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UNC Department of Family Medicine

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Presentation on theme: "UNC Department of Family Medicine"— Presentation transcript:

1 UNC Department of Family Medicine
Common Exanthems Adam Goldstein, MD Associate Professor UNC Department of Family Medicine Chapel Hill, NC

2 Objectives Understand nomenclature for common exanthems
Know an appropriate differential dx for most exanthems Improved ability to diagnose: Measles (rubeola) German Measles (Rubella) Chicken Pox (Varicella) Fifth Disease (Erythema infectiosum) Roseola (exanthem subitum) Hand, foot & mouth disease Pityriasis rosea Asymmetric periflexural exanthem of childhood (APEC) Kawasaki disease Smallpox Scarlet fever Drug eruptions Unknown exanthems

3 Exanthems Anyone of a number of systemic processes giving generalized eruption Usually not isolated Caused by: Viruses Bacteria Fungal Drugs Idiopathic


5 Exanthems (Historical)
1 Measles 2 Scarlet fever 3 Rubella 4 "Dukes' disease”- ? measles, rubella, scarlet fever, Staph infection, or one of several unspecified enteroviral infections; 5 Erythema Infectiosum 6 Roseola.

6 Measles (Rubeola) Diff Dx S/S’s: Fever, conjunctivitis, cough
Characteristic Koplik spots hours before rash Rash: Days 4-5, red & blotchy begins on face & behind ears usually with onset high fever spreads to body Usually spares palms/soles Rash coalesces on trunk/face

7 Rubella (German measles)
"little red”; 3rd Disease Schoolchildren highest infectivity in unvaccinated populations Congenital Rubella Syndrome deafness, eye lesions, heart malformations & mr 24 cases , mostly immigrant 25-50,000 cases Mexico 1998 Higher suspicion cases in patients immigrating from countries with higher rates Vaccination contraindicated pregnancy (MMWR, 2001)


9 Rubella Diffuse rash, LN enlargement, h/a, malaise, mild cough and conjunctivitis Pink rash appears on face and spreads to body CD/rubella.htm

10 Chicken Pox- Varicella
caused by varicella-zoster virus blister-like rash, itching, fatigue & fever itchy blisters, 3 stages at same time (papule, vesicle, scab) 1 in 10 complications: bacterial, pneumonia, encephalitis

11 Chicken Pox- Varicella

12 Fifth Disease (Erythema infectiosum)
Parvovirus B19 S/S’s: low fever, cold, mildly ill Skin: "slapped-cheek" rash on face lacy red rash trunk & limbs infected adults may develop joint pains hands, wrists, knees kids may return to school- no longer infectious pregnant women exposed- refer to guidelines (Crane J, J Obstet Gynaecol Can, 2002)

13 Roseola/Exanthem Subitum
Human Herpes Virus 6>7 spread via saliva 72-95% sero + in US early age S/S’s: irritable, diarrhea, cough, fever F, for 3-7 days; 10% seizure Skin: As fever resolves, faint macules develop on trunk and extremities that blanch upon pressure Rash resolves 1-2 days

14 Roseola/Exanthem Subitum
Skin: As fever resolves, faint macules develop on trunk and extremities that blanch upon pressure Rash resolves 1-2 days


16 Hand Foot and Mouth Disease
Common acute febrile illness of children Group A coxsackie viruses 2-7 days resolves Hand washing Rare complications

17 HFM Disease hand foot mouth

18 Pityriasis rosea Unknown cause Lasts 6-12 weeks
Herpes viruses 6 & 7 associated Herald patch 1-20 days before rash Sometimes confused with T. Corporis or psoriasis

19 Pityriasis rosea Oval patches follow line of ribs like fir tree
Erythromycin may be effective tx (Sharma, JAAD, 2000)

20 Asymmetric periflexural exanthem of childhood (APEC)
Laterothoracic exanthem Uncommon, G > B Viral symptoms can occur Often mistaken for eczema, fungal Skin: Usually starts in armpit or groin and extends outwards, on one side of body May spread to face, genitalia, hands or feet Patches are net-like or in rings Pruritic Resolves within 3 months

21 Kawasaki disease 80% in children < 4 years
Self-limiting & resolves spontaneously without treatment 4-8 weeks 15-20% have damage to coronary arteries and 2% of patients die from heart attack (Brogan PA, Arch Dis Child, 2002)

22 Kawasaki disease

23 Kawasaki disease

24 Kawasaki disease


26 Smallpox Classic generalized exanthem
Latin word for “spotted” referring to the raised bumps on the face and body Rash, high fever & mortality rate 30% Last natural case Somalia in 1977

27 Smallpox Exanthem from vaccination 1/100,000
Vaccinia rash or outbreak of sores Generalized vaccinia Erythema multiforme

28 Smallpox From Vaccination 1/50,000 Eczema vaccinatum
Progressive vaccinia Postvaccinal encephalitis

29 Scarlet fever Group A streptococcus toxin children aged 4-8
contagious by coughing/sneezing or touching the infected skin sudden fever with sore throat, swollen LN’s, h/a, n, v, loss of appetite, swollen and red strawberry tongue, abdominal pain, body aches, and malaise

30 Scarlet fever Skin: rash 12-48 hours after fever
ears, neck, chest, armpits, groin, then rest of body over 24 hours scarlet spots or blotches, often the first sign starts to look like sunburn with goose pimples skin may have a rough sandpaper-like feel as rash fades, it peels similar to that of sunburned skin

31 Drug eruptions Almost all drugs

32 Drug eruptions Dilantin

33 Drug eruptions Minocycline

34 Drug eruptions Fixed drug eruption


36 Unknowns 1

37 Unknowns 2

38 Unknowns 3

39 Unknowns 4

40 Unknowns 5

41 Unknowns 6

42 Unknowns 7

43 Unknowns 8

44 Unknowns 9

45 Unknowns 10




49 References Trizna Z. Viral diseases of the skin: diagnosis and antiviral treatment. Pediatr Drugs 2002;4:9-19. Crane J. Parvovirus B19 infection in pregnancy. J Obstet Gynaecol Can 2002; 24: Glatman-Freedman A. Rubella vaccine. Pediatr Rev 2002; 23(3): Smallpox Vaccine. Pediatrics American Academy of Pediatrics, Committee on Infectious Diseases; 110: 4. Bromberg K. Group A beta-hemolytic streptococcal pharyngitis. Am Fam Physician 2001; 63(8): Bisno AL. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America. Clin Infect Dis 2002; 35(2):

50 References Gable EK. Pediatric exanthems. Prim Care 2000; 27: 353-69.
Brogan PA. Kawasaki disease: an evidence based approach to diagnosis, treatment, and proposals for future research. Arch Dis Child 2002; 86: Hairston BR. Viral diseases of the oral mucosa. Dermatol Clin 2003; 21(1): De Araujo T. Human herpesviruses 6 and 7. Dermatol Clin 2002; 20(2): Sharma PK. Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial. J Am Acad Dermatol 2000; 42: MMWR. Control and prevention of rubella: evaluation and management of suspected outbreaks, rubella in pregnant women, and surveillance for congenital rubella syndrome. July 13, 2001; 50: 1-23.

51 Thank you.

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