Paediatric Exanthems

Dr. Elena Pope, MSc, FRCP

Paediatric Dermatology
SickKids Hospital

QUIZ
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Definition
Exanthem= skin eruption as symptom
of a systemic disease usually
associated with fever
Enanthem= mucosal involvement in
the context of an exanthem

15 mos girl, recent immigrant,

presents with a 2 day history of
fever, runny nose and a
generalized skin rash

Measles
Incubation : 8-13 ds
Communicability: 4 ds before
and after the rash
Isolation: respiratory

Measles
Rash ( morbiliform)
Conjunctivitis
Coryza
Cough

Measles
Rash:
Erythematous
Maculopapular
Starts at the hairline and spreads to face,
neck and trunk
Fades in order of appearance
Desquamates ( no palms and soles)

Measles
Complications:
Pneumonia
Otitis media
Encephalitis
Rare: myocarditis, pericarditis,
thrombocytopenia, glomerulonephritis
Subacute pansclerotic encephalitis

Measles
Treatment:

Patients
Symptomatic
Vit. A
Contacts
Ig
MMR

Prevention:

MMR - 12 months and booster at 4-6

years (MMRV)

12 yo girl, previously healthy,

presents with low-grade fever, and
a discrete maculopapular rash

Rubella
Rash
Pink
Maculopapular
Face
neck

trunk

Occipital and retroauricular nodes

Low grade fever

Rubella
Incubation: 14-21 ds
Communicability: 7 ds pre-/post eruption

STAR complex (sore throat, arthritis,

rash)
Complications:

Congenital rubella:

Deafness
Congenital heart disease
Cataract, glaucoma
Thrombocytopenia
Hepatitis

Rubella
Management:
Treatment: symptomatic
Prevention:
Immunization:
MMR 12 mos
Booster (MMRV)- 4-6 years

9 mo old boy, presents with a 3

day history of high fever and an
episode of shaking. 1 day after
hospital admission his fever
resolved, but developed a faint
rash.

Roseola ( exanthem subitum)

Etiology: HHV 6
Incubation: 5-15 ds
Communicability: unknown
Complications: none

Roseola
Rash:
Appears when fever subsides
Pink, maculopapular
Neck-arms-trunk + face

Posterior cervical
lymphadenopathy
Enanthem - Nagayama sign
10-25% febrile seizures

9 yo boy, previously healthy,

comes to your office with a 2 day
history of low-grade fever,
malaise, and red cheeks.

Erythema infectiosum
(5th disease)
Rash:

Red, flushed cheeks ( slapped cheeks)

Maculopapular eruption
lacy-like
trunk, extremities
Can reappear wks-mos later with exercise,
sun exposure

Erythema infectiosum
Etiology: parvo virus B19
Incubation: 4-14 ds
Communicability: unknown
Complications:
Aplastic crisis

Petechial
eruption
Anemia

Erythema
infectiousum

Parvo DNA

IgG
IgM

Infection

2 weeks

4 weeks

2 months

4 yo girl, comes in with a

generalized itchy eruption and
low-grade fever

Chickenpox ( varicella)
Etiology: HHV 3
Incubation period: 10-21 ds
Communicability: 1-2 ds pre-eruption
to 5 ds post eruption
Isolation: respiratory + contact

Chickenpox
Exanthem:
Crops of skin lesions ( q 2-3 ds)
Macule-papule-vesicle-crust
Multiple stage disease eruption
Itchy

Enanthem

Chickenpox
Complications:

Skin:

Bacterial suprainfection
Invasive group A Strep disease
(Necrotizing fasciitis)

CNS:

Acute encephalitis
Acute cerebellar ataxia

Systemic:

Hepatitis
DIC

Chickenpox
Treatment:
Symptomatic
Acyclovir only for complicated cases

Prevention:
VZIG: within 96 hrs (up to 1 week) from contact
Verivax- 15 months
85% effective for disease; 97% effective for severe disease

Booster at 4-6 years MMRV

2 yo girl, presents with low grade

fever and a vesicular eruption

Herpes simplex infection

Etiology: HHV 1,2
Exanthem:
Grouped vesicles on an erythematous base
Enanthem:
Vesicles/erosions
Buccal mucosa

2 yo girl, presents with refusal to

eat and a rash involving the hands
and feet

Hand-foot and mouth disease

Etiology: coxsackie group A
Exanthem:
Vesicles, pustules on an erythematous base
Acral distribution

Enanthem: vesicles involving tongue and posterior

pharynx
No treatment

Coxsackie virus A6 (CVA6)

80 North-American patients
Median age: 1.5 yr (range 4 mo-16 yr)
99% had a vesiculobullous/erosive eruption
61% had rash involving > than 10% BSA
Classical distribution
+
perioral, extremity and trunk

Coxsackievirus A6 (CVA6)
Four main morphologies:
1)Widespread vesiculobullous/ erosive lesions
2)Eczema coxsackium
3) Gianotti-Crosti-like eruption
4) Petechial/purpuric eruption

Gianotti-Crosti Syndrome
Papular acrodermatitis
Preceded by a viral prodrome
Rash: asymptomatic papules, cheeks, extremities
Resolves 3-12 weeks
Associations: EBV, HBV, coxsackie, parvo

2 yo boy, unwell for a few days is

seen in ER for fever and a skin
rash

Periflexural Exanthem
Sparing palms/soles/cheeks
Generalizes in 2-7 ds
Fever -40%
Lymphadenopathy -70%
Mean duration: 6 weeks
Presumed viral etiology

5 yo girl, comes in with 1 day

history of fever, headache, sore
throat and a generalized rash

Scarlet fever
Etiology: pyrogenic exotoxin GAS
Clinical presentation:
Exanthem:

Red papules
Sand-paper
Generalized
Flexural accentuation ( Pastias lines)
Desquamation

Enanthem: strawberry tongue, petechiae on the palate

15 mo old boy, presents with

several days of fever, extreme
irritability and a generalized
eruption

Kawasaki disease
Fever for 5 days +
4/5

Unilateral lymphadenopathy
Mucosal changes ( red, cracked lips,
strawberry tongue)
Extremities changes ( puffy, red hands and
feet)
Skin rash
Nonpurulent, bilateral conjunctivitis
Any morphology EXCEPT vesicular !!!