Erythema nodosum (EN) is an acute panniculitis consisting of deep, painful, bilateral erythematous nodules, usually on the lower extremities, resulting from an underlying systemic illness.
Erythema multiforme (EM) is an acute, immune-mediated mucocutaneous condition characterized by target lesions with concentric zones of color change, most commonly associated with herpes simplex virus (HSV) infection.
Stevens–Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe immune-mediated hypersensitivity reactions characterized by diffuse bullous lesions and mucocutaneous involvement most commonly precipitated by medications such as anticonvulsants.
Staphylococcal scalded skin syndrome (SSSS) is characterized by an erythematous rash followed by diffuse epidermal exfoliation.
Purpura fulminans is a severe form of rapidly progressive purpura with multiorgan failure, usually associated with meningococcemia.
Nonaccidental trauma should be suspected if bruising occurs on non-bony prominences or in areas not normally subjected to trauma during routine child play.
Toxic shock syndrome (TSS) is an acute, toxin-mediated illness characterized by fever, erythroderma, hypotension, multiorgan involvement, and desquamation. Streptococcal TSS (STSS) is a similar disease caused by invasive group A Streptococcus (GAS). Each of these is a shock state.
Necrotizing fasciitis (NF) is a rapidly progressive, life- and limb-threatening infection by virulent bacteria with severe inflammation of the fascia and surrounding subcutaneous tissues.
Kawasaki disease (KD) is an acute, self-limited, vasculitic syndrome in children. The diagnosis is established clinically by the presence of prolonged fever and four of the following five clinical features: conjunctival injection, oropharynx erythema, cervical lymphadenopathy, hand and foot erythema/swelling, and rash.
Urticaria, often referred to as hives, appears as blanchable, pruritic, raised, well-circumscribed areas of edema and erythema involving the epidermis and dermis.
Angioneurotic edema (AE) is a self-limited localized swelling due to extravasation of fluid into interstitial tissues, most commonly involving the head, neck, hand, and gastrointestinal tract. Laryngeal involvement is life-threatening.
Dermatologic signs of systemic disease are the primary focus of this chapter. Many diseases have clinical presentations where the dermatologic manifestations play a role in helping the clinician make the underlying diagnosis. Table 95-1 is a list of systemic diseases with their corresponding dermatologic manifestations, and the sections below describe pediatric emergencies in which the dermatologic characteristics play a large role in diagnosis.
TABLE 95-1Characteristic Dermatologic Manifestations of Systemic Diseases |Favorite Table|Download (.pdf) TABLE 95-1 Characteristic Dermatologic Manifestations of Systemic Diseases
|Dermatologic Manifestation ||Systemic Disease |
|Diffuse erythroderma and shock ||Toxic shock syndrome |
|Diffuse purpura with multiorgan failure ||Purpura fulminans, meningococcemia |
|Petechiae in an ill-appearing child ||Sepsis, Rocky Mountain spotted fever |
|Petechiae in a well-appearing child ||Immune thrombocytopenic purpura |
|Purpura in a well-appearing child ||Henoch–Schönlein purpura |
|Deep, painful, bilateral erythematous nodules ||Erythema nodosum |
|Target lesions with central clearing ||Erythema multiforme |
|Diffuse bullae in ill-appearing child ||Stevens–Johnson syndrome/toxic epidermal necrolysis, necrotizing fasciitis |
|Diffuse bullae in well-appearing child ||Impetigo, tinea, poison ivy |
|Nikolsky sign ||Toxic epidermal necrolysis |
|Periorbital bruising ||Child abuse, neuroblastoma |
|Strawberry tongue ||Scarlet fever, Kawasaki disease, toxic shock syndrome |
|Desquamation ||Kawasaki disease, ...|