CHIEF COMPLAINT: RASH FOR 3 DAYS

 



QUESTION: A 3yr old boy is brought to the clinic because of a 3 day history of a rash. His mother reports that he has had fever and malaise for 5 days. He attends daycare with several other children who have a similar rash. Now at the clinic, his temperature is 38.5C. Physical examination shows a diffuse rash more on the face and trunk. There is a wide range of lesions 5-10mm in diameter on an erythematous base. Some are maculopapular, some are vesicular and a few are crusted. There are no oral or mucosal lesions.

1)     1)  Give 4 differential diagnoses

2)      2) Tell the most likely diagnosis.

 

 

SOLUTION:

1)      DIFFERENTIAL DIAGNOSES:

A)     Chickenpox (Varicella/Varicella zoster)

B)     Impetigo

C)     Folliculitis

D)     Insect bite

 

2)      MOST LIKELY DIAGNOSIS = Chickenpox

 

 


ASSESSMENT:

CHICKENPOX:

-Also known as Varicella/Varicella zoster

-Transmitted via respiratory secretions

-Rash consisting of macules,papules,vesicles,pustules and crusts.

-May have ulcerative lesions involving the oropharynx and vagina.

-Rash characterized by crops of lesions in various stages.

-Diagnosis made clinically; no laboratory evaluations necessary

 

TREATMENT PLAN:

-Supportive treatment

-Good skin care to prevent bacterial superinfection

-Acyclovir in some cases

-Child may return to school or daycare when all lesions have dried and crusted.

 

 

IMPETIGO:

-May occur on the face, buttocks, perineum, trunk and extremities.

-In bullous impetigo, bullae rupture, leaving moist erosions that scab/crust.

-Topical or systemic therapy

 

 

FOLLICULITIS:

-Superficial infection of a hair follicle usually caused by staph aureus.

-Small, dome-shaped pustules on an erythematous base in the pilosebaceous canals around the hair follicles.

-Located in the scalp,buttocks and extremities.

-Lesions heal without scarring

-Causative factors; poor hygiene, wound drainage and exclusive wrappings

-Treatment; topical cleansers and topical antibiotics. More severe cases may require systemic antibiotics.

 

INSECT BITES:

-Fleas,bedbags,mosquitoes

-Lesion may be solitary,numerous or profuse.

-May develop papular urticarial

-Itchness sometimes

-Insect repellents may help alleviate the problem.

 

 

 

 

 

                                                                                                                                             RAF/ZANYA TUTORIALS             

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