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2	Rash Decisions in Hot Kids Bernard A. Cohen, M.D. Johns Hopkins Children’s Center dermatlas.org How to get started Systematic evaluation Algorithms Try your luck at dermatlas.org When all else fails ask your friendly neighborhood dermatologist
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4	Clues-the setting Office, OPD Inpatient NICU PICU Post surgery
5	More clues-past medical hx Medical disorders Drug exposure Time of year Geography
6	…and the age of the patient Variable morphology of the rash Variable course Immunologic parameters Variable exposure/susceptibility to infection (neonate <2 yrs <5 yrs <18 yrs) Variable incidence of disease
7	Clinical Check List Mucous membranes Palms/soles Nails Scalp
8	SJS v SSS
9	DDx for strawberry tongue?
10	…clues in the scalp
11	…copper pennies on the soles
12	… and Beau lines?
13	…nail dystrophy
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15	Course of skin findings How long? Progression? Pruritus?
16	Systematic Approach to Clinical Findings Pattern Organization Depth Morphology
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18	Papulosquamous? Itchyà Acralà PR patternà Intertriginousà Scarlatiniformà Dermatitis with infection Papular acrodermatitis R/O syphilis, drug LCH, infected seborrheic dermatitis Scarlet fever, Kawasaki syndrome, Staphy, viral exanthem
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20	For some reason Strep likes this site in these patients.
21	DDx?
22	same process…different color
23	….DDx?
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25	Papular acrodermatitis…DDx?
26	Vesiculopustular? Groupedà Disseminated Tzanck (+) à Tzanck (–) à Mucous membraneà HSV, H Zoster VZV, disseminated HSV SJS, TEN, SSSS Not in SSSS
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37	Reactive Erythema? Morbilliformà Urticariaà Scarlatiniformà Sweet syndromeà Annular erythemaà Viral, drug, Kawasaki, CTD, malignancy Same Same Idio, malignancy Lyme disease, CTD, other
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46	Persistent urticaria without itch… …think vasculitis Collagen vascular disease Henoch Schonlein purpura Drug reaction Infection
47	Purpura? Palpableà Non palpableà Vasculitis HSP, viral, drug, CTD, sepsis(bacterial, fungal, RMSF) Purpura fulminans (DIC), drug, viral
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57	Chronic Fever? General health, growth, development? Loss of landmarks? Loss of weight?
58	Clinical worries… R/O collagen vascular disease R/O malignancy R/O inflammatory bowel disease R/O chronic inflammatory skin disease
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62	Connective Tissue Disease Rheumatic fever Systemic lupus erythematosus Dermatomyositis Scleroderma
63	Special Considerations Erythroderma-total body red and scaly Cutaneous findings in malignancy erythroderma Sweet syndrome pyoderma gangrenosum
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66	When all else fails, ask your dermatologist, but make it a useful consult… Give pertinent history Include drug exposures Describe the pattern, organization, etc. And only then the morphology