BUY THIS AS A STUDY CARD

A kid without a rash just isn’t a kid.

Chicken Pox

• Incubation: 10-21d, infective until crusted over
• Rash: vesicles on macules (dewdrops on rosepetals),
• Very pruritic!
• Other symptoms: 1-3d prodrome of fever and respiratory symptoms
• Treatment: supportive, acyclovir for severe disease, VZIG for post-exposure prophylaxis
• Complications: 1st or 2nd trimester = congenital varicella syndrome

Roseola

• Incubation: 5-15d
• Rash: pink macules and maculopapules, starts on neck.
• Non-pruritic!
• Other symptoms: HIGH FEVER, cough, respiratory symptoms, erythematous pharynx, tonsils & TMs
• Treatment: supportive
• Complications: febrile seizures
• * Generally affects kids <5 years old

Measles

• Incubation: 10-14d, dx with measles IgM
• Rash: maculopapular, starts on face.
• Non-pruritic!
• Other symptoms: the 3 Cs
  • 1) Cough 2) Coryza (runny nose) 3) Conjunctivitis
  • Koplik spots in mouth 1-2d before rash
• Treatment: supportive, prophylactic Ig
• Complications: secondary bacterial infection, encephalitis (1:1000), subacute sclerosing panencephalitis (1:100000)

Rubella aka German Measles

• Incubation: 14-21d, infective 5d before rash and 7d after
• Rash: pink maculopapular, starts on face.
• Pruritic!
• Other symptoms: non-specific
• Treatment: supportive
• Complications: congenital rubella syndrome (very bad*), first four months of pregnancy highest risk (this is why we check rubella immunity status in prenatal screening)

* Congenital Rubella Syndrome
“Blueberry muffin baby” (purpura). Cataracts/congenital glaucoma, congenital heart disease, hepatosplenomegaly, jaundice, microcephaly, developmental delay

Fifth Disease aka Erythema Infectiosum

• Incubation: 4-14d, infective prior to onset of rash
• Rash: slapped cheeks (raised uniform maculopapular lesions on cheeks), may appear on extensor surfaces
• Usually not pruritic
• Other symptoms: flu-like illness ~3d prior to rash
• Treatment: supportive, blood transfusions if aplastic crisis
• Complications: arthritis (10%), vasculitis
  • Aplastic crisis: reticulocytopenia, not bad in normal people, very bad anemia if you already have chronic hemolytic anemia
  • During pregnancy: fetal hydrops/fetal loss

* This is a good one to actually know the virus name! PARVOVIRUS B19

Other rash descriptors to think about

• Sandpaper rash: scarlet fever (Group A Strep), they also have strawberry tongue, fever and sore throat
• Pink macules with central clearing: erythema marginatum (one of the major Jones criteria for rheumatic fever)
• Palpable purpura: Henoch-Schonlein Purpura
• Non-blanching petechiae: BAD (meningococcal disease), could be other things too, but need to rule out meningitis