When is a rash not ‘just’ a rash? A guide to recognition and treatment of paediatric dermatological emergencies

Published:October 29, 2020DOI:https://doi.org/10.1016/j.paed.2020.10.006

      Abstract

      Paediatricians are often asked to review patients with a rash. We all know the potential sinister causes of the non-blanching rash and can recognize the ‘viral rash’ which is a staple paediatric presentation. However, there are a myriad of other paediatric rashes of varying aetiology occurring alone and in association with systemic diseases. Paediatric dermatological emergencies are thankfully rare, but there are a few serious acute presentations that paediatricians should be aware of. This article will cover how to recognize and manage the most serious emergency presentations.

      Keywords

      To read this article in full you will need to make a payment

      References

      1. DermNet New Zealand https://dermnetnz.org/topics/scorad/

        • Bastuji-Garin S.
        • Rzany B.
        • Robert S.
        Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme.
        Arch Dermatol. 1993; 129: 92-96
        • McPherson T.
        • Exton L.S.
        • Biswa S.
        • et al.
        British Association of Dermatologists' guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in children and young people 2018.
        Br J Dermatol. 2019; 181: 37-54
        • Patel G.
        • Finlay A.
        Staphylococcal scalded skin syndrome diagnosis and management.
        Am J Dermatol. 2003; 4: 165-175
        • Fujita H.
        • Terui T.
        • Hayama K.
        • et al.
        Japanese guidelines for the management and treatment of generalized pustular psoriasis: the new pathogenesis and treatment of GPP.
        J Dermatol. 2018 Nov; 45: 1235-1270
        • Luca N.
        • Lara-Corrales I.
        • Pope E.
        Eczema herpeticum in children: clinical features and factors predictive of hospitalization.
        J Pediatrics. 2012; 161: 671-675

      Further reading

        • Amagai M.
        • Matsuyoshi N.
        • Wang Z.H.
        • et al.
        Toxin in bullous impetigo and staphylococcal scalded skin syndrome targets desmoglein 1.
        Nat Med. 2000; 6: 1275-1277
        • Bieber T.
        Atopic dermatitis.
        N Engl J Med. 2008; 358: 1483-1494
        • Ferrandiz-Pulido C.
        • Garcia-Patos V.
        A review of causes of Stevens-Johnson syndrome and toxic epidermal necrolysis in children.
        Arch Dis Child. 2013; 98: 998-1003
        • Gao P.S.
        • Rafaels N.M.
        • Hand T.
        • et al.
        Filaggrin mutations that confer risk of atopic dermatitis confer greater risk for eczema herpeticum.
        J Allergy Clin Immunol. 2009; 124 (513.e1–513.e7): 507-513
        • Gooderham M.
        • Van Voorhees A.
        • Lebwohl M.
        An update on generalized pustular psoriasis.
        Expert rev clin immunol. 2019; 15: 907-919
        • Howell M.D.
        • Wollenberg A.
        • Gallo R.L.
        • et al.
        Cathelicidin deficiency predisposes to eczema herpeticum.
        J Allergy Clin Immunol. 2006; 117: 836-841
        • Leman J.
        • Burden D.
        Psoriasis in Children: a guide to its diagnosis and management.
        Paeditr drugs. 2001; 3: 673-676
        • Mockenhaupt Maja
        The current understanding of Stevens-Johnson syndrome and toxic epidermal necrolysis.
        Expert rev clin immunol. 2011; 7: 803-815
        • Morris A.
        • Rogers M.
        • Fischer G.
        • et al.
        Childhood psoriasis: a clinical review of 1262 cases.
        Pediatr Dermatol. 2001; 18: 188-198
        • Rashid R.
        • Goodyear H.
        Management of paediatric dermatological emergencies.
        Paediatrics Child Health. 2014; 25: 78-83
        • Toyomi de Oliveira S.
        • Maragno L.
        • et al.
        Generalized pustular psoriasis in children.
        Pediatr Dermatol. 2010; 27: 349-354

      Linked Article