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Sarah Stein, MD
Sections of Dermatology and Pediatrics
University of Chicago
Definitions
Exanthem: A skin eruption occurring as a
symptom of a general disease.
Enanthem: Eruptive lesions on the mucous
membranes.
Measles (Rubeola)
Scarlet Fever
Rubella (German measles)
Filatow-Dukes Disease
Erythema Infectiosum
Roseola Infantum
1st Disease=Measles
Paramyxovirus
At risk: preschool-age children who escaped
vaccination; school-age children/adolescents in
whom vaccination failed
Season: late winter/spring
Incubation period: 8-12days
Infectious period: 1-2d before prodrome to 4d
after onset of rash
Measles:
morbilliform
exanthem
Presents day 14
after exposure
Measles: complications
Otitis media
Bronchopneumonia
Encephalitis
Myocarditis
Pericarditis
Subacute sclerosing panencephalitislate
sequellae due to persistent infx of the CNS
Strawberry tongues
Nonsuppurative
sequalae
Rheumatic fever
Acute
glomerulonephritis
3rd Disease=Rubella
Togavirus
At risk: unvaccinated adolescents
Season: late winter/early spring
Incubation period: 14-21 days
Infectious period: 5-7d before rash to 3-5d
after rash
Enanthem
Forschheimers spots = petechiae on the hard
palate
Rubella: exanthem
Rubella: complications
Arthralgias/arthritis in older patients
Peripheral neuritis, encephalitis,
thrombocytopenic purpurarare
Congenital rubella syndrome
Infection during first trimester
IUGR, eye findings, deafness, cardiac defects,
anemia, thrombocytopenia, skin nodules
4th Disease=Filatow-Dukes
Disease
Obsolete
Probably now better defined as another
clinical entity
5th Disease=Erythema
Infectiosum
Erythema
Infectiosum:
slapped cheek
appearance
EI: complications
Immunocompromisedchronic infection
with severe, persistent, relapsing and
remitting anemia, prolonged viral shedding
Patients with decreased RBC survival time
(hemoglobinopathies, hemolytic dis)
aplastic crises, prolonged viral shedding
Fetal infectionhydrops fetalis (overall
risk of fetal death 1-9%)
th
6
Disease=Roseola infantum
(aka Exanthem subitum)
Roseola: exanthem
Chicken Pox=Varicella
Varicella zoster virus, family herpesviridae
At risk: young children, nonimmune inds
Second attack rate within households is 80-95%
Season: sporadic
Incubation period: 10-21 days
Infectious period: via resp drop and vesicle
fluid, 2d before to 5d after onset of rash
Pruritus
Variable from mild to severe
Pneumonitis
Encephalitis
Cerebellar ataxia
Hepatitis
Smallpox
(variola):
exanthem
Varicella Zoster:
exanthem
Ulcerations
Secondary infection
Infectious Mononucleosis
Enterovirus rashes
Hand-foot-mouth disease
Herpangina
Nonspecific eruptions
Hand-foot-mouth disease
Typically due to Coxsackie A16
At risk: preschool-school aged children
Highly contagious
HFMD: enanthem
HFMD: exanthem
Herpangina
Coxsackie A viruses
At risk: young children
Prodrome
Fever, sore throat
Herpangina: enanthem
Nonspecific enteroviral
exanthems
Multitude of presentations
Morbilliform or rubelliform
Vesicular
Petechial (typical of echovirus 9)
Urticarial
Enterovirus:
nonspecific
exanthem
Named exanthems
Gianotti-Crosti Syndrome, aka papular
acrodermatitis of childhood
Unilateral Laterothoracic Exanthem, aka
asymmetric periflexural exanthem of
childhood (APEC)
Pityriais Rosea
Gianotti-Crosti syndrome:
clinical features
Most often due to EBV, also Hep B and all
other viruses
At risk: 6mo-14yrs, mean 2yrs
Season: spring and early summer
Constitutional symptoms: mild
Low grade fever, malaise, LAD, rare pruritus,
mild hepatitis (except in Hep B-associated case)
Gianotti-Crosti Syndrome
Gianotti-Crosti Syndrome
Gianotti-Crosti Syndrome
Unilateral Laterothoracic
Exanthem
aka Asymmetric Periflexural Exanthem
?viral: suggested by age, clustering, resp
symptoms
At risk: 1-5yos, mean 2yo
Prodrome: 60-75%
Rhinitis, pharyngitis, bronchitis, conjunctivitis,
gastroenteritis
Fever in 40-65%
Unilateral
Laterothoracic
Exanthem
Pityriasis Rosea
?viral: suggested by seasonality, mild
prodromal symptoms, assoc URI, clustering
of cases
Season: spring, autumn, winter
At risk: 10-35yos, can be seen in younger
Prodrome: very mild, if any
Malaise, nausea, anorexia, headache, low fever
Pityriasis Rosea
Pityriasis Rosea
Pityriasis Rosea