Visual Diagnosis in Pediatrics
1st Edition

69
Fine, Bumpy Rashes
George A. Datto III
Approach to the Problem
Small papular rashes that are acute tend to be noticed by parents, but chronic ones tend to go unnoticed or are ignored. These rashes are best appreciated by palpation rather than visual inspection. The distribution and elucidation of other signs will help with the identification of the rash.
P.460

P.461

DIAGNOSIS ICD-9 DISTINGUISHING CHARACTERISTICS DISTRIBUTION ASSOCIATED FINDINGS COMPLICATIONS PREDISPOSING FACTORS
Scarlet Fever 034.1 Erythematous, “sandpaper” papules Trunk
Skin folds
Pressure points
Palatal petechiae
Strawberry tongue
Pastia’s lines
Circumoral pallor
Suppurative complications
Rheumatic fever
Glomerulonephritis
Group A streptococcus
Keratosis Pilaris 701.1 Folliculocentric keratotic 1- to 2-mm papules
“Plucked chicken skin”
Upper arms and legs
Facial cheeks
None None Family history
Dry skin
Obesity
Lichen Nitidus 687.1 Minute, skin-colored, shiny papules Forearms
Trunk
Koebner phenomenon None N/A
Dyshidrotic Eczema (Pompholyx) 705.81 Fine bumps with clear or straw-colored fluid Palms
Soles
Lateral aspects of fingers
Burning or itching sensation None Stress
P.462

Figure 69-1 Scarlet fever. Fine papules, “sandpaper-like” rash on trunk of child with scarlet fever. (Courtesy of George A. Datto, III, MD.)
Figure 69-2 Keratosis pilaris. Tiny, rough-textured, follicular papules on lateral upper arms. (Used with permission from
Goodheart HP. Goodhearts photoguide to common skin disorders. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2003:49
.)
Figure 69-3 Lichen nitidus. Shiny small papules on elbow. (Courtesy of George A. Datto, III, MD.)
Figure 69-4 Dyshidrotic eczema. Note the fine, fluid-filled bumps on the fingers as depicted by the arrows. (Used with permission from
Goodheart HP. Goodheart’s photoguide to common skin disorders. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2003:60
.)
Figure 69-5 Dyshidriotic eczema. Note the fine, fluid filled bumps on the finger (as depicted by the arrows) and the distal area of peeling. (Courtesy of Esther K. Chung, MD.)
P.463

Other Diagnoses to Consider
  • Lichen spinulosis
  • Folliculitis
  • Keratosis follicularis
Suggested Readings
Bisno AL. Diagnosis and management of group A streptococcal pharyngitis: a practice guideline. Clin Infect Dis. 1997;25:574–583.
Garcia-Hidalgo L. Dermatoses in 156 obese adults. Obes Res. 1999;7:299–302.
Goodheart HP. Goodheart’s photoguide to common skin disorders. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2003:60.
Hurwitz S. Clinical pediatric dermatology. 2nd ed. Philadelphia: WB Saunders; 1993:126–127.
Tilly JT, Drolet BA. Lichneoid eruptions in children. J Am Acad Dermatol. 2004;51:606–624.