Differentials
Rash in children
SIGNS / SYMPTOMS
No accident in the history.
INVESTIGATIONS
No specific test.
Toxic epidermal necrolysis (Stevens-Johnson syndrome)
SIGNS / SYMPTOMS
Rash and blisters develop after a new medication (often anticonvulsants). Ulceration may occur in areas that could not be exposed to thermal or chemical agent, and on mucous membranes or conjunctivae.
INVESTIGATIONS
Skin biopsy shows keratinocyte apoptosis with detachment of the epidermal layer of the skin from the dermal layer. The area of separation may contain a number of CD8-positive T lymphocytes, and the dermis may contain CD4-positive T lymphocytes and macrophages, depending on the stage of the disease when the biopsy is taken.[35]
Staphylococcal scalded skin syndrome
SIGNS / SYMPTOMS
Most common in infants. Exfoliation usually follows erythematous cellulitis and rash. Preceding Staphylococcus aureus infection of skin, throat, mouth, nose, and/or umbilicus, often with fever, malaise, and irritability.
INVESTIGATIONS
Culture of local or distant focus of colonization (often negative). Gram stain may confirm staphylococcal infection.
Biopsy shows separation at granular layer of epidermis.
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