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
