Rashes of Childhood
Causes of Childhood Rashes
- Positive family history of atopy – eczema, asthma, allergic rhinitis
- Itching (pruritus) is main symptom (If NO itch, then it’s not eczema!)
- Infant >2mo: Rash on face and trunk
- Older child: Flexor/Friction surfaces
- Streptococcal and/or staphylococcal skin infection
- Localised, highly contagious (infected child should not go to school)
- Common with pre-existing skin disease eg. Eczema
- Lesions usually on the face, neck and hands
- Erythematous macules (initially), then vesicular/pustular or bullous
- Ruptured vesicles – ‘honey crust lesions’
- Bollous impetigo – uncommon, blistering form of impetigo in the newborn, Staph Aureus
- Human Herpes Viruses 6 & 7
- Scarlet Fever (+ strawberry red tongue)
- Kawasaki's Disease (+ strawberry red tongue)
- 'Fifth Disease'
- Henoch-Schonlein Purpura
- Idiopathic Thrombocytopenia
- Shingles (varicella zoster, classically dermatomal in distribution)
- Herpes Simplex
- Hand, Foot & Mouth Disease
- Mongolian Blue Spots
- Erythema Toxicum
- Strawberry Haemangioma
Identification and Pathology of Purpuric Rashes
This is a systemic vasculitis involving the deposition of IgA in the skin and kidneys. Henoch-Schonlein Purpura resolves spontaneously. It causes arthralgia, and abdominal pain from small vessel vasculitis. This is often referred to as 'abdominal angina'. Moreover, Henoch-Schonlein Purpura can cause nephritic syndrome, via the deposition of IgA and C3 in the kidneys. Bedrest can be beneficial in treatment.
Idiopathic Thrombocytopenic Purpura (ITP)
ITP presents in an otherwise well child, as opposed to meningococcaemia, which is a more likely diagnosis in the unwell child. Presentation involves acute bruising, sometimes associated with bleeding from the gums, rectum and nose. ITP can sometimes present in response to a viral infection, and can become chronic. The typical treatment pattern involves a 'watch and wait' approach.
Important note: If a child is ill with purport, Meningococcaemia should be suspected.
Mongolian Blue Spots
This is a lesion in the form of a patch which can present on the neonate. It is important to recognise the appearance of Mongolian Blue Spots, as they can be mistaken for bruising associated with child abuse.