Pediatric Rashes

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Pediatric Rashes Powered By Docstoc
					 Pediatric Rashes

David E. Berry, Ph.D., D.O.
  Lewis-Gale Physicians
      Salem, Virginia
   8 AM, June 3, 2009
Newborn Rashes
        uniform pinpoint yellow-
           white papules
        This healthy newborn had
           numerous pinpoint
           white and yellow
           papules on the nose,
           cheeks, and forehead
Newborn Rashes
        symmetric grouped 1-2 mm
          white papules
        Comments: This healthy
          newborn had milia
          clustered on his nose
          and upper lip.
Erythema Toxicum Neonatorum
                 urticarial plaques many
                     with central yellow
                     papules or pustules
                 Rapidly changing
                   urticarial plaques with
                   central papules and
                   pustules appeared on
                   the trunk of this
                   otherwise healthy 2
                   day old. Lesions
                   changed from hour to
                   hour and disappeared
                   completely 36 hours
Erythema Toxicum Neonatorum
              widespread red papules on an
                 urticarial base
              This healthy infant developed an
                 asymtomatic generalized eruption
                 which lasted for several days and
                 disappeared without treatment.
                 Although the lesions were
                 generalized, they were most dense
                 on the trunk.
Infant Acne
      2 to 4mm pink atrophic papules
      This healthy infant presented with
         several atrophic pink papules in
         various stages of healing on the
         bilateral cheeks. Her older brother
         had a history of similar infantile
Storkbite Hemangioma
                 midline blanching
                    discrete red 5 cm
                 This healthy 4-
                    month-old boy
                    had an innocent
                    salmon patch on
                    the nape of his
                    neck, over the
                    mid forehead, and
                    on both upper eye
Storkbite Hemangioma
               midline red
                  blanching v-
                  shaped patch
               Comments: This
                 healthy 5-month-
                 old boy sports a
                 salmon patch on
                 the back of his
                 scalp, nape of the
                 neck and in the
                 lumbosacral area
                 just above the
                 gluteal cleft and
                 on the left lower
Port Wine Stain
           red blanching patch on the
              lower lip and red
              macules and papules
              scattered on the tip of
              the tongue
           This healthy 6-year-old boy
              complained of episodic
              bleeding from the tip of
              his tongue. The vascular
              malformation on his
              tongue and lower lip had
              been present since birth
              but the bleeding had
              occurrred only for the
              last year. The lesion on
              the tip of the tongue was
              treated with pulsed dye
             slightly elevated oval
                 blue-purple 1.5 X
                 2.2 cm plaque with
                 surrouding pallor
             Comments: This
               healthy newborn
               developed a blue-
               purple oval plaque
               in the right side of
               the abdomen at 2
               weeks of age.
Mongolian Spot
             scattered well
                demarcated and
                poorly demarcated
                blue green macules
                and patches
             Large blue macules were
                noted at birth
                covering the buttocks
                and sacrum and
                scattered on the
                extremities. Similar
                lesions were found in
                other family
                members. The child
                also had atopic
Mongolian Spots
                  confluent blue gray
                     macules and
                     patchesThis healthy
                     infant was evaluated
                     for extensive
                     pigmentation present
                     since birth. The
                     prognosis for
                     extensive dermal
                     melanocytosis, also
                     known as Mongolian
                     spots, is generally
                     good, with regression
                     occurring in the
                     majority of cases
                     during childhood. The
                     infant is otherwise
                     healthy and well,
                     growing and
                     developing normally.
Ear Tags
           Two accessory
             skin tags These
             skin tags that
             were present at
             birth were not
             associated with
             other congenital
             anomalies in
             this healthy 4
             month old
Ear Pits
           clustered symmetric semi-
              circular ear depressions
           This healthy 15-month-old
              boy was evaluated for
              peculiar congenital
              symmetric circular ear
              depressions. He had no
              other skin findings, no
              history of organomegaly,
              omphalocele, intestinal
              malrotation, somatic
              hemihypertrophy, or
              macroglossia. Family
              history was unknown,
              because he was
Contact Irritant Diaper Dermatitis
                  symmetric confluent red plaques with
                     lichenification purple papules
                     over skin prominences and
                     relative sparing of the creases
                  This healthy 8-month-old girl
                     developed a recurrent and
                     chronic diaper dermatitis over the
                     skin prominences of the thigh,
                     vulva, and suprapubic area. She
                     was growing well, had no recent
                     exposure to systemic antibiotics,
                     and had not diarrhea or
                     constipation or underlying
                     medical disorders. The rash was
                     treated with barrier paste and
                     tapering topical steroids. A skin
                     biopsy was planned if the
                     eruption did not clear.
              confluent red papules
                 involving creases
                 and skin
              This 6-month-old girl
                 developed an itchy
                 painful contact
                 irritant dermatitis
                 with secondary
                 candida. The
                 eruption improved
                 with topical nystatin
                 cream applied with
                 diaper changes.
Perianal Streptococcal infection
                     well demarcated red
                       eroded crusted patch
                       with surrounding scale
                     This healthy 4-year-old boy
                        had a 3 month history of
                        itchy painful perianal
                        eruption that was
                        treated with oral
                        antibiotics with
                        temporary relief. A
                        streptococcal screen
                        was positive, and he
                        was retreated with a 3
                        week course of oral
Lip Licker Dermatitis
                This two year old boy
                   developed perioral
                   erythema, scaling and a
                   small area of
                   maceration on the left
                   aspect of the upper lip.
                   He is a frequent lip
                   licker and it is winter.
                This 2-year-old boy had
                   persistent well
                   demarcated scaly red
                   patch on the lower lip.
                   He confessed to
                   frequent lip licking
                   during the winter.
Lip Licker Dermatitis
                 scaly perioral plaque
                 A healthy 7 year old
                    developed a
                    worsening lip
                    licker's contact
                    irritant dermatitis.
                    He improved with
                    application of a
                    bland lubricant.
This boy aged 6 year-old
   has the habit of licking
   his lips. He does this
   as compulsively as
   others suck their
   thumbs or bite their
   nails. Notice how the
   design of the lesions
   conforms to the extent
   to which the lips can
   be licked by his
   tongue. This
   dermatitis improved
   somewhat in the
   summer and flared in
   the winter.
Contact Dermatitis Shoe
                 symmetric well
                   demarcated plaques
                   comprised of red
                   scaly discrete and
                   confluent papules
                   with excoriations and
                 Comments: This healthy
                   adolescent with a
                   history of atopic
                   dermatitis developed
                   a recurrent dermatitis
                   on the tops of his feet.
                   He was scheduled for
                   patch testing to
                   exclude an allergic
                   component related to
                   his shoes.
Poison Ivy
      irregularly shaped
          asymmetric edematous
          red discrete and confluent
          papules and plaques
      This healthy 7-year-old girl
         developed an extremely
         pruritic red eruption which
         started on her face and
         spread to her neck and
         extremities. Clothing
         protected areas were
         spared. Note the sparing
         where her bangs
         protected the right side of
         her forehead.
Poison Ivy
Poison Ivy
         grouped linear red
            edematous scaly
         This 5-year-old boy
            developed an
            itchy linear
            eruption oh his
            back the day after
            a camping trip in
            the woods.
Pityriasis Rosea
             generalized but primarily
                truncal 0.5-3.0 cm
                round and annular
                papules and plaques
                with dusky centers and
                gray borders with scale
                pointing centrally
             This 12-year-old boy was
                noted to have
                widespread scaly round
                and annular plaques at
                a scoliosis screening
                visit. A skin biopsy
                showed dermatitic
                changes consistent
                with pityriasias rosea.
Pityriasis Rosea
poorly defined oval
  minimally scaly
  patches with
This 6-month-old boy
   had a 3 week
   history of light
   patches on his
   abdomen. He had a
   history of dry scaly
   skin since age 2
   months consistent
   withy mild atopic
Atopic Eczema
diffuse erythema, scale, and
This healthy infant
   developed diffuse facial
   erythema, scaling, and
   crusting. He was noted to
   rub his face on his
   mother's shirt repeatedly
   while in the office. The
   eruption improved
   dramatically with liberal
   application of topical
   lubricants and judicious
   use of topical
   hydrocortisone 2.5
   percent ointment.
widespread symmetric red
   scaly patches and
   plaques some with
   crusting and purulent
This 9-year-old boy, with a
   history of chronic
   suppurative otitis media,
   rhinitis, dental caries and
   recurrent purulent
   conjunctivitis since 2
   years of age, had a 2 year
   history of chronic
   recurrent predominantly
   flexural eczema with
   secondary staphylococcal
symmetric thickened
  follicular papules
This adolescent had
   chronic atopic
   dermatitis with
   prominent follicular
   papules on the dorsal
   aspect of his hands and
   wrists. He admitted to
   episodic rubbing and
   scratching of the hands
   and forearms. He also
   had scattered lesions
   on his shins. He
   improved with topical
   steroids and non-
   steroidal anti-
uniform 2 mm hypopigmented and
   hyperpigmented papules
This 4-year-old boy had chronic atopic
   dermatitis marked by recurrent
   episodes of pruritic follicular
   papules on his chest, abdomen,
   shoulders and the flexural surfaces
   of his arms and legs. He responded
   well to aggressive use of emollients
   and judicious use of topical
   corticosteroids and non steroidal
   anti-inflammatory agents. Note the
   small congenital pigmented nevus
   on his right abdomen and the café
   au lait macule on the left upper
Scaly erythematous
  plaque in a nine
  month old with history
  of wheezing. It
  resolved with a low
  potency topical
  corticosteroid and a
  topical lubricant.
This 9-month-old boy
   with a history of
   asthma, developed a
   red scaly plaque on
   the right neck and
   cheek. It resolved
   within 2 days on a
   topical steroid and
Nummular Eczema
       acute red
          annular scaly
          and crusted
       A 4 year old boy
          with severe
          acute nummular
          plaques on his
          trunk with flares
          of his disease.
Nummular Eczema
     excoriated eroded
        nummular plaques
     A 6 year old boy with
        atopic dermatitis
        scratched at
        selected areas on
        his arms and legs
        resulting in chronic
        nummular plaques.
Contact Dermatitis
       This 4-year-old boy
          with atopic
          developed a
          chronic dermatitis
          on the lower
          abdomen. He
          cleared with
          topical steroids
          and avoidance of
          metal snaps and
          belt buckles.
Hair Loss
Hair Pulling
          well demarcated patch of decreased
             hair density with shiny lusterless
             hair and hairs of varying lengths
          Comments: This healthy 4-year-
            old girl was observed twirling
            her hair at nap time and bed time
            resulting a well demarcated
            patches of hair thinning. She also
            had dry lusterless hairs of
            varying lengths giving a moth
            eaten appearance. The hair loss
            disappeared a year later when she
             entered kindergarten.
Hair Pulling
Traumatic Hair Loss
                 hair thinning around
                    parts, plaits, and the
                    periphery of the scalp
                 This toddler was brought
                    by her mother for
                    evaluation of hair
                    loss. She kept her hair
                    in tight plaits
                    resulting in hair loss
                    at the edges of the
                    parts and the
                    periphery of the scalp.
                    A culture for tinea
                    was negative.
Traumatic Hair Loss
                      well defined patch
                         of hair
                         breakage and
                      This girl's mother
                         kept her hair in
                         tight plaits
                         resulting in
                         hair breakage
                         and thinning at
                         the periphery
                         of the scalp.
Traumatic Hair Loss
         tightly pulled braids with pustules and
             hair thinning along the parts
         This 2-year-old girl developed pustules
            along the parts created by braids in
            her scalp. Loosening of the braids
            and gentle shampooing usually
            relieves this superficial
            Staphylococcal folliculitis also
            known impetigo of Bockhart. Note
            the traction alopecia as well. These
            children may also be prone to tinea
            capitis which should be excluded
            when local measures fail to result
            in clearing.
Alopecia Areata
                  round to oval patches
                     of alopecia with
                     normal underlying
                  A healthy adolescent
                     began with patches
                     of alopecia at age 5.
                     Since then he
                     experienced periods
                     of regrowth and
                     recurrent alopecia
Alopecia Areata
                  complete scalp
                     hair loss
                  A healthy 6-year-
                     old boy had
                     episodes of
                     complete hair
                     loss followed
                     by full
                     regrowth over
                     the last 3 years.
                     His eye brows
                     have been
                     involved in the
Alopecia Areata
                  2.5 cm X 4 cm patch
                     of hair loss
                  This 9-year-old boy
                     with scattered
                     patches of
                     alopecia areata
                     on his scalp for
                     over a year points
                     out an area of
                     hair loss on his
Tinea Corporis
Tinea Corporis
Tinea Corporis
       scaly hypopigmented 3 cm patch with
          decreased hair density; subtle scaly
          annular patch on the left temple
       This healthy 9-year-old girl had an itchy
          scaly patch on her mid frontal scalp a
          year ago which was treated with topical
          steroids. The patch improved but hair
          loss slowly progressed. She
          subsequently developed several scaly
          patches on her forehead and left temple
          which also improved but never cleared
          with topical steroids. On evaluation a
          potassium hydroxide preparation was
          floridly positive from hair bearing
          (endothrix)as well as non-hair bearing
          (septate branching hyphae) areas. She
          was started on oral ultramicrosized
          griseofulvin. Note the annular patch on
          the left temple.
Tinea Corporis
       annular red scaly plaques on the
         mother's arm and fingers and
         diffuse scaling in the child's
         frontal scalp
       This healthy 8-year old girl
          demonstrates diffuse frontal
          scalp scaling and some hair
          thinning. A potassium
          hydroxide preparation from
          the child showed endothrix
          spores, while the mother had
          septate branching hyphae.
          The daughter was treated with
          oral antifungal medication,
          and the mother responded to
          topical antifungal cream.
Tinea Corporis
           Pustular lesions which
             progress to fairly oval in
             shape, demonstrate
             centralized clearing with
             a well-defined leading
           This healthy 4-year-old girl
              developed an itchy red
              scaly papulopustular
              eruption extending from
              the right armpit. A
              potassium hydroxide
              preparation showed
              branching septate
Tinea Corporis
       This 10-year-old girl developed a single pruritic
           expanding annular plaque on her left forearm. She
           had a history of animal exposure. A potassium
           hydroxide preparation was positive, and a fungal
           culture was pending. Classic tinea corporis
           presents on the trunk and limbs as single or
           multiple annular papulosquamous lesions with
           raised, erythematous, scaling borders and central
           clearing. . The two most common species cultured
           worldwide are Trichophyton rubrum and
           Trichophyton mentagrophytes. Inflammatory lesions
           may include vesicles, pustules, crusting, and
           occasionally perifollicular and deep dermal
           involvement with nodules. In general tinea corporis
           caused by zoophilic dermatophytes such as
           Microsporum canis is more inflammatory and more
           symptomatic than infections caused by
           anthropophilic dermatophytes. Risk factors for
           infection include exposure to infected animals,
           persons, and soil. Those at risk include athletes,
           veterinarians, animal handlers, and anyone who
           works outdoors. In addition, certain systemic
           diseases may predispose to infection, including
           Cushing’s syndrome, DM, atopy, and most
           immunodeficiency conditions.
Tinea Corporis
Tinea Capitis
            scaly round 1- 5 cm
               patches with broken
            This 11-year-old boy
               minimally itchy
               scaly patches with
               hair loss in his scalp
               2 months ago. A
               preparation was
               positive for hyphae.
Tinea Capitis Black Dot
                  diffuse alopecia with
                      pinpoint black dot
                      residua of broken
                      hair shafts
                  This healthy 4 week-
                     old infant
                     presented with a 2
                     week history of
                     progressive hair
                     loss and "black
                     dots" on the scalp.
                     His school aged
                     sibling was also
Tinea Versicolor
            symmetric truncal discrete
              and confluent
              minimally scaly papules
              and patches
            These healthy adolescent
              brothers complained of
              a minimally itchy light
              spots on the trunk for 2-
              3 years. Their father
              had a similar eruption.
              A potassium hydroxide
              preparation showed the
              typical spores and
              pseudohyphae of
              pt child male about 11
                  years complain from
                  multiple patch
                  posterior neck.
              This 11-year-old boy was
                 noted to have some
Tinea Versicolor minimally scaly
                 hypopigmented 0.2-
                 1.0 cm patches on his
                 neck and back. Note
                 the small pustules on
                 the upper back
                 consistent with a
Tinea Versicolor
            widespread truncal round
               minimally elevated annular
               discrete and confluent
               hypopigmented scaly 3 mm-
               1.0 cm papules
            This healthy adolescent boy
               was evaluated for a chronic
               minimally scaly eruption on
               the trunk, proximal
               extremities, and neck. A
               potassium hydroxide
               preparation of scale from
               the trunk demonstrated
               pseudohyphae and spores
               typical of tinea versicolor.
Scarlatina Eruption Pastia Lines
                      diffuse scarlatiniform
                          eruption with
                          accentuation in
                          skin creases
                          (Pastia lines)
                      This toddler with
                         developed a
                         eruption with
                         Pastia lines,
                         accentuation of the
                         rash in the skin
Streptococcal Pharyngitis
                   discrete and confluent
                   This healthy
                      developed a sore
                      throat, anterior
                      adenopathy, and
                      palatal petechiae. A
                      rapid strep test was
                      positive, and her
                      symptoms resolved
                      24 hours after
                      initiating oral
Streptococcal Scarlet Fever
                diffuse red sandpaper-like
                This 10-year-old boy
                   developed a fever to 103
                   degrees F, tachycardia,
                   cough, myalgias, numbness
                   in his legs, a diffuse red
                   eruption, and a strawberry
                   tongue. He had a history of
                   a strep throat 2 weeks
                   earlier. He was treated with
                   ceftriaxone and oral
                   antibiotics for 10 days. The
                   scarlatiniform eruption
                   started on his abdomen and
Scarlet Fever Strawberry Tongue
                  red tongue with prominent
                  This 10-year-old boy
                     developed a fever to 103
                     degrees F, tachycardia,
                     cough, myalgias, numbness
                     in his legs, a diffuse red
                     eruption, and a strawberry
                     tongue. He had a history of
                     a strep throat 2 weeks
                     earlier. He was treated with
                     ceftriaxone and oral
                     antibiotics for 10 days. The
                     scarlatiniform eruption
                     started on his abdomen and
Scarlet Fever
                red strawberry
                   tongue and
                   diffuse fine red
                   papular eruption
                This 4-year-old girl
                   was evaluated for
                   a strawberry
                   tongue and
                   diffuse red sand
                   papular eruption.
                   A throat culture
                   yielded Group A
Scarlet Fever
            generalized red fine
              papular sandpaper-
              like eruption
            This 5-year-old boy
               had a five day
               history of sore
               throat and fever.
               He developed a
               generalized fine
               sandpaper-like rash
               on day 4 of illness.
               He also had red,
               swollen tonsils, and
               palatal petechiae.
          generalized red papules and
             pustules many of which
             are elongated with
             overlying linear scale
          This 5-month-old was
             covered with scaly
             papules and pustules with
             most prominent
             involvement of the feet.
             Her mother had similar
             lesions with generalized
             excoriations. Note that
             many of the papules and
             pustules are elongated
             typical of burrows.
          generalized excoriated
             papules some with
             crusts, erosions, and
             surrounding erythema
          This 8-year-old boy had
             intensely pruritic bumps
             over his abdomen,
             hands, feet, groin, and
             axillae for the past few
             weeks. His siblings
             have similar bumps.
   an asymmetric truncal eczematous eruption
       comprised of linear red edematous papules
       and pustules, some with overlying crusts
       and surrounding hyperpigmentation
   This healthy 7-week-old girl developed a
      minimally itchy papulovesicularpustular
      eruption with crusting particularly in the
      right axilla. Many of the lesion also
      demonstrated hyperpigmentation. The
      lesions began in the right axilla and spread
      over the chest, abdomen, and back with
      sparing of the face, neck, arms, legs, and
      diaper area. A skin biopsy showed a
      spongiotic dermatitis with an infiltrate of
      neutrophils consistent with an infected
      eczematous process. Her mother had a few
      pruritic excoriated papules on her wrists and
      forearms. The entire family was treated with
      5 percent permethrin cream.
Wood Tick
            recently embedded tick
            This wood tick had
               recently embedded
               in this 9 year old
               girl's leg. It was
               easily removed by
               grasping the body
               of the tick with a
               forceps and slowly
               but firmly pulling
               away from the skin.
Rocky Mountain Spotted Fever
                subtle red macules
                This 9 year old boy developed a
                   red partially blanching papular
                   eruption on his hands and feet
                   including his palms and soles
                   that progressed to the trunk
                   over 3 days. He had a severe
                   headache, high fever,
                   arthralgias and myalgias. His
                   mother, who remembered
                   removing a wood tick from her
                   son's scalp 10 days earlier also
                   developed a rash, fever, and
Rocky Mountain Spotted Fever
                subtle red macules
                This 9 year old boy developed a
                   red partially blanching papular
                   eruption on his hands and feet
                   including his palms and soles
                   that progressed to the trunk
                   over 3 days. He had a severe
                   headache, high fever,
                   arthralgias and myalgias. His
                   mother, who remembered
                   removing a wood tick from her
                   son's scalp 10 days earlier also
                   developed a rash, fever, and
Rocky Mountain Spotted Fever
                  diffuse petechiae and edema
                  An ill appearing toddler with high
                     fever and a diffuse red rash
                     and edema suddenly developed
                     diffuse petechiae and
                     ecchymoses. Laboratory
                     studies showed a prolonged
                     bleeding time,
                     thrombocytopenia, anemia,
                     and neutropenia. After a
                     prolonged course in the
                     pediatric intensive care unit, he
                     recovered uneventfully with
                     the exception of necrosis of the
                     tips of several toes.
Rocky Mountain Spotted Fever
                  red partially blanching papules
                  This 9 year old boy developed a
                     red partially blanching papular
                     eruption on his hands and feet
                     including his palms and soles
                     that progressed to the trunk
                     over 3 days. He had a severe
                     headache, high fever,
                     arthralgias and myalgias. His
                     mother, who remembered
                     removing a wood tick from her
                     son's scalp 10 days earlier also
                     developed a rash, fever, and
Scabies Nit
          viable head louse egg
          This nit was still viable when it
             was cut from the scalp of a
             10 year old girl shortly
             before she was treated with
             permethrin lotion. At the
             time the image was taken,
             the nit was already dead.
             The left side of the nit is
             oriented toward the scalp
             while the operculum or
             breathing apparatus at the
             right end points away from
             the scalp. Note the intact
             embryo within the egg.
Head Lice
            excoriated crusts and
               live crawlers
            Live crawlers are seen
               scampering across
               the scalp where she
               has been itching for
Head Lice
            nits on hair shafts and
                fecal material on the
                skin above the ear
            A 10 year old girl
               complained of scalp
               pruritus for several
               weeks. Nits were
               visible on hairs above
               the ear. Note the
               brown scaly fecal
               material on the skin
               below the hair line.
Lyme Disease
      disseminated discrete and confluent
         annular 1-3 cm red plaques
      The parents found a tick behind the ear of
         this 27-month-old girl one week before
         she was evaluated in the office for a
         equivocal low grade fever and widely
         disseminated annular red plaques. The
         tick was tested with PCR and found to
         be negative for the DNA of Borelia
         burgdorfi. However, the following
         week serologic tests were positive for
         Lyme disease (both IgG and IgM). She
         was treated with oral amoxicillin, and
         the eruption cleared in 2 days.
Lyme Disease Erythema Chronicum
                       12 cm annular red plaque
                          with central 1.5 X 3
                          cm red patch
                       This healthy 9-year-old
                          boy developed fever,
                          head ache, sore throat,
                          myalgias, and an
                          annular red plaque
                          where a bite was
                          noted a week ago. A
                          tick was never
Lyme Disease Erythema Chronicum
                   10 cm edematous plaque with
                      purple center and red
                      advancing border
                   This healthy 4-year-old boy
                      developed a flu-like syndrome
                      associated with a solitary
                      asymptomatic expanding
                      plaque on the back and side of
                      his right knee. He lived in an
                      area endemic for Lyme
                      disease, and his mother pulled
                      many ticks from his skin
                      during daily tick inspections
                      during the summer.
Lyme Disease Erythema Chronicum
                    multiple expanding 3-5 cm
                      annular red plaques
                    This healthy 10-year-old boy
                       developed multiple
                       expanding annular red
                       plaques on his trunk and
                       extremities. He
                       complained of mild sore
                       throat, head ache,
                       arthralgias, and myalgias.
                       The skin lesions and
                       symptoms resolved within
                       2 days of starting oral
Viral Infections
          confluent red eruption;
             marked photophobia
          A 6 year old girl
             developed fever,
             photophobia, and a
             red papular eruption
             on the face that
             spread over 3 days to
             the trunk and
             extremities. Serologic
             studies were positive
             for measles.
          red confluent papular
          A 5 year old boy developed
             fever, headache, and
             sore throat followed
             several days later by a
             red papular rash on the
             face. Five days later the
             rash was confluent on
             his face and
             disseminated over the
             trunk and extremities
             including the palms and
          confluent papular
          A 6 year old girl
             developed fever,
             photophobia, and a
             red papular eruption
             on the face that
             spread over 3 days
             to the trunk and
             Serologic studies
             were positive for
      truncal discrete edematous
         pink 2-5 mm papules
      This 10-month-old with 3 day
         history of bounding fever
         to 103 degrees
         Fahrenheit axillary. He
         was less active than usual
         but not ill otherwise. The
         fever resolved on day 4,
         he was happy and playful,
         and he developed a pink
         papular rash over his
         trunk and proximal
Erythema Infectiosum
               symmetric red discrete
                 and confluent
                 edematous papules
                 and plaques
               This healthy 6-year-old
                  girl developed an
                  symmetric red
                  papular eruption on
                  her face, extremities,
                  and trunk which
                  became confluent on
                  her face a week ago.
Erythema Infectiosum
Erythema Infectiosum
                 diffuse symmetric red
                     papular eruption
                 This 22-year-old
                    school teacher
                    developed a diffuse
                    red papular eruption
                    5 days earlier
                    during a fifth
                    disease epidemic in
                    her school last
Erythema Infectiosum
            symmetric stocking glove purpura
            This 18 year old girl awoke one
               morning with asymptomatic
               symmetric purpura of the hands
               and feet which spread to involve
               the proximal extremities as well.
               The exanthem faded over 7-10
               days. Although an enanthem is
               not usually reported with
               Parvovirus infection, she also
               developed some erythema of
               the buccal mucosa and white
               plaques on a red base on the
               dorsum of the tongue.
Gianotti-Crosti Syndrome
            symmetric grouped discrete and confluent red
               edematous papules and plaques
            This 2-year-old girl had an upper respiratory tract
                infection 3 days before she developed a
                minimally pruritic red papular eruption on her
                face, arms, and legs with a few lesions on
                her palms and soles. She had copious
                rhinorrhea and swollen tonsils with exudate.
                A throat culture was sent and she started
                zithromycin for 3 days when the culture was
                reported as negative. Her respiratory
                symptoms began to improve, but the skin
                eruption persisted. Note that the eruption
                was most prominent on the cheeks and
                extensor surfaces of the arms and legs
                typical of Gianotti-Crosti syndrome which can
                be triggered by Hepatitis B virus, Epstein-Bar
                virus, and many other respiratory and
                gastrointestinal viruses. The asymptomatic or
                minimally pruritic eruption usually resolves
                without treatment or scarring over 6 to 8
Gianotti-Crosti Syndrome
Herpes Labialis
              widespread 2-4 mm
                 vesicles, pustules,
                 and erosions
              This 18-year-old girl
                 developed painful
                 vesiculopustules in
                 the mouth
                 associated with
                 fever and difficulty
                 eating and drinking
                 4 days ago.
Eczema Herpeticum
             scattered discrete and
                confluent clusters of
                uniform 2-3 mm
                vesicles and crusted
                vesicles on a red base
             This 5-year-old boy with
                mild atopic dermatitis
                developed eczema
                herpeticum with
                involvement primarily
                of his face and hands.
                The lesions were itchy
                and painful,and
                cleared within 3 days
                with oral acyclovir.
Eczema Herpeticum
           scattered discrete and
              confluent clusters of
              uniform 2-3 mm vesicles
              and crusted vesicles on a
              red base
           This 5-year-old boy with mild
              atopic dermatitis
              developed eczema
              herpeticum with
              involvement primarily of
              his face and hands. The
              lesions were itchy and
              painful,and cleared within
              3 days with oral acyclovir.
Herpes Simplex
             clusters of uniform 2-3
                mm vesicles some
                with crusting on a
                red base
             This 12-year-old boy
                developed tingling
                on his chin 3 days
                before the
                outbreak of a
                vesicular eruption.
                Culture was
                positive for Herpes
                Simplex Virus.
   swollen red toe with clustered
     discrete and confluent uniform 3
     mm vesicles and pustules with
     some crusting and erythema
     streaking over the top of the foot
   This healthy 4-year-old girl
      developed a nontender swollen
      red toe with clustered vesicles
      and pustules. Viral culture was
      positive for Herpes simplex virus.
      She was treated with parenteral
      acyclovir for 2 days and
      completed a 7 day course orally.
      The lesions improved within a
      week with decreased edema and
      erythematous. The vesicles and
      crusts dried and peeled.
Neonatal Varicella
             2 mm red papules and 2-4
                mm vesicles and
                pustules some with
                central crusts
             An 11-day-old boy
               developed an eruption
               of red macules and
               papules which evolved
               to vesicles and vesicles
               with central crusts over
               several days. His
               mother had a history of
               chickenpox 1 day
               before of delivery which
               was normal.
Chicken Pox Varicella
                vesicles with
                  hemorrhagic crust
                This otherwise healthy
                  toddler developed
                  increasing numbers
                  of vesicles and
                  pustules in various
                  stages of
                  development over
                  the course of
                  several days. She
                  had previously
                  received the
                  Varivax vaccine.
Chicken Pox Varicella
Chicken Pox Varicella
Herpes Zoster
            clustered discrete and
               confluent 2-5 mm red
               to purple papules and
               vesicles in
               dermatomal pattern
            This 13-year-old type 1
               diabetic girl
               complained of burning
               and severe pain on
               the right side of her
               trunk. Mutinucleated
               giant cells were seen
               on Tzanck smear
               confirming the clinical
               diagnosis of shingles.
Neonatal Herpes Zoster
                dermatomal clustered
                   uniform 3-5 mm
                   vesicles on a red
                A healthy newborn boy
                   developed an
                   eruption comprised
                   of uniform vesicles
                   to confluence on left
                   side of his scalp.
                   His mother had a
                   history of varicella
                   during the second
                   trimester. The
                   lesions cleared
Hand-Foot-Mouth Syndrome
               acrally distributed lancet
                  shaped red hemorrhagic
                  papules and vesicles
               This 28-year-old woman had a
                  2 day history of diarrhea,
                  fever, and abdominal pain.
                  The skin eruption involved
                  the hands, feet, and hard
                  palate where she had
                  several red punched out
                  erosions. Her daughter had
                  similar symptoms and a
                  blistering rash on the hands
                  and feet a week earlier.
Hand-Foot-Mouth Syndrome
Hand-Foot-Mouth Syndrome
Hand-Foot-Mouth Syndrome
Plantar Wart
               well demarcated,
                 round 1 cm plaque
                 comprised of rough
                 papules that disrupt
                 the normal
               This wart responded
                  well to topical
                  keratolytics (27
                  percent salicylic
Molluscum Contagiosum
               uniform 2-3 mm pearly
                  papules some with a
                  central dell scattered
                  and organized in a
                  linear cluster
               This healthy 4-year-old girl
                  had a few scattered
                  molluscum on the trunk.
                  However, after
                  accidentally scratching
                  her abdomen she
                  autoinnoculation of
                  multiple papules on her
                  abdomen and lower
Molluscum Contagiosum
Molluscum Contagiosum
                 linear cluster of 2-3
                     mm pearly papules
                     with central
                 This healthy 16-year-
                    old boy developed
                    an asymptomatic
                    cluster of
                    molluscum papules
                    behind his right
Molluscum Contagiosum

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