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Common Exanthems

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Hand, foot & mouth disease. Pityriasis rosea. Asymmetric periflexural exanthem of childhood (APEC) ... Hand Foot and Mouth Disease. Common acute febrile ... – PowerPoint PPT presentation

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Title: Common Exanthems


1
Common Exanthems
  • Adam Goldstein, MD
  • Associate Professor
  • UNC Department of Family Medicine
  • Chapel Hill, NC
  • aog_at_med.unc.edu

2
Objectives
  • Understand nomenclature for common exanthems
  • Know an appropriate differential dx for most
    exanthems
  • Improved ability to diagnose
  • Measles (rubeola)
  • German Measles (Rubella)
  • Chicken Pox (Varicella)
  • Fifth Disease (Erythema infectiosum)
  • Roseola (exanthem subitum)
  • Hand, foot mouth disease
  • Pityriasis rosea
  • Asymmetric periflexural exanthem of childhood
    (APEC)
  • Kawasaki disease
  • Smallpox
  • Scarlet fever
  • Drug eruptions
  • Unknown exanthems

3
Exanthems
  • Anyone of a number of systemic processes giving
    generalized eruption
  • Usually not isolated
  • Caused by
  • Viruses
  • Bacteria
  • Fungal
  • Drugs
  • Idiopathic

4
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5
Exanthems (Historical)
  • 1 Measles
  • 2 Scarlet fever
  • 3 Rubella
  • 4 "Dukes' disease- ? measles, rubella, scarlet
    fever, Staph infection, or one of several
    unspecified enteroviral infections
  • 5 Erythema Infectiosum
  • 6 Roseola.

6
Measles (Rubeola)
  • Diff Dx
  • S/Ss Fever, conjunctivitis, cough
  • Characteristic Koplik spots 24-48 hours before
    rash
  • Rash
  • Days 4-5, red blotchy
  • begins on face behind ears
  • usually with onset high fever
  • spreads to body
  • Usually spares palms/soles
  • Rash coalesces on trunk/face

7
Rubella (German measles)
  • "little red 3rd Disease
  • Schoolchildren highest infectivity in
    unvaccinated populations
  • Congenital Rubella Syndrome
  • deafness, eye lesions, heart malformations mr
  • 24 cases 1997-1999, mostly immigrant
  • 25-50,000 cases Mexico 1998
  • Higher suspicion cases in patients immigrating
    from countries with higher rates
  • Vaccination contraindicated pregnancy

(MMWR, 2001)
8
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9
Rubella
  • Diffuse rash, LN enlargement, h/a, malaise, mild
    cough and conjunctivitis
  • Pink rash appears on face and spreads to body

www.info.gov.hk/dh/diseases/ CD/rubella.htm
10
Chicken Pox- Varicella
  • caused by varicella-zoster virus
  • blister-like rash, itching, fatigue fever
  • 250-500 itchy blisters, 3 stages at same time
    (papule, vesicle, scab)
  • 1 in 10 complications bacterial, pneumonia,
    encephalitis

11
Chicken Pox- Varicella
12
Fifth Disease (Erythema infectiosum)
  • Parvovirus B19
  • S/Ss low fever, cold, mildly ill
  • Skin
  • "slapped-cheek" rash on face
  • lacy red rash trunk limbs
  • infected adults may develop joint pains hands,
    wrists, knees
  • kids may return to school- no longer infectious
  • pregnant women exposed- refer to guidelines

(Crane J, J Obstet Gynaecol Can, 2002)
13
Roseola/Exanthem Subitum
  • Human Herpes Virus 6gt7
  • spread via saliva
  • 72-95 sero in US early age
  • S/Ss irritable, diarrhea, cough, fever
    102-105F, for 3-7 days 10 seizure
  • Skin
  • As fever resolves, faint macules develop on trunk
    and extremities that blanch upon pressure
  • Rash resolves 1-2 days

14
Roseola/Exanthem Subitum
  • Skin
  • As fever resolves, faint macules develop on trunk
    and extremities that blanch upon pressure
  • Rash resolves 1-2 days

15
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16
Hand Foot and Mouth Disease
  • Common acute febrile illness of children
  • Group A coxsackie viruses
  • 2-7 days resolves
  • Hand washing
  • Rare complications

17
HFM Disease
  • hand
  • foot
  • mouth

18
Pityriasis rosea
  • Unknown cause
  • Lasts 6-12 weeks
  • Herpes viruses 6 7 associated
  • Herald patch 1-20 days before rash
  • Sometimes confused with T. Corporis or psoriasis

19
Pityriasis rosea
  • Oval patches follow line of ribs like fir tree
  • Erythromycin may be effective tx

(Sharma, JAAD, 2000)
20
Asymmetric periflexural exanthem of childhood
(APEC)
  • Laterothoracic exanthem
  • Uncommon, G gt B
  • Viral symptoms can occur
  • Often mistaken for eczema, fungal
  • Skin
  • Usually starts in armpit or groin and extends
    outwards, on one side of body
  • May spread to face, genitalia, hands or feet
  • Patches are net-like or in rings
  • Pruritic
  • Resolves within 3 months

21
Kawasaki disease
  • 80 in children lt 4 years
  • Self-limiting resolves spontaneously without
    treatment 4-8 weeks
  • 15-20 have damage to coronary arteries and 2 of
    patients die from heart attack

(Brogan PA, Arch Dis Child, 2002)
22
Kawasaki disease
23
Kawasaki disease
24
Kawasaki disease
http//www.dermnetnz.org/index.html
25
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26
Smallpox
  • Classic generalized exanthem
  • Latin word for spotted referring to the raised
    bumps on the face and body
  • Rash, high fever mortality rate 30
  • Last natural case Somalia in 1977

http//www.bt.cdc.gov/agent/smallpox/overview/dise
ase-facts.asp
27
Smallpox
  • Exanthem from vaccination
  • 1/100,000
  • Vaccinia rash or outbreak of sores
  • Generalized vaccinia
  • Erythema multiforme

http//www.bt.cdc.gov/agent/smallpox/
28
Smallpox
  • From Vaccination
  • 1/50,000
  • Eczema vaccinatum
  • Progressive vaccinia
  • Postvaccinal encephalitis

29
Scarlet fever
  • Group A streptococcus toxin
  • children aged 4-8
  • contagious by coughing/sneezing or touching the
    infected skin
  • sudden fever with sore throat, swollen LNs, h/a,
    n, v, loss of appetite, swollen and red
    strawberry tongue, abdominal pain, body aches,
    and malaise

30
Scarlet fever
  • Skin
  • rash 12-48 hours after fever
  • ears, neck, chest, armpits, groin, then rest of
    body over 24 hours
  • scarlet spots or blotches, often the first sign
  • starts to look like sunburn with goose pimples
  • skin may have a rough sandpaper-like feel
  • as rash fades, it peels similar to that of
    sunburned skin

31
Drug eruptions
  • Almost all drugs

32
Drug eruptions
  • Dilantin

33
Drug eruptions
  • Minocycline

34
Drug eruptions
  • Fixed drug eruption

35
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36
Unknowns 1
37
Unknowns 2
38
Unknowns 3
39
Unknowns 4
40
Unknowns 5
41
Unknowns 6
42
Unknowns 7
43
Unknowns 8
44
Unknowns 9
45
Unknowns 10
46
BONUS
47
BONUS
48
BONUS
49
References
  • Trizna Z. Viral diseases of the skin diagnosis
    and antiviral treatment. Pediatr Drugs
    200249-19.
  • http//home.mdconsult.com/das/guideline/view/26827
    010/N/11196820?sid166362089sourceMI
  • Crane J. Parvovirus B19 infection in pregnancy. J
    Obstet Gynaecol Can 2002 24 727-43.
  • Glatman-Freedman A. Rubella vaccine. Pediatr Rev
    2002 23(3) 106-7.
  • Smallpox Vaccine. Pediatrics 2002. American
    Academy of Pediatrics, Committee on Infectious
    Diseases 110 4.
  • Bromberg K. Group A beta-hemolytic streptococcal
    pharyngitis. Am Fam Physician 2001 63(8)
    1486-7.
  • Bisno AL. Practice guidelines for the diagnosis
    and management of group A streptococcal
    pharyngitis. Infectious Diseases Society of
    America. Clin Infect Dis 2002 35(2) 113-25.

50
References
  • Gable EK. Pediatric exanthems. Prim Care 2000
    27 353-69.
  • Brogan PA. Kawasaki disease an evidence based
    approach to diagnosis, treatment, and proposals
    for future research. Arch Dis Child 2002 86
    286-90.
  • Hairston BR. Viral diseases of the oral mucosa.
    Dermatol Clin 2003 21(1) 17-32.
  • De Araujo T. Human herpesviruses 6 and 7.
    Dermatol Clin 2002 20(2) 301-6.
  • Sharma PK. Erythromycin in pityriasis rosea A
    double-blind, placebo-controlled clinical trial.
    J Am Acad Dermatol 2000 42 241-4.
  • MMWR. Control and prevention of rubella
    evaluation and management of suspected outbreaks,
    rubella in pregnant women, and surveillance for
    congenital rubella syndrome. July 13, 2001 50
    1-23.

51
Thank you.
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