A Dangerous Rash in Children (Pedcast)

Here we go with another edition of DocSmo. Com…the podcast for parents on the go. Portable, practical pediatrics for modern parents.  Thank you for joining me today.  I hope you are having a wonderful day. One of my phone triage nurses the other day asked me if I would do a podcast that could help her know when to bring children into our office who have skin rashes, particularly rashes that might be a sign of a serious disease.   I explained to her that rashes over the phone are really difficult because the parent who is describing the rash usually has no experience describing rashes… no skin vocabulary so to speak. Given that limitation, her goes my attempt at helping phone nurses and parents know more about a one specific rash of the skin called a petechia that can indicate serious disease.

Before we get started with today’s talk, I have a confession to make… the truth is that it’s just as difficult for doctors to describe rashes in an accurate way as it is for parents to tell us about rashes over the phone.  I will do my best, you know I always do, but if you have any concerns about your child’s rash, health, well being etc., please consult your pediatrician directly and let them LOOK at his or her rash.  Seeing is so much better than describing!!!!

OK, lets get specific.  First you need to learn something about petechia.

Petechia are really small bruises in the skin. They form when blood leaks out of small blood vessels in the skin. They tend to be darker than most skin spots and cannot be felt, they are deeper in the skin than most other skin spots. Since they are bruises, they change color as they age starting red in color and gradually turning a brownish color.  When you push down on them, they do not disappear like most red spots in the skin.  Repeat.  This is crucial that you know.  This is how they are distinguished from other red spots of the skin.

So what causes petechia you ask?  Good question. Since they come from blood leaking out of blood vessels, anything that causes vessels to leak can cause them to form.  Mostly, this falls into one of 3 categories:

-Trauma-scratching, vigorous rubbing, or increased pressure inside delicate vessels.

-Infections of blood and blood vessels- Microbes literally damaging vessels and making them leak

-Lack of cells called platelets in the blood that stop leaks in small vessels. These are called platelets.

OK so now you know what a petechia is…its time to put this to use.  Imagine you are now a triage nurse and parents are calling in telling you about their sick children.

Here is your first call on line 1 – A mom calls about her 6 year old who has been tired and pale for about 2 weeks. She says she now sees a dark rash, little dark red spots all over.  You recognize her description as petechia and suspect leukemia.  Petechia can be associated with very serious illness and almost always mean a visit to the doctor. This decision is an easy one for the triage nurse; this child comes to the doctor immediately!  You turn out to be right, the child does have leukemia but this child ends up doing well, being cured like most children with leukemia today.

2nd call- The next line you answer is a Dad who tells you about their 12-year-old boy scout who has had a fever, a bad headache, and now a rash that sounds like petechia… what to the Dad looks like bruising on the skin.   Fever and any rash means a doctor visit but fever and petechia is a medical emergency.  You direct them to the ED where the child gets admitted with Rocky Mountain Spotted Fever. Petechia  are the beginning of the “spots” in RMSF. Good call phone triage nurse.

Line 3 is a Mom and child you know well… Little Janie has eczema and her mom calls all the time.  Janie has been scratching a lot recently and Mom has noticed some tiny red spots in areas where she has been scratching.  You suspect these are petechia, but since she is not sick and has been scratching, you decide to just bring her in for one of the doctors to see.  They confirm your suspicion…scratching petechia. .. totally benign.  Her eczema regimen is tweaked and the rash disappears in 2 weeks.

You are on a roll and are feeling fairly confident of your skin acumen so you go ahead and answer line 4. The Mom on this line tells you about her 3 year old who has what she believes is a stomach flu.  She has been vomiting all morning and she has a fever of 102. Mom has noticed some red spots around her eyes that don’t blanch with pressure.  Her face is the only place she sees the rash. You are pretty sure they are petechia!  Now it’s decision time.  The last call was sort of the same, fever and petechial rash and that child had a life threatening illness.  Should I send this one to the ED as well?  No you decide.  You know that vomiting a lot can cause petechia in a non-

serious way so you decide to bring them into the office for a visit instead…. Right. This child turned out to just have pressure petechial from straining with vomiting.  This is not serious and she turned out to just have stomach flu after all.  Mom was absolutely right.

So you get the idea. You need to consider the context of any spot to have an idea of what is wrong. Your child can get petechial rash from wrestling with Dad, but in the context of paleness and fatigue…that’s leukemia until proven otherwise.  Remember, rashes that appear during illnesses are usually significant and important.  Make sure you learn to recognize the important rash of petechial in children.

I hope that helps your knowledge base. Listen out soon for another in my skin series on hives.  Understanding them will really help your parenting skills. If you like pedcasts, take a second to write a comment on my website, www.docsmo.com or a review on iTunes.   This is Dr. Paul Smolen, your pedcast host, broadcasting from studio 1E, hoping you will can describe your child’ next rash in a flash. Until next time.