Not only do fall and winter bring chilly weather, with the changing of the seasons comes a whole host of pediatric illnesses. Fevers, flu, and the sniffles plague schools and daycares. Many times as nurse practitioners we can’t give a specific name to these wintertime ailments. But, on occasion, an illness gives us a clue. Rashes can help you pinpoint the cause of illness in kids and, more importantly, know if you are dealing with a serious diagnosis.
Rashes can be difficult to distinguish, but most have a few hallmark features. Identifying these telltale signs can help aid your diagnosis and treatment of pediatric patients. Here are seven rashes nurse practitioners and physician assistants must be able to identify.
With the advent of the varicella vaccine, most providers no longer treat chickenpox. But, with many children still not vaccinated and the off chance of contracting the virus regardless of vaccination status, NPs and PAs must refresh their memories concerning chickenpox.
The varicella zoster virus causes a vesicular rash located mainly on the trunk and head rather than the limbs. The rash begins as small, painless red macules which progress to raised vesicles then itchy, raw pockmarks which eventually scab. All stages of skin lesions may be present on the body at once. Other symptoms of chickenpox include bodyaches, nausea, headache, oral lesions, and fever. Chickenpox is rarely serious in children and resolves within five to ten days.
Children with roseola present with a history of high fever, bodyaches, runny nose, irritability, and decreased appetite typically for about three days. A few days after the fever subsides and the child appears to be recovering, a red rash appears. The rash is a diffuse, pale pink macular or papular exanthem that usually beings on the chest, back and abdomen then spreads to the neck or arms. Often, it does not reach the legs or face. The rash is not itchy or painful. It lasts for several hours to several days and resolves spontaneously.
Roseola most commonly affects children between six months and two years of age. Most cases resolve without complication, however febrile seizures may occur in some children.
3. Kawasaki Disease
Kawasaki disease can be fatal if left untreated so nurse practitioners need to be on the lookout for signs of the illness in children, especially those ages one to two years old. Kawasaki disease is a condition causing inflammation in the walls of the arteries including the coronary arteries. Its cause is unknown. Symptoms include high fever lasting at least five days, conjunctivitis and lymphadenopathy. In Kawasaki Disease, fever is often unresponsive to antipyretics. The disease also causes a characteristic redness of the tongue and cracking of the lips. Redness and swelling of the palms of the hands and soles of the feet may also occur. A generalized rash may also be present.
Cardiac complications such as coronary artery aneurysm occur in as many at 20 to 25% of untreated cases so providers must be able to identify the hallmark symptoms of Kawasaki Disease.
4. Fifth Disease
Fifth disease, technically referred to as erythema infectiosum, is a viral infection causing a hallmark ‘slapped cheek’ appearance. The infection begins with a low-grade fever, headache, runny nose, and cold-like symptoms. These symptoms resolve and within a few days a rash appears. The rash is bright red and most commonly appears on the face. An erythematous, reticular rash may also appear on the arms, torso, and legs. The rash may be itchy. Usually, the rash persists for two days after which the individual is no longer contagious.
Fifth disease is most often mild and resolves spontaneously without complication. One exception is that in pregnant women infection in the first trimester has been linked to spontaneous miscarriage. Individuals infected with the virus should avoid contact with pregnant women.
Several outbreaks of measles have occurred in the United States in recent years as a result of anti-vaccination movements. So, healthcare providers must know how to identify the measles rash. The three C’s, cough, coryza (cold-like symptoms), and conjunctivitis are typical features of measles and are accompanied by fever and rash. The rash associated with measles is a generalized, erythematous, papular rash. It appears several days after the onset of illness usually behind the ears then spreading to the head, neck, and eventually the rest of the body. The rash is often itchy and ‘stains’ changing from red to a dark brown color before resolution.
6. Hand, Foot and Mouth Disease
Hand, foot, and mouth disease is a viral illness causing rash in and around the mouth, on the soles of the feet, and the palms of the hands. The rash is papular with lesions eventually turning to vesicular sores. The rash can be painful, especially the intra-oral lesions, and is rarely itchy in children. Other symptoms of the illness include fever, fatigue, and loss of appetite.
Hand, foot and mouth disease is most common in toddlers and commonly occurs in the fall and summer months. Most cases are mild and resolve on their own in 7 to 10 days. Rarely, serious neurological complications can occur.
7. Scarlet Fever
Scarlet fever can be fatal if left untreated, so nurse practitioners must be able to identify its characteristic appearance. The illness results in a fine, red, rough-textured rash that blanches on pressure. It appears 12 to 72 hours after onset of fever. The rash typically begins on the chest and behind the ears and may be present on the groin as well. It forms red streaks known as Pastia lines in skin folds. On the face, the rash causes erythema on the cheeks with a characteristic circumferential pallor around the mouth. Many children also develop a characteristic ‘strawberry tongue’. The rash begins to fade three to four days after onset. Then, desquamation, or peeling, of the skin occurs most often on the palms, fingers, and toes.
Scarlet fever is treated with antibiotics. If left untreated complications may include glomerulonephritis, rheumatic fever, and sepsis.
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