Common Skin Rash
[Link] Shalalfa
FAMILY MEDICIN SPECIALIST
Ms EPIDEMIOLOGY/BUPLIC HEALTH
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Why skin rash ?
• A very important sign of the disease
• Avoid spread of infection .
• İmportant for public health
exa: meningoccoccemia
• Differential diagnosis is done by history of rash,
clinical findings, laboratory results,
Primary skin lesions
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Approach to a child with rash
1- History of lesion
*Date of the appearance.
* Place of first appeared
*Distrubution, appearance and fading
* sense of pain, burning, parahestesia,
pururitus
2- Experienced rash illness
3- Vaccination
4- Family history: eczema, astma, allergic rhinitis
5- Breast feeding
6- Rash illness at family, siblings, neigbourhood and
school
7- Rash stimulated by:Uv, heat, food, drug,
infection.
8- Other findings
*Fever
*Tonsillitis
*Arthralgy
*Growth retardation
*Adenomegaly
*Hepatosplenomegaly
*Ichterus
Neonate rashes
Neonate rash
• Milia in neonate • Cutis marmorata in neonate
• Napkin dedrmastitis in neonate
Childhood rashes
• Mongolian spot in neonate • Miliaria crystallina
• Acne neonatorum • Craddle cap (seborrheic
dermatitis)
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▪ ID: 9-month-old male
▪ HPI: presents for evaluation of fever
and rash. His mother noted a fever
of 40˚C two days ago. He appeared
well and was eating and playing
normally, so his mother was not
alarmed. After the fever resolved,
he developed a red rash on his
trunk that progressed rapidly over
the past 24 hours.
▪ PMH: up-to-date with vaccinations.
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Case One, Question 1
▪ Based on history and exam, what is the
most likely diagnosis?
a. Drug Eruption
b. Erythema Infectiosum
c. Measles
d. Roseola
e. Rubella
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Roseola Infantum
▪ Acute febrile illness, lasting approximately 3 to 7 days
▪ Prodrome: High fever (39-40°C), palpebral edema, cervical
lymphadenopathy, mild upper respiratory symptoms. Child
appears well. As fever subsides, exanthem appears
(“exanthema subitum” means “sudden rash”).
▪ Exanthem: pink macules and papules surrounded by white
halos. Begins on trunk, spreads to neck and proximal
extremities. Lasts 1-3 days.
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Roseola Infantum
▪ Synonyms: Exanthema subitum, Sixth disease
▪ Caused by Human Herpesvirus 6 (HHV-6) and
less commonly Human Herpesvirus 7 (HHV-7)
▪ Mode of transmission unknown (possibly from
nasopharyngeal secretions)
▪ Children 6 months – 4 years
▪ Most common exanthem before age 2
▪ No vaccine; infection results in immunity
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• A 10-year-old boy with asthma reports itching
that has recently become relentless,
resulting in sleep loss.
• 1. What is this rash?
• 2. What causes it?
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clustered papules
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Atopic dermatitis
symmetric scaly red plaques
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• Atopic Dermatitis
It is the most common form of eczema. It often affects people who
also have:
• Asthma or hay fever
• Family history of eczema, asthma, or hay fever
• Defects in the skin barrier, allowing moisture out and germs
• Atopic dermatitis usually begins during infancy or childhood. But it
can strike people at any age.
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Treatment
• Avoid Irritants that can make symptoms of atopic dermatitis worse
include:
• Soap ,Rough clothing and household chemicals
• Products to lubricate and moisturize the skin
• Steroid creams and ointments
• Drugs that control the immune system including dupilumab
(Dupixent)
• Ultraviolet light
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Seborrhoea dermatitis
• scaly patches, red skin and stubborn dandruff.
• Seborrhoea dermatitis can also affect oily areas of the body, such as
the face, sides of the nose, eyebrows, ears, eyelids and chest.
• It may go away without treatment. Or may need many repeated
treatments before the symptoms go away. And they may return later.
Daily cleansing with a gentle soap and shampoo can help reduce
oiliness and dead skin buildup.
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NAPPY RASH : confluent bright red papules and plaques with scattered
pustules, overlying scale, and satellite lesions at the periphery , symmetric
uniform 2-3 mm red eroded papules , NOT on the folds
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Dermatosis affecting the napkin area
Disorder Features
Psoriasis Scattered beefy red papules which may coalesce into well
defined plaques, often lacks scale. Look for other skin/ nail
signs of psoriasis or a family history
Primary Erythema with satellite pustules, may be sharply demarcated
candidiasis with a raised edge, involves groin folds, often follows
systemic antibiotics.
Acrodermatitis Treatment resistant eczematous looking rash, may blister or
enteropathica become crusty, look for perioral involvement
Zinc deficiency
Granuloma Red papule granulomastous nodules, a foreign body reaction
gluteale infantum to talc or barrier preparations, benign & self limiting
Langerhans cell Erythema & scale, progresses to purpuric nodules, extremely
histiocytosis rare & may be serious
staph infections
• Most of the time, these bacteria cause no problems or result in
relatively minor skin [Link] staph infections can turn deadly
if the bacteria invade deeper into your body, entering your
bloodstream, joints, bones, lungs or heart.
• Treatment usually involves antibiotics and drainage of the infected
area.
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Erythema Infectiosum
Confluent, erythematous, edematous plaques on the
cheeks - “slapped cheeks.” Erythematous reticular
eruption on the trunk and extremities.
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Erythema Infectiosum
▪ Prodrome: low-grade fever, malaise, headache,
pruritus, coryza, myalgias,
▪ Caused by Parvovirus B19
▪ Exanthem:(“slapped cheeks”) and fades over 1-4
days and eruption usually lasts 5-9 days.
▪ B19 is the most common cause of transient aplastic crisis
in patients with chronic hemolytic anemias (i.e. sickle cell
disease)
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Measles
▪ Prodrome: Fever, Malaise, Conjunctivitis, Cough,
Coryza*
▪ Exanthem: Erythematous macules and papules begin
on the face and spread cephalocaudally and centrifugally
(by the 3rd day, the whole body is involved).
▪ Enanthem: Koplik spots (occur in prodromal period)
▪ Recovery: Clinical improvement begins within 2 days of
appearance of the rash. The rash tends to fade after 3-4
days and will last around 6-7 days.
*Coryza: “head cold” with nasal congestion, rhinorrhea, sore
throat
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Measles (Rubeola)
▪ Measles is a viral disease spread by respiratory
droplets
▪ Incubation period tends to be 8-12 days from exposure
to onset of symptoms
▪ Patients are contagious from 1-2 days before onset of
symptoms (3-5 days before the rash) to 4 days after
appearance of the rash
▪ Immunocompromised patients can be contagious for
the duration of the illness
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Dx & Rx
• Serology: Anti-measles IgM and IgG, isolation of measles virus or
identification of measles RNA
• Histologic evaluation of skin lesions or respiratory secretions may
show syncytial keratinocytic giant cells
▪Treatment in the majority of cases is supportive (antipyretics, fluids).
▪Vitamin A supplementation has shown to be of benefit in the treatment of
measles
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Another Classic Exanthem:
Rubella (German measles)
Clinical presentation
•Low-grade fever, headache, sore throat,
rhinorrhea, cough
•Conjunctivitis and lymphadenopathy
•Pruritic, pink to red macules and papules which
begin on face and spread to neck, trunk, and
extremities over 24 hours
•20% with petechial lesions on soft palate and
uvula (Forchheimer's sign)
Treatment is usually supportive
▪ All women of child-bearing age with suspected rubella should be screened for
pregnancy
▪ Infection during pregnancy may can result in miscarriage, fetal death, or cause
congenital rubella syndrome
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Viral Syndrome Causative Exanthem/Enanthem Age/Epidemiol Associated Symptoms
Virus ogy
Roseola HHV-6 Erythematous macules and Infant-Preschool High fever x 3 days, then rash.
(HHV-7) papules surrounded by Mild URI sx.
white halos. Complications: febrile sz.
Erythema Infectiosum Parvovirus B19 Erythematous School-age Low-grade fever
“slapped” cheeks, followed
by reticulate erythema on
body
Hand-Foot-and-Mouth Coxsackie A16, Oval vesicles on palms, Infant-Preschool Fever, sorethroat, respiratory
Disease A6; Enterovirus soles, buttocks; oral and GI sx.
71; others erosions.
Measles Measles Erythematous macules and Majority of cases in Prodrome: Fever, Malaise,
papules; spread from head US are imported. Conjunctivitis, Cough, Coryza
down. White erosions on Infectious complications.
buccal mucosa (Koplik
spots)
Rubella Rubella Pruritic pink macules and Majority are Fever, HA, URI sx,
papules, spread from head vaccinated. conjunctivitis,
down over 24 hrs. lymphadenopathy.
Petechial lesions on soft Congenital rubella syndrome.
palate (Forsheimer’s sign)
Scarlet fever
• It is an infection that causes a blotchy,
pink-red rash. It's most common in young
children, but can affect people of any age.
• It isn't usually serious and can be treated
with antibiotics . Once you've had it, you're
unlikely to get it again.
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Chickenpox
• varicella, is a highly contagious disease caused by the varicella
zoster virus(VZV).
• The disease results in a characteristic skin rash that forms itchy
blisters, which eventually scab over.
• It usually starts on the chest, back, and face then spreads to the rest
of the body.
• Other symptoms may include fever, tiredness,
and headaches Symptoms usually last five to seven days.
• Complications may occasionally include pneumonia, inflammation of
the brain, and bacterial skin infections.
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Pityriasis alba
• It may be related to another skin condition called atopic
dermatitis or eczema that causes a skin rash. People whose skins
are very sensitive or who get a lot of sun may be more likely .
• Pityriasis alba often gets better on its own. A moisturizer or cream
can help with dryness. If your skin is inflamed, itchy, or red, your
doctor may prescribe a corticosteroid or a nonsteroidal cream.
Targeted phototherapy may help reverse or stop it.
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symmetric oval 0.5-3.0 cm
red patches with central
scale
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Pityriasis rosea
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Pityriasis rosea
• This rash usually disappears on its own without treatment. You can
expect to see the rash for about 6 to 8 weeks. Sometimes the rash
lasts much long .
▪ multiple widespread round to oval 1-3 cm almost confluent plaques
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SPOT DDX??
annular scaly plaque with occipital
adenopathy 41
Tinea capitis
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• Recommended dose is 20-25 mg/kg/day in single or two divided
doses for microsized or 15-20 mg/kg/day in single dose or two
divided doses for ultramicrosized griseofulvin.
• The duration of treatment should be between 4 and 6 weeks.
• Topical treatment alone usually is ineffective and is not
recommended for the management of tinea capitis.
antifungal medications, such as itraconazole, terbinafine, and
fluconazole, have been reported as effective alternative therapeutic
agents
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SPOT DDX?
concentric red scaly annular plaques
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Tinea corporis
• Tinea corporis is a fungal skin infection also known as ringworm of
the body.
• The most common cause of ringworm is infection from person to
person.
• The disease can also be transmitted from pets to humans, and then
on to other people.
• Ringworm is a common and very contagious disease.
• Epidemics sometimes occur in kindergartens
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Pityriasis versicolor
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Well-demarcated
hypopigmented
macules with
minimal scale ,
TREATED by
antifungal shampoo
or cream
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References
▪ Fölster-Holst R, Kreth HW. Viral exanthems in childhood--infectious (direct)
exanthems. Part 2: Other viral exanthems. J Dtsch Dermatol Ges. 2016
May;7(5).
▪ Mathes EF, et al. "Eczema skin rash ” and unusual cutaneous findings in an
enterovirus outbreak. Pediatrics. 2020 Jul;132(1):e149-57.
▪ James WD, Berger TG, Elston DM. “Chapter 19. Viral Diseases” (chapter).
Andrews’ Diseases of the Skin Clinical Dermatology. 10th ed. Philadelphia,
Pa: Saunders Elsevier; 2021: 394-397.
▪ Jordan J. Clinical manifestations and pathogenes and skin disease.
UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2022.
▪ Scott LA, Htone MS. Viral exanthems. Dermatology Journal. 2019; 9(6)
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