Pediatric Exanthems
-Part II-
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Objectives
•
Be able to identify the rashes of:
– Varicella, Zoster, & Ramsey Hunt
– Coxsackie and Enteroviruses: Hand Foot
Mouth Disease and Herpangina
– Named exanthems including Gianotti Crosti,
Unilateral Laterothoracic Exanthem, and
Pityriasis Rosea
•
Know the general clinical features
accompanying each of the above rashes
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Varicella (Chicken Pox)
• Varicella zoster virus
• At risk:
– Unvaccinated, young children
– 2nd attack rate within household=80-95%
• Season: sporadic
• Incubation: 10-21 days
• Infectious period:
– via respiratory drops and vesicular fluid
– 2 days before to 5 days after onset of rash
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Varicella
• Prodrome
– Ranges from asymptomatic to fever, malaise,
cough, coryza, and sore throat
• Pruritis
– Variable from mild to severe
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Varicella - Exanthem
Atypical – after vaccine
Typical Disease
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Varicella - Complications
• Secondary bacterial infection: 5-10%
• Otitis media: 5%
• Higher risk for adults, neonates, immune
compromised: pneumonitis, encephalitis,
cerebellar ataxia, hepatitis
• Rare complications: Reye Syndrome,
Guillain-Barre, nephritis, carditis, arthritis,
orchitis, uveitis
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Herpes Zoster
• Reactivation of latent varicella in dorsal
root ganglia (sensory)
• At risk: elderly, immune compromised,
children who had varicella in utero or in 1st
year of life
• Prodrome: unusual in children, in adults
dull ache for up to a week before rash
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Varicella Zoster - Exanthem
Dermatomal clusters of uniform 2 mm
red papules with central vesicles and
crusts
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Unilateral, dermatomal,
grouped vesicles
Cephalic Herpes Zoster – Ramsey
Hunt Syndrome
Acute facial paralysis that occurs in association with herpetic blisters of
the skin of the ear canal, auricle, or both is referred to as the Ramsay
Hunt syndrome, or herpes zoster oticus.
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Varicella Zoster - Complications
• Post-herpetic neuralgia: uncommon in
kids
• Disseminated disease: immune
compromised
– Widespread cutaneous lesions
– Visceral disease
• Ulcerations
• Secondary Infection
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Enterovirus Rashes
Hand Foot Mouth
Herpangina
Nonspecific
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Hand-Foot-Mouth Disease
• Hand-foot-and-mouth disease (HFMD) is a viral
illness with a distinct clinical presentation of oral
and characteristic distal extremity lesions
• Usually Coxsackie A16
• At risk: preschool children
• Incubation period
• Prodrome: 1-2 days before rash
– Low grade fever, anorexia, malaise, sore mouth
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Hand-Foot-Mouth: Enanthem
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Hand-Foot-Mouth: Exanthem
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Herpangina
• Herpangina - acute febrile illness
associated with small vesicular or
ulcerative lesions on the posterior
oropharyngeal structures
• Various enteroviruses cause the condition,
most commonly Coxsackie A
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Herpangina: Enanthem
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Nonspecific Enteroviral Exanthems
• Multitude of presentations – these will
frustrate you!
– Morbilliform or rubelliform
– Vesicular
– Petechial (often echovirus 9)
– Urticarial
• Involvement of other organ systems is rare
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Enterovirus or Rubella?
RUBELLA!
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Named Exanthems
Gianotti-Crosti Syndrome
Unilateral Laterothoracic Exanthem
Pityriasis Rosea
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Gianotti-Crosti Syndrome
• Most commonly due to EBV, but also
Hepatitis B and other viruses
• At risk: 6 months-14 years (mean = 2 yo)
• Season: spring and early summer
• Constitutional symptoms: mild
– Low grade fever, malaise, lymphadenopathy,
mild pruritis, mild hepatitis
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Gianotti-Crosti Syndrome
AKA – Papular Acrodermatitis of Childhood
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Unilateral Laterothoracic Exanthem
• Viral etiology supported by patient's history (eg,
age at presentation, multiple affected children in
a family), lack of efficacy of antibiotics, serologic
findings, & presentation during spring and winter
• At risk: 1-5 years old (mean 2 years old)
• Prodrome: 60-75%
– Rhinitis, pharyngitis, bronchitis, conjunctivitis,
gastroenteritis
– Fever in 40-65%
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Unilateral Laterothoracic Exanthem
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Pityriasis Rosea
• Viral etiology suggested by seasonality,
mild prodromal symptoms, associated
URI, clustering of cased
• Season: spring, autumn, winter
• At risk: 10-35 years old
• Prodrome: very mild if present
– Malaise, nausea, anorexia, headache, low
fever
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Pityriasis Rosea
Herald Patch
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GOOD LUCK!
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