Rash

Question 1

Rash history

Answer 1

• PC
  
  • Duration & onset
    
    • Was there a prodrome?
      
      • Cough
      • Cold
  • Location
    
    • Where did it start?
    • Has it spread anywhere else?
  • Has it changed over time?
  • Previous episodes
  • Associated symptoms
    
    • Itch
    • Tenderness
    • Bleeding or discharge
    • Systemic symptoms
      
      • Infective
        
        • Fever
        • Immunisations?
      • IBD
        
        • Diarrhoea
        • Abdominal pain
      • Meningitis
        
        • Nuchal rigidity
        • Headache
        • Photophobia
        • Tumbler test?
• Triggers
  
  • Allergies
    
    • Food
    • Medication
    • Pets
  • Travel/Come into contact with others with rash?
• Provoking or relieving factors
  
  • What have they tried?
• PMH
  
  • Skin conditions
  • Atopy
  • Medications
  • Allergies
• Family history
  
  • Atopy
  • Psoriasis
• Obstetric history
  
  • Immunisations
  • Feeding (breast/bottle/weaned)
• Developmental history
• Social history
  
  • Pets

Question 2

Chickenpox (Varicella)

Answer 2

• Varicella-zoster virus (highly infectious)
• Prodromal fever
• Crops of vesicles appear first on the head, then spread to the trunk and limbs
• Very itchy
• Natural history: Papule (‘drops of water’) → vesicle → pustule → crust
• 3-5 days

Question 3

Measles

Answer 3

• Presents as discrete, erythematous maculopapular rash behind the ears, then spreads downwards to the whole body. Rash becomes blotchy and confluent.
• Koplik’s spots (white spots on the inside of the mouth)
• Prodrome - 4 Cs
  
  • Cough
  • Coryza
  • Conjunctivitis
  • Very Cranky!

Question 4

Rubella (German measles)

Answer 4

• Pink macules and papules starting on the forehead and spreading to the face, trunk and extremities on the first day.
• Fades from the face on the second day and the rest of the body by the third day.
• Low fever
• (Looks similar to measles)

Question 5

Henoch-Schonlein purpura (HSP)

Answer 5

• Palpable, non-blanching rash
• Usually occurs on the legs
• Tetrad
  
  • Rash
  • Abdominal pain
  • Arthritis/arthralgia
  • Glomerulonephritis

Question 6

SLE

Answer 6

• Malar ‘butterfly’ rash

Question 7

IBD

Answer 7

• Erythema nodosum

Question 8

Idiopathic thrombocytopenic purpura

Answer 8

• Occurs following infection or immunisation
• Self-limiting, resolves spontaneously after 6-8 weeks

Question 9

Kawasaki disease

Answer 9

• Fever > 5 days + 4 of the following:
  
  • Conjunctivitis
  • Red mucous membranes
  • Cervical lymphadenopathy
  • Rash
  • Peeling of fingers and toes
• Complications
  
  • Coronary artery aneurysms
  • Sudden death
• Rx
  
  • IV immunoglobulin
  • Aspirin