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What's new with common, uncommon and rare rashes in childhood

Dinulos, James G.a,b

Current Opinion in Pediatrics: April 2015 - Volume 27 - Issue 2 - p 261–266
doi: 10.1097/MOP.0000000000000197
OFFICE PEDIATRICS: Edited by Henry H. Bernstein

Purpose of review Children with rashes account for many of the outpatient visits to a general pediatrician. As such, pediatricians are often the first to identify and treat these rashes. Establishing an approach to common, uncommon and rare pediatric rashes assists in accurate assessment. This review highlights newly identified clinical patterns and disease severity.

Recent findings Group A β-hemolytic streptococci (GABHS) have been shown to be an important cause of intertrigo and to cause more widespread disease in some instances. Superficial skin infections with GABHS have been associated with strains secreting exfoliating toxins, whereas deeper infections have been associated with superantigen toxins. Hand-foot-and-mouth disease (HFMD) outbreaks have occurred with more virulent strains, causing more widespread disease that may be confused with eczema herpeticum or varicella. Mycoplasma pneumoniae has been shown to be an important cause of common disorders such as urticaria, and less common disorders such as Stevens–Johnson syndrome and Mycoplasma-associated mucositis. Recurrent toxin-mediated erythema is a recently described entity that must be differentiated from Kawasaki disease.

Summary The number of rashes acquired in childhood is vast, requiring the pediatrician to be able to identify worrisome rashes from those with a more benign course. Key clinical signs may assist in clinical diagnosis and treatment.

aGeisel School of Medicine at Dartmouth, Hanover, New Hampshire

bUniversity of Connecticut, Farmington, Connecticut, USA

Correspondence to James G. Dinulos, MD, Seacoast Dermatology, 330 Borthwick Avenue, Suite 303, Portsmouth, NH 03801, USA. Tel: +1 603 431 5205; fax: +1 603 436 4257; e-mail:

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