Pediatrics

Razan Abu Khaizaran

The basic of skin Rash Loading...

Description of Rashes

Description of Rashes Loading...

Approach to Rash of acute onset Ø Ø Ø Ø Ø Ø Ø

History : how the symptoms started ? Suspected prodrome symptoms Is he ill/febrile Are there associated symptoms ? Purpuric conditions Past medical history Immunization Contact with anyone ill

Approach to Rash of acute onset Physical examination : Ø general examination Ø Rash : • Characteristic : blench with pressure or not • Distribution • The presence of an enanathem

Rash characteristic

Definitions Exanthem – a skin eruption occurring as a symptom of a general disease

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Enanthem – eruptive lesions on the mucous membranes

Classic Childhood Exanthems q “1st Disease”-Measles q “2nd Disease” – scarlet fever q “3rd Disease – Rubella q “5th Disease- Erythema Infectiosum q 6th Disease- Rosolea infantum q Varicella-Zoster

“1st Disease”-Measles • • • • • •

Rubeola- 9 day measles RNA Paramyxovirus … very contagious At risk : - preschool age children unvaccinated Season : late winter/spring Incubation: 10-12 days before prodrome symptoms Infectious : 1-days before prodrome to 4 days after onset of rash .

Pathophysiology

2-3 days

4-7 days

7-11 days

Clinical manifestation Ø Ø Ø Ø

Four phases : incubation 10-12 d prodrome (catarrhal) exanthematous (rash) Recovery

3d Maculopapular eryth. Descending, 4-7 d

Prodrome phase After 10 days of incubation lasts for 3 days Prodrome symptoms: v 3Cs : cough , coryza , conjunctivitis, fever

enanthem v Koplik spots.. Pathogonomic Then after 12- 24 hours of enanthem the rash phase

Koplik Spots

Buccal mucosa

Rash phase

• After 14 days of incubation period/ after 3 days of prodrome

symptoms . • Rash + fever

• Fever : high grade ( 40 c)/ baby looks ill • Rash : maculopapular erythematous rash • Starts on the back of ears spreads to the head and neck before

spreading to cover most of the body in 24 hours in a descending fasion • Lasts for 4-7 days .. Disappear in the same manner • as it disappears( in stains )changing color from red to dark brown and desquamate • The rash could be petechial or hemmoragic ( black measles)

Measles Rash

Diagnosis Clinically serology : IGM within 1-2 days after rash and to 1 -2 months

Treatment Ø Ø Ø

Supportive : Vitamin A : improve outcome highly recommended in children btw 6 months and 2 years requiring hospitalization immunocompromised

Complications: Pneumonia : Ø bacterial pneumonia : the most common complication & the most common cause of morbidity Ø interstitial pneumonia Ø Giant cell (Hecht) pneumonia cell mediated immunity compromised Otitis media

Complications: Encephalomyelitis: Early : due to direct viral infection Late : demyelinating due to immunologic process Subacute sclerosing panencephalitis after 8 to 10 years

MMR vaccine • Live attenuated vaccine • For children at 12-15 months • • • • •

5% not covered in first one so give another

4-6 years ( not a booster dose) CI: immunocompromised states conginetal immunodefieciency sever HIV infection ( but recommended in those who do not have evidence of sever immunosuppressant ) leukemia lymphoma

• cancer therapy ( but recommended in those in remission

who did not receive chemotherapy in last 3 months • Immunosuppressive course of corticosteroids (>= 2 mg/kg/day for >= 14 days ( in those who toke these doses after one months recommended) • Pregnancy • Recent administration of IG(3 to 11 months ) modified measles

“2nd Disease”-Scarlet fever Due to erythrogenic exotoxin-producing group A beta-hemolytic streptococci At risk: