Unusual rash

31.12.2014
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Recently, I had a case of an unusual rash including elements which are similar to the chickenpox's rash, but the child I am treating already got it a year ago.

It was a very unusual rash. There were small (up to 5 mm long) blisters at the edges of both palms and soles of my little patient. It could not be chicken pox since the patient had that a year ago.

Maybe it was an allergic reaction, but to what allergen? What changed in the girl's environment or diet?

The mother mentioned that new sand was brought to the kindergarten's sandboxes the day before they consulted me. However, I asked myself why her daughter’s throat was red while doing a home visit and examining the girl (in our medical culture, home visits are standard for routine complaints).

The mother's main concern was if it was okay to send the girl back to kindergarten tomorrow.

I actually didn’t know. Two days before there was nothing on her skin, then wheals appeared and turned into blisters the next day. She already had chickenpox. Her throat was red. She had no fever, her temperature was normal. The rash did not itch.

I told the mother I didn’t know what it was.  I told her: “Let me examine her again tomorrow and also get CBC tomorrow morning please, so I can see the results in the afternoon.”

CBC was compatible with a viral infection. There were no cells pathognomic for an acutely allergic state.

Then, during the re-exam, I saw new sore spots in her mouth.

A few days later, a 3-year-old boy who lives nearby, developed similar symptoms.

It turned out there were more than 50 of such cases that autumn.

I think that it was the hand-foot-and-mouth disease, which is a mild viral exanthem. It is usually young children that are affected. It is considered to be caused by a coxsackievirus.

This virus spreads orally by airborne contamination, by contact with nasal secretions, saliva, weeping blisters, droplets sprayed into the air after a cough or a sneeze, or by stool particles because young children often put their fingers in their mouth. Sometimes, adults are infected without symptoms and pass the virus to others.

There is no specific treatment for hand-foot-and-mouth disease since it is self-limited. Intervention is necessary only if the child has difficulties eating because of oral lesions or when the child's condition gets worse and complications show.

For preventing hand-foot-and-mouth disease good hygiene is effective.

Image copyright: kmrep/thinkstock

Article last time updated on 20.01.2015.

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