Pediatric Pearls: Pediatric Rashes

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Ian L., Dr -

It is time to do parvovirus 19 as part of the preconception and antenatal screen especially in health workers that would likely be exposed to Parvovirus whilst pregnant .

ilene c. -

Agreed. I had a few scares during pregnancy and it was terrible!

Mary C. -

Wonderful discussion! Any tips on diagnosing cutaneous manifestations of herpes simplex from other vesicular rashes? If it is disseminated like with eczema herpeticum it is more obvious, but in cases where the child is well appearing and the lesions are limited in number, vesicular lesions can be quickly attributed to impetigo, HFM/coxsackie, or my favorite vague “viral exanthem” categories, in which case treatment could be misguided or absent.

ilene c. -

Absolutely true and we all know the classic appearance of a vesicle/ cluster of vesicles on an erythematous base doesn't always look that way when a child has been scratching and a parent has put on everything from mercurachrome to calamine! I would say a herpetic rash is a big problem in the following scenarios: immunocompromise, infant <6 weeks, genital/ anal rash in child who may be victim of abuse, eczema herpeticum. Herpeticum and a cored out genital/ anal rash are usually pretty easy to recognize. For the neonate <6 weeks or the severely immunocompromised child, the risk of a miss is so high that I would treat it as herpes if there is any chance. And if we over treat 1 hand foot and mouth/ year, that is OK. If there are oral lesions, herpes tends to be a bit more lip/ tongue tip, which herpangina and hand-foot-mouth a bit more soft palate/ tonsillar pillar

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