Paediatric Rashes and Other Conditions
Introduction
Rashes are a common paediatric ED presentation, with causes ranging from benign viral exanthems to life‑threatening sepsis, severe allergic reactions or widespread epidermal loss.
Assessment should combine rapid recognition of red flags, appropriate infection‑control measures, focused history and examination, targeted investigations, and prompt condition‑specific management or escalation.
Use national guidance as the framework for assessment and escalation (particularly NICE NG143, NG240 and NG195), and local protocols for antimicrobials, antivirals and admission criteria.
Initial approach - triage, infection control and priorities
- Triage and isolation: any child with fever plus a generalised rash should be side‑roomed/isolated and assessed urgently (NICE NG143). Apply standard, droplet or airborne precautions as indicated (for example, measles, varicella).
- Primary survey: assess ABCs, circulation/perfusion, respiratory status and level of consciousness; treat immediately if compromised.
- Focused history (concise): onset and tempo of rash; fever pattern and duration; mucosal involvement; pruritus versus pain; distribution (face, trunk, acral, palms/soles); recent antibiotics or new drugs; vaccination history (MMR); recent contacts or travel; immune status; and age (neonate = ≤28 days).
- Focused examination: blanching versus non‑blanching (pressure test); presence of petechiae/purpura; mucosal lesions; vesicles/bullae; epidermal detachment (Nikolsky’s sign); dermatome distribution; lymphadenopathy; conjunctivitis; joint or abdominal tenderness; and signs of shock or meningism.
- Initial investigations (tailor to clinical status): point‑of‑care glucose; capillary or venous blood gas and lactate...