The ED Approach to Pediatric Rash

Ashley Strobel MD, FACEP

Assistant Professor of Emergency Medicine

Hennepin County Emergency Department Faculty

University of Minnesota Masonic Children’s Hospital Division of Emergency Medicine

Adjunct Faculty

Objectives

• Describe a simple approach to pediatric rashes

• Highlight life-threatening, can’t miss rashes

• Discuss management of some common rashes

NO DISCLOSURES

What’s this rash?

Rashes are ubiquitous!

Red Flags to

Slow Down

your Thinking

Historical Clues for

Pediatric Rash

Exam Red

Flags for

Pediatric

Rash

Approach to Pediatric Rashes

Step 1: Sick or not sick?

Step 2: Exam Red Flags• Mucous membrane?

• Palms and soles?

• Nikolsky?

• Petechiae or purpura?

Step 3: Named pediatric rash?

Step 4: Neonate?

Step 5: Pruritic?

Step 6: Admit you aren’t sure! Offer a referral

to Dermatology.

Even Dermatology doesn’t have all the answers!

EXCEPTIONS: Mucous Membrane Involvement

Benign Newborn Rashes…

Can’t Miss Rashes:

Kawasaki

Pruritis?

Stop the Itch:

Cetirizine, Ranitidine,

Diphenhydramine

Anti-Inflammatory:

Tacrolimus, Pimecrolimus

Steroids (ointments > creams)

Skin Barrier Emollients: Aveeno, Eucerin, Vanicream, Vaseline, Aquaphor, Cetaphil

2018 EBM Atopic Dermatitis Therapy:

RASH

NOT SICKTOXIC

Labs

ED Derm

Consult vs

Admission

IV Antibiotics

o SJS/TEN/MERM

o Syphilis

o RMSF

o Meningococcemia

o ITP

o HUS

o Leukemia

o Disseminated

HSV

o TSS

o Necrotizing

Fasciitis

o Kawasaki

Pruritis?

Steroids & Anti-

histamine

Mucous

Membrane

Petechiae/

Purpura

Palms and

Soles

Nikolsky

NeonateIt’s viral

Supportive cares

Yes, this includes

Gianotti CrostiPain out of

proportion

Summary: Rash Algorithm

Gianotti Crosti: Papular Acrodermatitis

Questions?

Common Pediatric Rashes

Change the diaper more often

Let the skin breathe

Apply barrier ointment

Apply Nystatin ointment or powder for Candida

Apply Zinc Oxide

Can’t Miss Rashes: Eczema Herpeticum