12 Rashes

Viral Exanthems

slapped cheek disease, fifth disease
path: parvo B19
symptoms: slapped cheek, fever and rash at same time. Lacy rash in glove stocking distribution
diagnosis: clinical
treatment: support
f/u:
- Can go back to school immediately
- if Hgb problems, aplastic crisis
- hydrops fetalis: if mom pregnant with another kid, isolate from current B19 kid

aka rubeola
path: paramyxovirus
Symptoms
- fever and rash same time, begin on face, spread to trunk and arms. Also rash clear top to bottom
- prodromes: cough, coryza (runny nose), conjunctivitis, koplik spot (white dots in mouth)
diagnosis: clinical
treatment: supportive
prevent: MMRV vaccine. Give Vitamin A to prevent secondary pneumonia
f/u: develop subacute sclerosing panencephalitis. Post measles pneumonia staph aureus from destroying elevator.

aka rubella
path: rubella
symptoms
- fever and rash
- rash on face, then spread to trunk and arms
- prodrome: generalized and posterior LAD
diagnosis: clinical
treatment: support
prevention: MMRV

path: HHV 6
symptoms
- prodrome: high spiking fever, >104
- rash: after fever breaks
- rash: starts on trunk and expands outward
diagnosis: clinical
treatment: supportive, control fevers with acetaminophen
f/u: febrile seizures, viral otitis media

path: varicella
- adult: shingles
- baby: chickenpox
symptoms
- rash without fever
- diffused, vesicules on erythematous base, in different stages of healing (eruption, ulceration, crusting)
- itchy, painful, all over body
- shingles: immunocompromised due to aging, >60. Painful prodrome, vesicular rash inside dermatome, do not cross midline. Control pain. Shingles vaccine
diagnosis
- clinical
- don't do Tzank for chickenpox. Only use for herpes
- don't do PCR
treatment
- kid: supportive
prevention: do not do pox parties. Use MMRV

Mono like fever and pharyngitis:

HIV
EBV: monospot only good for > 4yo because no good immune IgG against heterophile antibody.
CMV
Strep

Last updated 4 years ago