1. OSCE PAEDIATRIC
DERMATOLOGY
RASHES
Dr S FISH

2. Terminology
• 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

3. Summary of Paediatric Skin Rashes: Adapted from Paediatric Handbook
6th Ed. Royal Children's Hospital, Melbourne

4. SLIDE 1

5. SLIDE 1
1-Name condition and causative organism
2-Describe what you see
3-How would you treat it

6. SLIDE 2

7. SLIDE 2
1-Name the condition
2-What are typical causative organism
3-describe typical features
4-How would you treat it

8. SLIDE 3

9. SLIDE 3
1-Name the rash and the associated
syndrome
2-name infective and drug causes
3-describe typical features

10. SLIDE 4

11. SLIDE 4
• Name this disease ,what is its cause.
• Name the features
• Name a major complication of this disease
• treatment

12. SLIDE 5

13. SLIDE 5
• Name this condition
• What is the causative organism
• How do you treat it

14. SLIDE 6

15. SLIDE 6
• What is this rash
• Describe features

16. SLIDE 7

17. SLIDE 7
• What is this called
• What is the causative organism
• Describe features
• treatment

18. SLIDE 8

19. SLIDE 8
• What is the broad term used to describe
this condition
• Name the subset of conditions which
cause it.
• How do you treat this condition ?

20. SLIDE 9

21. SLIDE 9
• Name this condition
• What is the cause of it
• How do you treat it

22. SLIDE 10

23. SLIDE 10
• What is this called
• What organism causes it
• treatment

24. SLIDE 11

25. SLIDE 11
• Name the condition
• What causes this condition
• Describe the features
• How do you treat it

26. SLIDE 12

27. SLIDE 12
• Name the rash
• What causes this condition
• Name 2 types of this condition
• How do you treat this condition

28. References
• Pictures – Derm atlas
• Oxford Handbook of Dermatology for
primary care ,Saxe ,Jessop
• Topics in Paediatrics ,Basson& Ginsberg

29. SLIDE 1
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
or immunocompromised.

30. SLIDE 2
• 1-Impetigo
• 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.
• 4-topical-bactroban(mupirocin)
ointment/betadine cream
- antibiotics – flucloxacillin or erythromycin

31. SLIDE 3
1-Erythema Multiforme
Steven-Johnson Syndrome (mucous membrane involvement)
2-Drug
most commonly associated-Allopurinol5
Recent drugs- Nevirapine, lamotrigine, sertraline, pantoprazole, tramadol
Antibiotics- Sulphonamides, including co-trimoxazole, penicillin
cephalosporins, fluoroquinolones, vancomycin
NSAIDs-
Piroxicam, fenbufen, ibuprofen, ketoprofen, naproxen, tenoxicam, diclofena
c, sulindac
Anti-TB- Rifampicin, ethambutol, isoniazid, pyrazinamide
Anticonvulsants-
Barbiturates, carbamazepine, phenytoin, valproate, lamotrigine
- Infective herpes simplex
3-target lesion –round ,erythematous papules contain central blister or darker
area of necrosis

32. SLIDE 4
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
• Rash
• Inflammation of the lips, mouth and/or tongue
• Cervical lymphadenopathy
3- coronary artery aneurysms
4 -Intravenous Immune Globulin 2g/kg x1
• Aspirin:
– 80-100 mg/kg/day until fever  x 14 day, then
– 3-5mg/kg/day x ≥ 6-8 weeks
• echocardiograms

33. SLIDE 5
1-Scabies
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
-permethrin cream
Antiscabial soap alone is not an effective treatment
Babies <2 months -5% sulphur ointment

34. SLIDE 6
1-Measles
2-single stranded RNA Morbillivirus from the paramyxovirus family.
3- Symptoms
• 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

35. SLIDE 7
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-
4 days.
• 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.

36. SLIDE 8
1-Napkin /Daiper dermatitis
2- Contact dermatitis
prolonged exposure to urine and faeces, friction
mild erythematous ,glazed appearance
-Seborrhoeic dermatitis
salmon coloured greasy lesions and a predilection for intertriginous
areas.
- Candidiasis
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

37. SLIDE 9
• 1- tinea capitis
• 2- fungal infection by a group of organisms
called dermatophytes
• 3-griseofulvin for 6 weeks ,10mg/kg

38. SLIDE 10
• Meningococcal meningitis
• Neisseria meningitidis
• Cefotaxime

39. SLIDE 11
1-Molluscum contagiosum
2-From direct innoculation of pox virus
3-tend to heal spontaneously within 6 months – 1
year
-liquid nitrogen 2-3 weeks
-express contents with sharp curette
-benzoyl peroxide cream apply daily

40. SLIDE 12
1-Miliaria
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
dermis.
3-Two types
• -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