What is this child's rash? - Central Skin answers ED doc's question about a child with a rash.

On Sep 2, 2013

In addition to being one of the contributing writers/editors of Central Skin, I am also a current resident physician. A while ago, I was asked by a colleague, a current Emergency Medicine resident physician in Chicago area about a patient that she saw in the Emergency Room who presented with a rash. I thought I would share my response to her with the readers of Central Skin. For privacy concerns, I excluded any specific identifying information of the patient and I also obtained permission from my doctor colleague about publishing her question and my answer. For people not versed in "doctor-speak," I translated and explained various technical lingo used in her question and in my answer. I hope you all find it informative!

ED doctor question: What caused the rash that this child has?

child with Fifth disease (slapped cheek disease)
A 16 month old child with Fifth Disease
Image Source: Wikipedia

ED Doc: "Heyy hope you're well. I have a derm question for you. I saw an 8 month old healthy male Chinese baby in the ED last night. He has had a macular (translation=flat) rash present for about 5 days. It started on the back of his neck and then he developed little patches of the same erythematous (translation=red), macular rash on his trunk and extremities. Nothing on the palms of the hands or the soles of the feet. It then developed in a beard like distribution on his face, with circumoral (translation=around the mouth) sparing. No other symptoms, patent airway, no fevers, he looked and sounded great otherwise, eating, drinking, pooping, peeing normally. Had all his vaccinations and no recent travel or sick contacts. I was thinking Fifth disease (parvovirus B19) (translation=Fifth Disease is also known as slapped cheek syndrome) , mostly because of what the face rash looked like. Any other thoughts? I know 8 months is a bit early for parvovirus(translation=the virus responsible for Fifth Disease) but they can still get it i think."

"Oh and one more thing that threw me off... He didnt have the classic "lacelike" pattern of rash on the extremities... It was more just small areas of red, macular rash spread sporadically around his body."

Central Skin answer

Central Skin: "I think that you might have hit the diagnosis on the head. Erythema Infectiosum (AKA Fifth Disease or slapped cheek syndrome) usually starts with some symptoms of low grade fevers and cold like symptoms of runny nose. After those symptoms pass, the rash develops. The rash usually spreads from face to body like you described. And I don't think the rash always looks lacy. It sometimes starts as erythematous macules and patches (translation=red small and large spots) which then get central clearing leading to the lace like pattern. Also usually kids that get Fifth Disease aren't really sick appearing and frequently don't even itch. In addition, if it is parvovirus, the child is usually no longer contagious by the time the rash develops."

Roseola on 21 month old girl
Roseola on a 21-month-old girl
Image Source: Wikipedia

"The other possible thing it could be is Roseola. Roseola usually infects kids of this age and it also presents with a rash on the trunk and body that can spread to the face. However the rash usually happens after the child has several days of high fever and so I am not sure this was the case with this child. The other things any rash could be before a child's MMR vaccine (translation=measles, mumps, rubella vaccine administered at the age of 1 year) is measles or rubella especially in today's society of non-immunization. However, a child with measles will be much sicker and have the 3 C's cough coryza conjunctivitis (translation= 3Cs refer to the symptoms of cough, runny nose and red itchy eyes in patients with measles) and a high fever. A child with rubella they would have more lymph node involvement around the neck and may have conjunctivitis (translation = red eyes)."

Key point:

Rashes are very common in children and a lot of rashes are caused by viral infections. However, a myriad of other causes including drugs reactions, allergies, and contact dermatitis can cause a rash in a child. It is for this reason that you should not rely on the advice of any website or online source and should contact your physician for any advice regarding a rash that has developed in your child.

Fifth Disease


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