Viral skin infections in a child

Differential diagnosis

  • Roseola infantum
    • High fever followed by macular rash. After rash develops, fever settles
    • Rash – pink almond-shaped macules – may be discrete or merge – lasts up to two days
    • No scaling
  • Measles
    • General – fever, malaise, runny nose
    • Eyes – red conjunctiva, photophobic
    • Mouth – white spots on buccal mucosa
    • Rash – day four of illness, starts on forehead and behind ears – spreads within 24 hours to face, trunk, limbs – initially macular and then develops into red papules that coalesce
  • Molloscum contagiosum
    • Rash – discrete, pale, flesh-coloured, dome-shaped papules with central umbilications
  • Rubella
    • Lymph nodes – enlaged sub-occipital, post-auricular and cervical LN up to 1 week before rash
    • Mouth – dull red macules
    • Rash – first on face then spreads to trunk and limbs – initially discrete pink macules, the face clears and the trunk becomes more erythematous as the macules coalesce. Generally fades by day four.
  • Herpes zoster (Shingles)
    • Prodromal symptoms – four day history of hyersensitivity in the affected dermatome before the rash appears
    • Rash – swollen red plaque affecting a dermatome followed by clusters of vesicles on the plaque which eventually become purulent
  • Hand, foot and mouth disease
    • General – fever
    • Mouth – painful stomatitis, multiple aphthous ulcers
    • Hands and feet – (1/3 will not have these) small red macules which develop into oval vesicles
  • Herpes simplex rash
    • Prodromal symptoms – tenderness or burning before rash appears
    • Rash – vesicles on an erythematous background – characteristically focal, recurrent infection affecting the same site
  • Erythema infectiosum (Fifth disease / Slapped cheek)
    • Rash – slapped cheek appearance sparing nasolabial folds and circum-oral region – two days later, a lace pattern of erythema may develop on the extremities, trunk and buttocks
  • Varicella (Chicken pox)
    • Prodromal symptoms – low-grade fever, malaise, headache
    • Rash – red papules which become itchy vesicles and pustules – typically begins on trunk and spreads to face and extremities

 

Data gathering

  • History
    • As above
  • Examine
    • HR, RR, Temperature, Sats

 

Clinical management

  • Treatment
    • As per condition
  • Followup/Safety-Net