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• Macule – flat lesion ,usually a circumscribed change of colour
• Papule – small , solid, elevated lesion
• Nodule – a large , solid , palpable and elevated lesion
• Plaque – a lesion slightly raised over a larger area
• Blister – an elevated lesion ,fluid filled
• Ulcer – depressed lesion with loss of surface epithelium
• Atrophy – a depressed lesion with intact surface epithelium
• Crust – a mixture of scale and serum – yellowish accretions on the
surface of a lesion
• Petechiae – non raised red-brown non blanchable lesions
Summary of Paediatric Skin Rashes: Adapted from Paediatric Handbook
6th Ed. Royal Children's Hospital, Melbourne
• Name the rash
• What causes this condition
• Name 2 types of this condition
• How do you treat this condition
• Pictures – Derm atlas
• Oxford Handbook of Dermatology for
primary care ,Saxe ,Jessop
• Topics in Paediatrics ,Basson& Ginsberg
1-Chicken-pox , Varicella zoster virus
2-Crops of vesicles mainly on the trunk and head.
-Pass through various stages of
papule, vesicle, pustule and crust.
3-Symptomatic :analgesia – paracetamol for
discomfort and pyrexia.
-pruritis – antihistamine or calamine lotion
- acyclovir only for those at risk of complications
• 2-staph areus and streptococcal pyogenes
• 3-Thin–roofed vesicles or bullae surrounded by
narrow margin of erythema. The vesicles /bullae
rupture to release thin cloudy yellow fluid. This
fluid dries to form thick yellow crusts.
- antibiotics – flucloxacillin or erythromycin
1-Kawasaki Disease, systemic vasculitis
2- Classical features of Kawasaki disease
• Fever lasting ≥5 days
• Marked irritability of the child
• Erythema, swelling and desquamation affecting the skin of the extremities
• Bilateral conjunctivitis
• Inflammation of the lips, mouth and/or tongue
• Cervical lymphadenopathy
3- coronary artery aneurysms
4 -Intravenous Immune Globulin 2g/kg x1
– 80-100 mg/kg/day until fever x 14 day, then
– 3-5mg/kg/day x ≥ 6-8 weeks
2-Mite –sarcoptes scabeii
3 -Clothes, towels, and bed linen should be machine-washed (at 50
degrees Celsius or above) to prevent re-infestation and
transmission. Items that cannot be washed can be kept in plastic
bags for at least 72 hours to contain the mites until they die.
-benzyl benzoate lotion ,apply for 24hours ,may be repeated in 1 week
Antiscabial soap alone is not an effective treatment
Babies <2 months -5% sulphur ointment
2-single stranded RNA Morbillivirus from the paramyxovirus family.
• Prodrome - lasts 2-4 days with fever, runny nose, mild conjunctivitis and diarrhoea.
Koplik spots are pathognomic and appear on the buccal mucosa opposite the second
molar teeth as small, red spots each with a bluish-white speck (sometimes compared
to a grain of rice) in the centre.6 They occur in 60-70% of patients during the
prodrome and for up to 2-3 days before the onset of the rash.
• Rash - (morbilliform = measles-like) first seen on forehead and neck and
spreads, involves trunk and finally limbs over 3-4 days. It may become confluent in
some areas. Rash then fades after 3-4 days in the order of its appearance. It leaves
behind a brownish discoloration sometimes accompanied by fine desquamation.
4-Uncomplicated measles is usually self-limiting and treatment is mainly symptomatic
with paracetamol or ibuprofen and plenty of fluids. Patients should remain at home to
limit disease spread.
It is a notifyable disease
1- erythema infectiosum, slapped cheek disease, slapped cheek syndrome, fifth
disease, Parvovirus B19 (PV-B19), Sticker's disease
2- Parvovirus B19
3- After 3-7 days, the classic 'slapped cheek' rash appears as erythema on the
cheeks, sparing the nose, peri-oral and peri-orbital regions.6 This disappears after 2-
• About 1-4 days after the facial rash appears, an erythematous macular/morbilliform
rash develops on the extremities, mainly on the extensor surfaces.7 It is usually not
itchy in young children, but may be itchy in older children and adults. This gradually
fades over the next 3-21 days, but may recur in reaction to various stimuli such as
exercise, heat and sunlight
4- It is usually mild and self-limiting in healthy people. It may also cause fetal loss or fetal
hydrops, reactive arthritis in adults, and severe anaemia in those with haematological
conditions or immunocompromise.Detection in pregnancy is important for monitoring
and possible treatment.
1-Napkin /Daiper dermatitis
2- Contact dermatitis
prolonged exposure to urine and faeces, friction
mild erythematous ,glazed appearance
salmon coloured greasy lesions and a predilection for intertriginous
beefy red in colour with pin point pustulo-vesicular satellite lesion
3- frequent daiper changes
barrier cream zinc and caster oil
apply hydrocortisone 1% in aqueous cream bd
if candidiasis suspected -10% steriod and nystatin 20% in zinc cream
• 1- tinea capitis
• 2- fungal infection by a group of organisms
• 3-griseofulvin for 6 weeks ,10mg/kg
2-From direct innoculation of pox virus
3-tend to heal spontaneously within 6 months – 1
-liquid nitrogen 2-3 weeks
-express contents with sharp curette
-benzoyl peroxide cream apply daily
2-Miliaria is a common disorder of the eccrine sweat glands that often occurs in
conditions of increased heat and humidity. It is thought to be caused by blockage of
the sweat ducts, which results in the leakage of eccrine sweat into the epidermis or
• -miliaria crystallina-clear superficial pinpoint vesicles
• -miliaria rubra –(prickly heat )-small discrete red papules,vesicles,papulovesicles
4-No compelling reason to treat miliaria crystallina exists because this condition is
asymptomatic and self-limited. he prevention and treatment of miliaria primarily
consists of controlling heat and humidity so that sweating is not stimulated. Measures
may involve treating a febrile illness; removing occlusive clothing; limiting activity;
providing air conditioning.
• Topical treatments that have been advocated involve lotions containing calamine