Stumped by pediatric rashes? Emily A. Rose, MD, FACEP, FAAP, assistant professor of clinical emergency medicine at the Keck School of Medicine of the University of Southern California, Los Angeles County and USC Medical Center (Los Angeles) offered a rapid-fire session with plenty of visuals to help emergency physicians identify common rashes that can present in uncommon ways.
She compared the process of identifying rashes to reading an ECG saying “You must be a little systematic.” First, she recommends taking a thorough history. “Don’t forget to ask what have you been putting on the rash,” she said. “It can really change the look of a rash.”
Dr. Rose spent the rest of the session using photos to challenge the audience to “Guess the Rash.” First up was several variations of eczema, a common rash that can be bacterial, viral, or herpetic.
Photos of slapped cheek syndrome (also known as fifth disease or parvovirus B19) looked alarming, but the typically mild infection resolves by itself in a few weeks. According to Dr. Rose, most patients have no problem with this rash, but there are two populations you need to worry about: pregnant women and those suffering from sickle cell anemia.
After several slides showing various presentations, Dr. Rose suggested that the best way to identify roseola is by getting a good patient history. Reports of nasal sniffles and a generous fever of 102-104 degrees for one to two days is generally the tipoff. These patients often appear with mild symptoms.
Another rash that can look like roseola is measles. It starts on the head and neck, spreading down to the trunk. “Any time you have a rash, do a good head-to-toe exam,” Dr. Rose said. She will also often ask if the patient had recently visited Disneyland. “History gives it away,” she said.
Correctly identifying measles is important. “It’s a significant cause of both mortality and morbidity worldwide. It’s a public health issue and really important to diagnose,” she said.
The patient who presents with a headache prior to a rash may be suffering from chicken pox (also called varicella). But to correctly identify this rash, Dr. Rose recommends asking a few key questions. If it turns out that, two weeks previous, the patient had a play date with the “Vaccines are Evil” family, you probably have your answer.
Dr. Rose warned that a new strain of hand, foot, and mouth disease has emerged. “It’s hand, foot, and mouth on steroids,” she said. Called coxsackie enterovirus A6, it presents with “really impressive vesicles or in more extensive areas,” she said. Despite its appearance, she said that these children respond well to standard treatments.