Rashes in Children (PAP18)
Notes by Isabel Viebla
- Usually starts in childhood <12 months
- Typically remits and relapses
- Classic distribution in kids – face and neck, toddlers – extensor surfaces
- older children/adults – flexural.
- Mainstay is avoid trigger and use emollients
- Step up and down treatment according to severity
- Take into account psychosocial aspects of the disease, not sleeping, avoiding activities etc when assessing severity
- Use lowest potency steroid possible
- Should see response in 3-7 days with steroid if not working step up or think about infection
- Other therapies include calcineurin inhibitors, wet wraps and phototherapy
- Don’t routinely prescribe antihistamines but sedating option eg. Chlorphenamine good for acute flares and if itch is a predominant symptom can have a 1 month trial of non-sedating option e.g. cetirizine.
Application advice for parents – use emollients all the time. Smooth down don’t rub in. Use 1 fingertip amount of corticosteroid to cover an area of skin the size of an adults palm size.
Eczema herpeticum should be admitted and treated with acyclovir.
Bites and stings:
- Reactions vary from local to life threatening.
Black widow and brown recluse main dangerous ones (not native to UK – mainly US/Canada) treat with good wound care.
- can cause muscle spasms and autonomic instability If necessary give benzodiazepines and beta blocker
- can cause progressive necrosis. Give Dapsone (exclude G6PD first). May need surgical referral for debridement.
Can be viewed as viral/bacterial/fungal/parasitic/tick bourne
Image attributes (click here)
- Is it measles? UMEM Education Pearls
- notifiable disease
- 10 days incubation
- fever disappears with presentation of the rash (starts on face and works down)
- look for complications – otitis media, pneumonia, encephalitis
- Supportive management
All you need to known about measles – LITFL
Image by nl.wikipedia –
- smooth umbilcated papules come and go over weeks and may last 12-18 months
- Contagious – use own towels etc.
- Don’t need to be off school
Scabies (images attributes)
recognise by itch – constant + usually a contact. Lesions can be anywhere. Look for burrows. Can do skin scraping to confirm diagnosis. Permethrin 5% 2 applications a week apart
don’t send serology unless clinically relevant. Erythema Migrans is diagnostic – give amoxicillin/doxycycline