythema infectiosum e. Roseola d. low-grade fever. Symptoms of rubella. and a high fever that reaches its peak at the height of the generalized macular rash. The answer is a. arthralgia. conjunctivitis. or arthritis. photophobia. which fades centrally at first. occasionally. marked enlargement of the posterior cervical and occipital lymph nodes. conjunctivitis. Erythema multiforme is a poorly understood syndrome consisting of skin lesions and involvement of mucous membranes. A number of infectious agents and drugs have been associated with this syndrome. and. coryza. usually a mild disease. Persons with rubeola develop a severe cough. mild sore throat. Erythema infectiosum (fifth disease) begins with bright erythema on the cheeks (“slapped cheek” sign). in which the high fever abruptly abates as a rash appears. which typically lasts for 5 days. Roseola is a viral exanthem of infants. Koplik`s spots on the buccal mucosa are diagnostic. followed by a red maculopapular rash on the trunk and extremities. . include a diffuse maculopapular rash that lasts for 3 days. . . . . . . . . . THANK YOU . . . .5 and 2 is correct ans. . ANWER IS RSV .
Report "Rashes in Children by Dr. Muhammad.rashid"