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Acute skin eruptions in children
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The following skin eruptions (some of which may also occur in adults) are outlined in common childhood infectious diseases:
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measles
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rubella
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viral exanthem (fourth syndrome)
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erythema infectiosum (fifth syndrome)
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roseola infantum (sixth syndrome)
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Kawasaki disorder
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varicella
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Acute skin eruption: diagnostic strategy model
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Probability diagnosis (especially children)
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Varicella (chickenpox)
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Measles
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Rubella
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Erythema infectiosum (‘slapped cheek’ disease)
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Roseola infantum
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Other viral exanthema (e.g. enterovirus)
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Hand, foot and mouth disease
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Pityriasis rosea
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Herpes zoster (shingles)
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Drug reaction eruption
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Impetigo
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Herpes simplex
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Allergic rash (incl. contact dermatitis)
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Serious disorders not to be missed
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Vascular:
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Henoch–Schönlein purpura
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Stevens–Johnson syndrome
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other vasculitides
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Infection:
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purpura of meningococcus, other septicaemias
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primary HIV infection
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folliculitis (e.g. Pseudomonas, Staphylococcus)
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secondary syphillis
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scarlet fever
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Pitfalls (often missed)
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Guttate psoriasis
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Epstein–Barr virus (EBV) mononucleosis
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Arbovirus infection (e.g. dengue, Ross River fever, Barmah Forest virus, Japanese encephalitis)
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Scabies
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Kawasaki disease
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Eczema herpeticum
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Zoonoses (e.g. listeriosis, Q fever)
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Many diagnoses are clinical. Consider:
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FBE/ESR/CRP
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EBV test
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HIV test
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serology for rubella, parvovirus, syphilis and other suspected infections
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viral and bacterial cultures
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The rash usually appears 6–8 wks after the primary chancre. It is relatively coarse and asymptomatic. It can involve the whole body, inc. the palms and soles.
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Primary HIV infection
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A common manifestation of the primary HIV infection is an erythematous, maculopapular rash. If such a rash, accompanied by an illness like glandular fever, occurs, HIV infection should be suspected and specific tests ordered.
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The sudden eruption of small (less than 5 mm) round, very dense, red papules of psoriasis on the trunk. Usually seen in children and adolescents following a sore throat. The rash may extend to the limbs, and soon develops a white silvery scale. It may undergo spontaneous resolution or enlarge to form plaques and tends to last 6 months. Treatment is with UV light and tar preparations.
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A rash is one of the most common side-effects of drug therapy, which can precipitate many different types of rash; the most common is toxic erythema. Examples are antibiotics, esp. penicillin, thiazides, antiepileptics, allopurinol, NSAIDs.
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An acute eruption affecting the skin and mucosal surfaces, mainly backs of hands, palms and forearms; also feet, toes, mouth. It is a vasculitis, the causes of which are many but mainly unknown (50%) and herpes simplex virus. Mainly seen in children and young adults.
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Stevens–Johnson syndrome
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A very severe and often fatal variant. Sudden onset with fever and constitutional symptoms.
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Identify and remove cause (e.g. withdraw drugs). Symptomatic treatment (e.g. antihistamines for itching). Refer severe cases—usually need hospitalisation and high doses of steroids.
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Characterised by the onset of bright red, raised, tender nodules on the shins and sometimes thighs and arms.
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Sarcoidosis (commonest known cause)
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Infections (e.g. tuberculosis, streptococcal)
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Inflammatory bowel disorders
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Drugs (e.g. sulphonamides, antiepileptics, penicillin)
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Unknown (50%)
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Tests include FBE, ESR, chest X-ray (the most important), Mantoux test.
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Identify the cause if possible. Rest and analgesics or NSAIDs for the acute stage. Systemic corticosteroids speed resolution if severe episodes.
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There is a tendency to settle spontaneously over 3–4 wks.
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Hand, foot and mouth (HFM) disease
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HFM disease affects both children and adults but typically children <10 yrs. The lesions develop on hands, palms and soles (usually lateral borders) and vesicles lead to shallow ulcers on buccal mucosa, gums and tongue. Caused by a coxsackie A virus.
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Reassurance and explanation (lesions resolve in 3–5 d). Symptomatic treatment: careful hygiene