DERMATOLOGY
Rubella (German Measles)
■ Viral illness characterized by fever, exanthem (cephalocaudad), and lym-
phadenopathy (cervical, postcervical, suboccipital, postauricular)
■ The rash is red to pink maculopapules that appear first on the face and
then spread rapidly down. The lesions on the trunk may coalesce, but the
ones on the extremities do not. The rash usually disappears after 3 days
and may rarely have associated fine desquamation.
■ Can cause congenital deafness or cardiac defects when occurs in pregnant
women in first trimester
Erythema Infectiosum (Fifth Disease)
■ Caused by parvovirus B19 infection
■ Most common in children 4–10 years old, the disease may begin with
mild prodrome of systemic symptoms and occasional fever then character-
istic red macular exanthem on cheeks (“slapped-cheek”appearance) with
circumoral pallor. Four days later, an erythematous reticular (lacelike)
rash starts on the arms and moves to the trunk, buttocks, and thighs.
Arthritis and arthralgias occur in 10% of patients.
■ Papular purpuric glove and stocking syndrome is a separate manifestation
that affects young adults. Hallmark findings are edema and erythema of
palms and soles, with petechiae and purpura. Oral erosions and petechiae
may occur as well.
■ The disease is spread by respiratory tract infection, no longer infectious by
time exanthem appears.
Hand, Foot, and Mouth Disease
■ Hand, foot, and mouth disease is caused by coxsackie virus, enterovirus.
Highly contagious, it occurs both as isolated events and as epidemics.
■ Initial infection includes fever, anorexia, malaise, and sore mouth. Oral
lesions appear 1–2 days later and cutaneous lesions shortly thereafter. Oral
lesionsare vesicles on an erythematous base which ulcerate. They occur
on the buccal mucosa, tongue, soft palate, and gingiva but spare the lips.
■ Cutaneous lesions start as red papules that change to gray vesicles about
3–7 mm in size. They are found on the palms and soles but may also be
found on the dorsum of hand and feet and on the buttocks.
■ Complications include aseptic meningitis, myocarditis, pulmonary edema,
and orchitis.
INFESTATIONSPediculosis
■ Infestation is by parasitic blood sucking insect (louse) on various body
regions.
■ Adult lice are the size of sesame seed and live up to 30 days on infested
individual feeding on blood and living up to 2 days on inanimate objects.
■ Transmission is through direct contact with infected individuals or their
objects such as bedding, clothing, combs, or brushes.
■ Pruritis is a common feature as an irritant response to lice saliva or excreta.
■ Diagnosis is made by identifying louse nits (eggs) or live lice securely
attached to hair shafts (head lice) or in seams of clothing (body lice).
Congenital
infections—
TORCHES
Toxoplasmosis
Rubella
Cytomegalovirus
Herpes
Syphilis