PANCE Blueprint Dermatology (5%)

Roseola is a common exanthem in young children that presents with a high fever followed by a rash. It is usually caused by Human Herpesvirus 6 (HHV-6), which is an enveloped linear double-stranded DNA virus. Children will have 3-5 days of a high fever, which may exceed 40C or 104F, causing some children to develop febrile seizures. Following this, a diffuse macular rash starts on the trunk and spreads to the face and extremities.

Rubeola virus is a single-stranded RNA paramyxovirus that causes measles. Measles is an exanthem that is distinguished by a fever, Koplik spots, cough, coryza (head cold), conjunctivitis and a characteristic rash. Koplik spots are pathognomonic for measles and present as small red spots with a blue-white center on the buccal mucosa. They usually appear during the prodrome phase or about 48 hours before a rash. The rash found in measles is an erythematous maculopapular rash that begins on the face and moves down to involve the entire body, much like the rash in rubella. However, in measles, the rash darkens over time and is confluent (the rash merges together). A rare but fatal complication of measles is subacute sclerosing panencephalitis, which can occur 7-10 years post-infection and is thought to be caused by persistent measles infection in the CNS. In immunocompromised patients, measles can cause pneumonia with Warthin-Finkeldey multinucleated giant cells. Children in the United States are typically vaccinated against measles; however, outbreaks are seen in under-vaccinated or unvaccinated children.

Coxsackievirus is a virus that belongs to the Picornaviridae family. These viruses are divided into group A and group B. In general, group A coxsackieviruses infect the skin and mucous membranes, causing febrile pharyngitis, hand, foot, and mouth disease, herpangina, and conjunctivitis. This virus is also one of the most common causes of aseptic meningitis that usually occurs in the late summer months. Group B coxsackieviruses tend to infect the heart and the pleura, as well as the pancreas. Infection of the heart can lead to myocarditis, and dilated cardiomyopathy and can lead to pericardial effusions. Recently, the development of type 1 diabetes mellitus has been associated with previous coxsackievirus B infection.

Rubella is a viral exanthem that occurs in both children and adults. It is caused by the rubella virus, which is an enveloped, single-stranded icosahedral RNA virus, and is a member of the togavirus family. It is also known as the German measles or the three-day measles. Rubella can present with fever and tender postauricular lymphadenopathy. Following this is a diffuse, light pink maculopapular rash that first appears on the face and then spreads to the trunk and extremities within 24 hours. The rash usually lasts about three days, hence the name three-day measles. Adults can also have arthritis. In pregnancy, rubella is a TORCH infection and can cause serious complications, including hearing loss, ocular and cardiovascular defects, and mental retardation.

Erythema infectiosum or Fifth’s Disease is a mild viral infection that is characterized by the slapped face appearance. It typically occurs in school-age children; however, adults can contract the disease. Pain and swelling in the joints (polyarthropathy syndrome) is a common finding in adult women with the disease. It is transmitted by respiratory secretions, blood, and blood products. The period of communicability is uncertain and the incubation period is 4 to 14 days and may be as long as 21 days. Isolation is not necessary.