Rashes

Question 1

• Diffuse, red, small, papular, goose-like sandpaper rash
• Blanchable
• Pastia’s lines (reddened axillary skin creases)
• Circumoral pallor (ring of paleness around mouth)
• Strawberry tongue (red, bumpy tongue)
• Eventually desquamates

Answer 1

Group A Strep - Scarlet Fever

(Scarlatiform Rash)

• Fever, sore throat, HA, LAD, sandpaper rash
• 5-15yo
• 2/2 exotoxins A-C
• GAS = Strep pyogenes
• Long-term sequelae:
  
  • PSGN
  • Rheumatic heart disease
  • Arthritis

Question 2

Erythema Infectiosum

Answer 2

Parvovirus B19 “slapped cheeks” rash

(Children)

Question 3

Erythema Migrans

Answer 3

Early Lyme disease target rash

• Can appear anywhere between 1-30d after tick bite

Question 4

Erythema Multiforme

Answer 4

HSV or Drugs

(IgM complexes)

• If HSV: pruritic & painful
• If Drugs: EM → SJS → TEN
  
  • Think multiforme = “multiple forms” → Final boss w/ many forms is the biggest and baddest of the “erythemas”

Question 5

Erythema Nodosum

Answer 5

Inflammation of the fat cells under the pretibial skin

(Panniculitis = adipose cell layer inflammation)

• Strep (children), Sarcoidosis, TB, IBD, Behçet disease, NHL, Sulfa drugs, OCPs
• Self-limited–resolves within a few weeks
• W/u:
  
  • CXR - Sarcoidosis, TB
  • Anti-streptolysin-O titer - Strep infection
  • VDRL - Syphilis
  • CBC, ESR

Question 6

Erythema Toxicum

Answer 6

Extremely common neonatal rash

(Benign; ~50% of term neonates)

• Appears @ 2-5d
• Resolves within first 2 weeks of life
• Small papular lesions each on a separate reddened base
• Thought to be due to immune activation

Question 7

Answer 7

• Pemphigus Vulgaris
• TEN (Toxic Epidermal Necrolysis)
• SSSS (Staphylococcal Scalded Shock Syndrome)

Question 8

Answer 8

Erythema Multiforme

• HSV or Drugs
• EM → SJS → TEN
• Multiforme = final boss has multiple forms = bad

Question 9

Answer 9

Impetigo

(Strep school sores)

• Highly contagious skin infection which causes sores and blisters
• Very common, affects mainly children
• Two types:
  
  • Bullous impetigo: Large, painless, fluid-filled blisters
  • Non-bullous impetigo: More contagious; sores quickly rupture (burst) and leave a yellow-brown crust

Question 10

Answer 10

A. Scarlet Fever

(GAS - Strep pyogenes)

Key Associations:

• Sandpaper
• Strawberry tongue
• Perioral pallor
• Pastia’s lines
• Blanchable
• Desquamation

Question 11

Answer 11

D. Infectious Mononucleosis

(EBV)

Question 12

Answer 12

D. Kawasaki Disease

(Post-viral mucocutaneous LN syndrome)

CRASH & Burn:

• Conjunctivitis (BL, nonexudative)
• Rash (desquamating or other)
• Anterior Cervical LAD (>1.5cm, UL)
• Strawberry tongue or lip mucositis
• Hand/foot edema +/- erythema
• Fever _>_5d

Question 13

Answer 13

B. Rubella

Question 14

Answer 14

Livedo Reticularis

• Reticular, lacy skin discoloration/erythema that blanches on pressure
• Causes:
  
  • Cholesterol Embolism (+ blue toe syndrome, +post-cardiac cath)
  • Amantadine side-effect (Parkinson drug; +ankle edema)

Question 15

Answer 15

Tuberous Sclerosis

(Hypopigmented macule)

• Occur in 80% of infants with Tuberous Sclerosis by 1 year of life