MORBILLIFORM

Rash/Exanthem Epidemiology Associated Symptoms Appearance Complications Treatment/Vaccination

Measles (Rubeola) - RNA virus Prodrome = 3Cs Exanthem - Otitis media - MMR vaccine given at 1
1. Cough - Morbilliform rash (erythematous - Pneumonia year + booster at 18
- Transmission by 2. Coryza macules and papules) - Secondary bacterial months
infectious droplets or 3. Conjunctivitis infection
airborne spread - Begin on head (hairline and - SSPE - Treatment is supportive
May also have anorexia, diarrhea, behind ears) and spread - Encephalitis
- IP: 10d abdominal pain cephalocaudally

- Spreads quickly over the face

and trunk → then coalesces to
a bright red then disappear in
the same order it appeared

- Fever peaks when rash

appears and usually falls 2-3
days after

Enanthem
- Koplik spots appear during
prodrome and disappear after
2-3 days (pathognomonic)
-

Scarlet fever - group A beta hemolytic May have suddenly high fever, - Sandpaper like rash on neck and - Rheumatic fever Penicillin within 10d of
streptococcus vomiting and abdominal pain during chest - Post streptococcal symptom onset to prevent
the incubation period Glomerulonephritis development of rheumatic
- Transmitted through - Accentuation of rash in skin folds = - Peritonsillar abscess fever
respiratory secretions Sore throat (Strep throat) Pastia lines - Retropharyngeal abscess
Erythromycin if allergic
- IP: 2-5d - Flushed face with circumoral pallor

- Children 1-10 years - Strawberry tongue

Rubella (3 day - RNA virus May have mild prodrome of low grade Exanthem Rare Supportive & symptomatic
measles or german fever, headache, conjunctivitis and - Fine maculopapular rash that
measles) - Transmission by upper respiratory symptoms become near confluent starting
direct/droplet contact with on face (not hairline) then
nasopharyngeal Lymphadenopathy (posterior spreading to cover whole body
secretions auricular and suboccipital nodes)
- Resolve within 3 days
- Infants with congenital
rubella syndrome are Enanthem
contagious for 12 months - Forscheinheimer spots =
pinpoint rose coloured macules
IP: 14-23 days on the soft palate (not unique
to rubella → May also be seen
in Measles and scarlet fever)

Erythema - Parvovirus B19 infection May have mild prodrome 7-10 days - Initially rash on cheeks = slapped - Arthritis - IVIG
infectiosum (Fifth before eruption of rash ⇒ low grade cheek (5 fingers on your face) - Encephalitis - May require transfusion
disease) - Transmission via fever, headache, myalgia, malaise - Neuropathies for aplastic crisis
respiratory secretions - Lacy reticulated rash on the
Patient is viremic and contagious extremities
- IP: 4-14d prior to onset of rash but not after
onset of rash - Spreads distally and symmetrically
- Most common in ages - Palms, soles usually spared
4-10 - Trunk, neck and buttocks commonly
involved

Roseola Infantum - Caused by infection with - High fever that lasts 3-5days ⇒ Exanthem Associated with febrile Treatment is supportive
(Sixth HHV6 and HHV7 rash appears at defervescence - Fine non-pruritic blanchable seizures and symptomatic
Disease/exanthe (within 24hrs) macules/papules with a halo
m subitum) - Most common in children that appear on trunk and - Neurologic disturbances
6mo-2yr or 6mo-3yrs - May have upper respiratory spread to extremities including encephalitis and
symptoms and lymphadenopathy (centrifugally) neuropathies

- May have vomiting and diarrhea - Non pruritic - Papular-purpuric gloves

- Coalesce and disappear within and socks syndrome
1-2days without pigmentation or (PPGSS)
desquamation

Enanthem
- Nagayama spots ⇒
erythematous papules on soft
 palate and uvula

Enteroviral - Caused by coxsackie,

infections echoviruses and
enteroviruses

- Spread is by fecal-oral, HIGHLY VARIABLE

fomites, respiratory or
vertical (MTC)

- IP: 3-6 days

Kawasaki Disease - Acute self limited Diagnosis is by the presence of high Rash varies in appearance - Coronary artery Treatment is supportive
vasculitis of uncertain fever for >5days + ⅘ (morbilliform, scarlatiniform) aneurysms and symptomatic
etiology
1. Bilateral non-purulent - Acquired heart disease
conjunctivitis

2. Extremity changes (erythema,

edema, desquamation)

3. Oral mucosal changes

(fissured lips, strawberry
tongue)

4. Anterior cervical
lymphadenopathy (1 node
>1.5cm)

5. Exanthem (varies)

Gianotti-Crosti - Hepatitis B Prodrome of fever, upper respiratory - Monomorphic, pink to skin coloured
Syndrome - EBV symptoms, generalized
- Hepatitis A lymphadenopathy, - Papules
(Acrodermatitis of - Measles hepatosplenomegaly
childhood) - Face, buttocks, extremities
- Seen most frequently in
children 1-6yrs

Rocky mountain - Rickettsia rickettsii Prodrome 3-5 days before rash ⇒ Blanchable pink macules.papules that Severe infection may Treat with doxycycline
spotted fever Fever, headache, malaise (GI evolve into petechial/purpuric cause long term
- Spread by ticks symptoms may be present) non-blanching lesions neurological complications
- Seen in children <15yrs Begins on wrist and spreads
centripetally
 PAPULOSQUAMOUS ERUPTIONS

Condition Appearance Location Associated conditions/symptoms Complications Management

Atopic Dermatitis - Xerosis, erythema and pruritic Infants = Face, scalp, extensor Associated with other atopic Scratching and rubbing may - Vigilant skincare
(Eczema) papules surfaces conditions (rhinitis, asthma, food lead to weeping, crusting and - Emollients, moisturizers or
allergies) + family hx lichenification medications
- May have Children = antecubital fossa,
hypo/hyperpigmentation neck, popliteal fossa A. Xeroderma = dry skin - Topical corticosteroids
(hydrocortisone,
B. Pityriasis alba = Hypopigmented triamcinolone)
areas with a fine scale usually on
the face - Systemic
immunomodulators
C. Ichthyosis vulgaris = dirty
appearing excessive scaling and - UV therapy
hyperlinear palms
- Calcineurin inhibitors
D. Dennie-morgan lines and (Tacrolimus, pimecrolimus)
cheilosis may be seen
- Antihistamines & clipping
E. Hyperlinear palms fingernails to manage itching

F. Keratosis pilaris = erythematous

1- to 2-mm folliculocentric papules
ofen on lateral upper arms, anterior
thighs, and cheeks

Seborrheic Salmon coloured, scaly Locations with large - Topical corticosteroids

dermatitis papules/plaques ⇒ may have concentration of sebaceous (hydrocortisone,
greasy appearance glands ⇒ scalp, behind ears, triamcinolone)
face, chest, penis, intertriginous
Less pruritic than atopic areas - Calcineurin inhibitors
dermatitis (Tacrolimus, pimecrolimus)
- Onset is often in first few
Apppear within the first 3 months weeks of life = Cradle cap in - Topical keratolytics &
of life infants antifungals

Contact Well defined erythematous Location depends on contact Can have oozing and - Oral steroids
dermatitis vesicles, papules or plaques with allergen/irritant subsequent lichenification
A. Irritant
B. Allergic Common allergic contact
dermatitis = Rhus (poison
oak/ivy & nickel allergy)

Plaque type Well defined, erythematous In pediatric population, most Pruritus is variable but not
psoriasis papules and plaques with a often affects scalp, face and prominent
silvery scale intertriginous areas
Guttate Psoriasis = Smally
scaly papules usually
precipitated by group A strep
infection in the pharynx/perianal
region

Ptyriasis Rosea Self limited papulosquamous Often have a herald patch on May be pruritic - Acyclovir
eruption the trunk/proximal thigh that - Erythromycin
precedes the eruption & may be May be linked to HHV7 infection - UV therapy
Raised red scaly patches that accompanied by a mild
are round or ovoid prodrome

Mainly adolescents affected Lesions typically symmetrical

and extend at 45 degrees along
skin tension lines (Christmas
tree)

Lichen planus Pruritic, polygonal, pink/purples Flexor surfaces often affected

flat topped papules

May have a white scale

Lichen striatus Skin colour to slightly Along the lines of Blaschko

hyperpigmented flat topped
papules

Affects children 9mo - 9yr

Scabies Papules, pustules or vesicles Hands, feet, palms, soles, Reaction relates to the development Scratching and secondary - Topical = permethrin
intertriginous areas (finger of cellular/humoral immunity to the infection can alter the - Oral = ivermectin
May see burrow (3-10mm webs) mite, feces or eggs appearance of the rash - Wash clothing and bedding
greyish/white line) in hot water + dry with heat
May involve face and head in Signs and symptoms become In immunocompromised
 Reddish brown nodules in infants apparent 10-30d after infestation persons, extensive infection
chronic infection due to immune can cause crusted scabies
rxn to dead mite In infants, rashes may May resemble atopic/sebhorreic = thick greasy appearing
develop in areas awat from dermatitis in infants and young yellowish scale and crusts
site of infection due to children over the extremities and trunk
allergic rxn to foreign material

Fungal infection Scaly papules grouped in a circle - Topical/systemic antifungals

or coalesced into a plaque with a
central clearing - Treat with oral ketoconazole

- Selenium sulphide shampoo

can reduce spread
 VESICULAR EXANTHEMS

Condition Epidemiology Associated features Rash Complications Treatment/Management

Varicella (chicken Varicella zoster virus transmitted Prodrome of malaise Vesicles in varying states of resolution If staph aureus infects the Varicella vaccine can be
pox) by airborne spread from and mild fever vesicles, it can result in given from 1yr ⇒ 2 doses;
respiratory secretions, vertically Concentrated on the head and trunk bullous varicella which has 2nd dose at least 1 month
Most common (MTC) or by contact a higher risk of scarring after first
vesicular “Dewdrop on a rose petal”
exanthem seen Children <10 years
in childhood
IP: 10-21 days

Zoster (Shingles) Reactivation of a latent varicella May have pain Dermatomal distribution over 1-3 sensory
infection before appearance dermatomes
of lesions
Lesions do not cross the midline

Herpes simplex Caused by HSV1 and HSV2 May have prodrome Typical herpetic lesions
of paresthesia
HSV gingivostomatitis and perioral vesicles

Hand-foot-and-mo Coxsackie A16 Prodrome of fever, Exanthem

uth disease Enterovirus 71 malaise, mouth pain - Erythematous macules and papules
(HFMD) with a central grey vesicle

- One volar surfaces of hands & feet +

on buttocks

Enanthem
- Lesions on tongue, buccal mucosa,
palate, uvula, anterior tonsillar pillars

Herpangina Same enteroviral agents as Associated fever, Painful enanthem of small greyish white
above malaise, headache, vesicles that ulcerate with a surrounding halo
neck pain
- Soft palate, uvula, buccal mucosa,
pharynx, tonsils

Bullous impetigo Coagulase positive staph aureus May have associates Small vesicles that enlarge rapidly into flaccid
 fever, weakness & bullae that easily rupture
Transmitted by direct person to diarrhea
person contact or fomites

Seen in infants, neonates and

small children

Scabies Sarcoptes Scabiei (parasite) Usually intensely pruritic papular lesions but Immunocompromised Permethrin cream
can be vesicular especially in children persons can have a very
Transmitted by prolonged contact >2years severe infection ⇒ crusted
with an infected individual scabies
Infants ⇒ Head, neck, palms and soles

Older children -==> trunk, waistline, flexor

surface of wrists, in between fingers ,
interdigital folds, genital area

Fungi Tinea capitis, tinea pedis These fungi can either cause a direct rash
(tinea pedis) or a hypersensitivity reaction
known as an id rash (interface dermatitis)

Tinea pedis direct reaction

- Vesicles on palms, soles, sites of
fingers (+ extremities and trunk
occasionally)

Id reaction (eg. tinea capitis)

- Deep seated pruritic vesicles that
develop secondary to tinea infection
elsewhere on the body ⇒ hands,
face, trunk

Dyshidrotic Intensely pruritic itchy vesicles that are deep

eczema seated and tapioca pearl like

Palms, soles and sides of fingers