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1 year child developed maculopapular rash around both knees. Is it erythema multiforme or viral illness?

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I have a 1 year old child that developed a maculopapular rash around both knees with redness and warmth of the knees. It has spread to the arms and belly as well. Some of the lesions are small and look like mosquito bites, but a few of the ones around her knees are irregular and about 1cm in size. She has been pretty upset the last few days with teething but felt a tad more listless/tired this morning. She was dropped off at daycare by her mother so we never got a temperature but are considering taking her into a physician this morning. Initially I thought it might be a contact dermatitis or erythema multiforme, but now I'm wondering if might be a viral illness. Your help would be greatly appreciated.
Posted Mon, 27 Aug 2012 in Child Health
Answered by Dr. Michelle Gibson James 1 hour later

I agree with you that she should be taken to see a doctor this morning as soon as you can especially since you state that she is behaving listless and fatigued this morning.

The rash can be something as simple as a viral illness, some children with viral upper respiratory tract infections can have a rash to go along with it. It is usually a wide spread rash.

There are however other causes of widespread rashes in children such (1)chicken pox ( this however does not fit into your description because they would start as water bumps which would then burst, when you look at the skin you would see different stages, it would also itch her alot)
(2)measles , mumps and rubella can also cause widespread rash. If she has been vaccinated up to date then these would be unlikely.You would have to check her immunisation status because at present with immunity levels in the population so low alot of the old diseases are propping up again.
((3) scarlet fever is caused by a virus and cna present with a rash on the trunk as well, it is usually treated with antibiotics if diagnosed
(4) Children this age can also present with a rash secondary to human herpes virus 7. It is called roseola and caused small, pink rash on the skin. She would have a fever with this but this rash will resolve on its own.

What I am worried about though is the possibility of meningococemia (infection which would spread to involve the brain) which can only be diagnosed if seen by a doctor. This is infection due to neisseria meningitidis.
It would present with fever and a rash. The rash is due to bleeding within the skin.
The child would have other symptoms such fever. They are other symptoms but a 1 yr old would not be able to state that she was experiencing- headache, feeling nauseous or muscles aching. It NEEDS to be diagnosed and treated as soon as possible, treatment is with IV antibiotics.

In terms of contact dermatitis there would be usually be a history of itching the rash and weals may be present.It would not usually be widespread because it occurs as a result of contact with a specific substance at a point on your skin.
It also would not not cause systemic symptoms such as fatigue and listlessness.
In terms of erythema multiforme- this is also as result of increased sensitivity to a particular toxin or medication. It can be minor or very serious and require medication. This can be diagnosed if you see lesions that are surrounded by a pale ring- these are called target lesions. Again she would be expected to have fever, itching, you can look at her lips and in her mouth because lesions may be there as well.

I think that she should be taken to see a doctor because even though it may be a simple rash that can come with having the cold ,it may also be something more serious and at her age she cannot state the other symptoms that she may be feeling.

Your concern is very good and good instincts.

I hope this information is helpful to you, feel free to ask any other questions.

I hope the baby girl feels alot better soon and it is nothing serious
Above answer was peer-reviewed by
Follow-up: 1 year child developed maculopapular rash around both knees. Is it erythema multiforme or viral illness? 1 hour later
Thank you very much for your advice Dr. Gibson XXXXXXX I appreciate your expert opinion, thoughtful comments, and concern.
Answered by Dr. Michelle Gibson James 44 minutes later
Ok, I hope everthing works out .
Above answer was peer-reviewed by
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