The rash is a common pediatric disease with a variety of forms, making diagnosis difficult. Identification of pediatric rashes is a prerequisite for clinical treatment.
The rash is quite common in pediatric diseases, and the situation is complex. It can be divided into maculopapular rash (including macules and papules), herpes (including macules, pustules and pustules) and purpura according to its form. The same kind of rash can be seen in different kinds of diseases, the same kind of disease can be seen in different rashes, should be combined with the medical history and clinical manifestations of a comprehensive analysis …, here, the most common causes of pediatric rash in outpatient clinics for a brief introduction.
I. Papular rash
Maculopapular rash is a common clinical rash in pediatrics. The maculopapular rash is caused by the expansion of blood vessels in the dermis and makes the skin appear red, not protruding from the skin surface, and can be discolored by finger pressure, its size varies, and can be fused into a patch, or can form a ring-shaped red spot. Papules are formed by focal edema, inflammatory infiltration or foreign body deposition or follicular keratinization within the superficial layer of the epidermis or dermis, and inflammation. The papules are above the skin surface, vary in size, and may fuse into patches.
Diseases with common pediatric clinical maculopapular rash are as follows.
1. Rash acute infectious diseases.
(1) Measles, rubella, early childhood emergency rash, enterovirus infections (enterovirus C and ECHO virus), mostly seen as maculopapular rash, varying in size, may fuse. The skin between the rash is normal, distributed on the face, trunk, and extremities.
(2) Scarlet fever, Staphylococcus aureus and other infections and sepsis: small, dense maculopapular rash, slightly above the skin surface, in the shape of “chicken skin”, with little normal skin between the rashes. The whole body epidermis is congested, only around the mouth shows pale circles, in the axillae, groin can be seen obvious congestion line.
(3) Identify the rashes of these infectious diseases specifically as follows.
(1) the time of appearance of the rash: when infected with a rash infectious disease, the rash appears a few days after the fever, there is a certain pattern.
② rash starting site and distribution: measles starts from behind the ears, hair edge, followed by the face, then the trunk and limbs, especially the palms of the hands, feet most; scarlet fever starts from the neck, upper chest, spread to the whole body; chicken pox starts from the trunk can spread to the hair, oral mucosa; typhoid appears in the chest, abdomen but the number is sparse; epidemic encephalomyelitis can appear in any part of the body. Rubella and early childhood emergency rash are also distributed on the trunk.
(3) The shape and number of rashes: chicken pox starts as a small papule, soon appears as a blister with a red halo around the pustule, round or oval herpes; rubella and early childhood rash are red papules; scarlet fever is a flushed skin all over the body, uniform fine dot rash like chicken skin; epidemic cerebrospinal meningitis rash, the size and number of each patient varies greatly, are hemorrhagic red dot rash or patches of petechiae; measles is a bright red papule all over the The whole body is a bright red papule slightly protruding from the skin; typhus is very similar to measles; typhoid is a bright red, finger pressure can fade small red rash.
2, drug rash: is a rash caused by drug allergies. The rash form is more, common maculopapular rash or scarlet fever-like rash, the rash can be fused into a patch, or even throughout the trunk or limbs, forming a whole body epidermis red or with epidermal desquamation, or with herpes, or visible urticaria, etc.
3, infant eczema: a variety of forms, lesions mostly occur in the cheeks, forehead, between the eyebrows, neck and head, serious trunk and limbs also have. Initially erythematous, later punctiform papules, and then the formation of scabs. The lesions are often symmetrically distributed. Eczema is sometimes dry, i.e. there is a small amount of grayish-white bran-like flaking on the papules. It can also be seborrheic, oozing yellowish fatty liquid on the maculopapular rash, and then crust, to the top of the head and eyebrows, next to the nose, behind the ears, but the itch is less pronounced.
4, urticaria: commonly known as rubella block, can be seen as a result of a variety of diseases caused by the allergic reaction, rapid appearance, rapid fading, rash size varies, with mild congestion or congestion is not obvious.
5, Kawasaki disease can be seen in multiple lines of erythematous rash, mostly on the trunk, there are still other skin changes.
II. Herpes
Mostly seen in pediatric clinics, its morphology varies in size and can be divided into blisters and pustules. Blisters are superficial, transparent or translucent, and contain plasma, and later mostly leave no scarring, while pustules often leave scarring of varying depths.
The diseases of common herpes are as follows.
1, viral infectious diseases
(1) chickenpox: the rash first occurs on the trunk, gradually spreads to the head, face and limbs, and can also be seen in the hairline. It starts as a red pinpoint-sized rash, then develops into a papule, which becomes a blister after a few hours, and can be oval or round, with a thin wall that breaks easily, drying and crusting in 2-3 days, and later heals with the scab off.
(2) Herpes zoster: clusters of herpes arranged in bands along the innervated skin area, accompanied by neuralgia. In the literature, it is called “waist-wrapping fire tan”, and in folklore, the disease is called “string waist dragon”, because herpes zoster invading the chest and waist area accounts for more than 60% of the incidence of the disease. In fact, the disease can also affect the head, face, ears and upper and lower limbs. As the virus attacks the nerves, the onset is always along the nerves, in the form of strips, so it is called “herpes zoster”.
(3) Herpes simplex: It occurs on the lips and perioral skin, such as the perioral area, nose, nasolabial folds and chin. The skin is red, itchy and burning at the beginning, followed by the appearance of blisters, which are small in clusters, clear and later cloudy, and finally form yellow scabs, which soon fall off and leave temporary local pigmentation.
(4) Herpetic eczema: initially erythematous, later punctate papules, herpes, very itchy, herpes broken, exudate outflow, so also known as exudative eczema.
2.Purulent infection
(1) Impetigo: is a common bacterial skin infection, commonly known as yellow sores, is a common disease, contact infection, mostly in the summer and autumn, invading children. It is a common disease that is transmitted by contact, mostly in summer and autumn, and affects children. It occurs on the head, face and extremities, but can also spread to the whole body, initially as erythematous spots or blisters, and then becomes pustules of different sizes, surrounded by a red halo, with loose walls, and pus deposited in the bottom of the blisters, with transparent liquid in the upper part, forming a half-moon shape, with the rupture of the blister membrane revealing a vesicular surface, and after drying, forming a honey-yellow pus crust.
(2) Neonatal pemphigus: a purulent disease caused by bacterial infection. The pathogenic organisms are mostly Staphylococcus aureus and Streptococcus. The blisters start out as scattered blisters and then rapidly increase to superficial blisters with a diameter of 2 cm or more, and the blister fluid starts out yellowish and clear, and then becomes cloudy. Due to the thin and loose walls of the blisters, the pustules often break down and the lesions are usually seen as superficial vesicles left after the blisters break down, which form yellowish pustules after drying. Most of the disease does not have systemic symptoms, but a few may have malaise, fever, diarrhea and other systemic symptoms. Newborns may have life-threatening complications such as golden glucose sepsis, pneumonia or meningitis.
(3) Allergic diseases: As mentioned above, herpes can appear in various rashes.
III. Purpura
Purpura is a manifestation of blood nightly exuding from the capillaries of the skin or mucous membranes and pooling in the tissues. The surface of the skin first has bright red spots with different shapes and sizes, finger pressure does not fade, later turns purple and turns blue H hole9|, finally becomes brownish yellow and disappears. Purpura can be caused by different reasons.
1, the number of platelets decreased or quality changes within the skin appear punctate bleeding. The size is more ~ consistent, distributed all over the body, more in the skin by friction, extrusion site. It is often combined with mucosal bleeding.
2, capillary wall permeability increased red blood cells and plasma from the capillary wall exudation, bleeding rash occurs, commonly in the following diseases.
(1) scurvy: caused by vitamin C deficiency, can be in the skin, mucous membrane, subperiosteal, joint cavity and muscle bleeding
(2) Neonatal or infant sepsis: It is due to high permeability of the mucous membrane in neonates, insufficient function of the mucosal barrier composed of cilia, glandular cells and their secretions, insufficient reserve of neutrophils in the blood, poor ability to adsorb, phagocytose and kill pathogenic insects, especially in preterm infants, very low birth weight infants or in the presence of hypoxia and acidosis, and some bleeding points may have bacterial embolism.
(3) Allergic purpura: It is a common vascular metaplasia hemorrhagic disease. Due to the metamorphic reaction of the body to certain allergenic substances, it causes extensive small vasculitis, which increases the permeability and fragility of small arteries and capillaries with exudative bleeding and edema. Most of them are mainly manifested by recurrent petechiae and petechiae on the skin, mostly on the lower limbs and buttocks, symmetrically distributed and appearing in batches, with petechiae of different sizes, purplish red, or fused into patches or slightly above the skin surface, in the form of hemorrhagic papules or small urticaria, which may be accompanied by a slight itching sensation.
3, bacteraemia or septicemia hemorrhagic rash of varying shape, size, very easy to fuse or protrude from the epidermis, can be distributed throughout the body and the extremities are often more. Mostly accompanied by signs of severe infection poisoning.