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Exanthem
- Exanthem means widespread rash. This may be caused by drugs, autoimmune disease, bacterial or viral infection.
- The exanthems discussed in medicine include a group of viral infections seen in children.
- Six childhood exanthems were named and numbered in 1905
- First disease Rubeola (Measles)
- Second disease Scarlet Fever
- Third disease Rubella (German Measles)
- Fourth disease was probably a Staph infection but is no longer part of the list
- Fifth disease Erythema infectiosum
- Sixth disease Erythema infantum (Roseola)
Rubeola (Measles)
- Caused by a paramyxovirus
- Highly contagious
Clinical Presentation
- Fever
- Malaise
- Coryza
- Fancy way to say, nasal mucous membrane inflammation with
- Stuffy nose
- Runny nose
- Post nasal drip
- Sneezing
- Fancy way to say, nasal mucous membrane inflammation with
- Cough
- Conjunctivitis
- Koplik spots are pathognomonic – These a clusters of white spots on the buccal mucosa. These fade as the rash begins to appear.
- Rash
- Appears 3–5 days AFTER first signs of illness and may last up to a week
- Begins behind the ears moves to the face and neck and then travels down
- Red blanching macules
- Pruritic
- Lesions darken to brown and fade in the order that they appear
Labs and Studies
- Clinical diagnosis
- Viral culture
Treatment
- Supportive care
- Self limiting disease only progressing with secondary infection
- Live attenuated vaccine is given at 12 months old and a booster is given before a child enters school
Scarlet Fever
- Strep throat with a rash
Clinical Presentation
- Symptoms of strep throat
- Rash
- Feels like “sandpaper”
- Looks like a painful sunburn with tiny bumps that blanch with pressure
- May be itchy
- Starts on neck, face and chest with circumoral pallor
- Lasts about 6 days and desquamates (peels)
- Bright red swollen strawberry tongue (also seen in Kawasaki)
Treatment
- Penicillin or Amoxicillin x 10 days
Rubella (German Measles)
- The biggest issue here is that if a pregnant mother gets rubella within the first 20 weeks of pregnancy there is a 20% risk of spontaneous abortion. In addition to this the child may have severe permanent congenital defects.
Clinical Presentation
- Flu like symptoms for about a week
- Rash on the face which spreads to the trunk and out to the extremities
- Typically fades after about three days
Labs and Studies
- Diagnosis is made clinically
Treatment
- Live attenuated virus for vaccination
- Supportive treatment
Erythema infectiosum (Fifth disease, slapped cheek)
- Caused by a parvovirus.
- No longer contagious once the rash appears
Clinical Presentation
- Fever
- General malaise
- Headache
- Rash
- Red macular rash found on the cheeks with circumoral pallor
- Lacy red rash on the trunk arms and upper legs
- Swelling and painful joints
Labs and Studies
- Clinical diagnosis
Treatment
- Supportive care
Erythema Infantum (Roseola)
- Caused by human herpesvirus 6 and 7
Clinical Presentation
- Child < 2 years old
- High fever up to 105 for several days then the fever drops
- Rash appears as fever drops
- Rash is pink maculopapular rash
- Begins on the trunk
- Lasts a few hours or up to three days
Labs and Studies
- Clinical diagnosis
Treatment
- Supportive care
- Monitor fever closely. Roseola is the number one cause of febrile seizures.