Rashes

Erythema Infectiosum… Kinda sounds like a Harry Potter spell, so what is it??

/ Katie P. Tolley, RN, MSN, CPNP-PC / Leave a comment

No magic wand is going to work with this virus… The only thing magical about Erythema Infectiosum, is the rash appearing out of nowhere. Erythema Infectiosum is a virus, aka Fifth Disease, and also “slapped cheek” disease. If you’re a HP fan, you understand my enthusiasm with the verbiage. Here’s an interesting fact about Erythema Infectiosum for you, it’s called Fifth Disease because it was the 5th documented childhood virus many years ago when all those childhood viruses, like measles, rubella, and scarlet fever were being documented.

Her cheeks are awfully pink, but she's happy! :-)

Her cheeks are awfully pink, but she’s happy! 🙂

Today, I thought… it’s time to write a post about Erythema Infectiosum, because I saw a 12 year old with a “lacy” rash; and just days ago, my cousin sent me pictures of her 4 year old with a rash… They both had Fifth Disease. So, that tells me it’s time for a post on Parvovirus B19. Doesn’t that sound disgusting? It’s not really a big deal, as long as you are healthy and not pregnant. This is NOT the parvovirus that animals get.

In healthy kids, Erythema Infectiosum/Fifth Disease is a rather benign ailment. Some kids have it, and you don’t even know it. Many kids get a fever and upper respiratory infection/URI symptoms (cough, congestion, headache, runny nose) before the rash. Some have no symptoms at all and just break out in a rash. And then, some have such a mild case, symptoms go completely unnoticed. Regardless, the virus leaves antibodies behind that are quite important for girls (more on this below). The rash may last for a few days to weeks, but may be more noticeable when the skin is hot from physical activity, hot bath water, etc.

You may be wondering what a “lacy” rash looks like…

Typical "lacy" rash of Fifth Disease

Typical “lacy” rash of Fifth Disease

Here ya go…Miss Molly’s legs and arms matched her cheeks. But, as you can see in her smiley face picture, she is feeling well. The rash can look more spread out, but commonly grows together into large red, lacy patches.

The 12 year old patient I saw today, was a little less happy. His rash was really itchy. I’ve seen very few Fifth’s rashes that are itchy, but his was pretty bad. I read somewhere that the itching is more common in teens and adults. I don’t promote any particular product, but I like to use Calmoseptine ointment. We applied this to his rash, and he immediately felt better. Do not apply Benadryl (diphenhydramine) cream to large areas of skin. Benadryl cream is absorbed through the skin and there is no way to monitor the dosing, it is not safe. Zyrtec or Benadryl can be taken by mouth to help combat the itchiness. Do not take both Zyrtec and Benadryl at the same time, be sure to follow the instructions on the package insert.

So, when can Parvovirus B19 be a problem? The first thing that comes to any providers mind is pregnancy. Parvovirus B19 can be detrimental to an unborn fetus. It has to do with depletion of the red blood cells (RBCs), leading to fetal anemia and the inability to replenish the lost RBCs to maintain adequate oxygenation, but I won’t get into the sciency stuff. The CDC reports that about 50% of women are immune to Parvovirus B19. If you want to read more about the science, check out CDC or KidsHealth.

What YOU need to know about Fifth Disease:

  • Contagious during the fever and URI period.
  • NOT contagious with the rash. Can attend school or daycare.
  • Incubation period is a few weeks after initial exposure.
  • Treatment should focus on comfort measures. Motrin for fever. Creams/oatmeal bath for itching. Zyrtec or Benadryl orally for itching.
  • There is no medication to prevent or cure Fifth Disease.
  • Pregnancy = Red Flag (see below)

One of the most important pieces of knowledge you can take away from this post is about Fifth Disease and Pregnancy. If your child has Fifth Disease, please think of anyone that you know that may be pregnant, and was in contact with your child during the contagious period. (Think about teachers.) There usually is not a problem, but it is important for a pregnant woman’s obstetrician to be aware of and monitor the exposure appropriately. If the pregnancy is into the 2nd trimester, the blood work is probably already done. For more information about Parvovirus B19 and Pregnancy, check out the CDC’s website.

Erythema infectiosum is one of the easier illness we will encounter on this journey called parenthood. If you have any questions or comments, let me know. If you want to know more about Erythema Infectiosum check out the CDC Parvovirus B19 and Fifth Disease website.

Enjoy the journey, friends! 😉

Hand, Foot and Mouth…..and Butt??

/ Katie P. Tolley, RN, MSN, CPNP-PC / Leave a comment

I’ve been on call this weekend, and gotten quite a few calls about fevers and rashes that sound like Hand, Foot and Mouth Disease. This illness is very common during the Spring and Summer months, is highly contagious, and very common among young children. For those of you that are wondering, is this the same thing as Foot and Mouth Disease? NO, totally different!!!

Hand, Foot and Mouth is a Coxsackievirus that causes bumps, blisters, and/or ulcers 

  on the hands, the feet,

in and around the mouth, 

and Yes, on the buttocks and backs of the legs. 

The bumps that appeared on the backside and back of the legs of a toddler is what prompted one of the calls from a Mom this weekend. Actually, the only symptoms that this child had were fever and red throat when he was seen in the office. Over the past 24 hours, the bumps on the buttocks and back of the legs appeared. So far, there is no hand or foot rash involved. All cases of Hand, Foot and Mouth present differently, not everyone gets the typical rash. Some kids will only have a fever and sores in the mouth, and possibly go undiagnosed.

This virus is spread via direct contact with nose and throat secretions, saliva, fluid from blisters, or the stools. Most people will get Hand, Foot and Mouth as a child, and then more than likely never get it again. The incubation period is about 3-7 days.  Most parents will not get the virus because they were exposed as children. Although, I do know of one mom that got it, and got it pretty bad. Ouch!!

Hand, Food, and Mouth starts with a fever, and usually the fever is pretty high, up to 103’s. The fever starts prior to the arrival of the rash. During the febrile stage the child typically doesn’t want to eat. They aren’t eating because the sores in the mouth are painful. The goal of treatment during this stage is to keep the child hydrated. I highly recommend giving cold drinks, freeze pops, popsicles, pudding, yogurt, milkshakes, smoothies, etc. DO NOT give the child anything that is hot, spicy, or acidic. Orange juice, soda and pizza would be a NO NO!

There is no medicine to treat Hand, Foot and Mouth. The only thing Mom and Dad can do is keep their little one comfortable. Giving Tylenol or Motrin for the fever and for the pain caused by the ulcers is the best way to handle this difficult time. As with any other virus, antibiotics will not help! I’ve said it before and I’ll say it again – Antibiotics are for bacterial infections, they will NOT get rid of viruses. Viruses are not bacteria. Keeping your child comfortable and treating the fever are your top priorities. If you need to know more about fevers in children, please check out my blog on Fevers: To Treat or Not To Treat??

Hand, Foot and Mouth usually last about 5-7 days. Keeping the child home from daycare, school, and away from other children will help prevent the spread of disease. Unfortunately, the fever typically precedes the rash and may not be that high in the beginning, so others may be exposed accidently. I was guilty of this when Joshua was in pre-school. I thought he was cutting molars, and gave him Motrin because his temperature was 100-101F. After a few days, his temp when up to 102.9. I had him evaluated by his pediatrician, and that is when we discovered the ulcers in his mouth. So, the fever and not eating wasn’t teething after all, and I had exposed the whole preschool. Oops, I felt bad, but there wasn’t anything I could do except warn the teachers and other parents, and tell them what to watch for.

Hand, Foot, and Mouth is one of those childhood illnesses that everyone gets. As parents, it’s all part of the journey. Every parent has had to deal with Hand, Foot and Mouth. Some kids will only get a mild case, and their parents won’t ever know what that fever was because the rash was only in the mouth and never observed by a practitioner for diagnosis. Those children (and parents) that experience those mild, undiagnosed cases are the lucky ones! Hand, Foot and Mouth hurts, and if you child doesn’t have to suffer through it, be thankful!!

So, if you have a child that experiences a high fever anytime soon, keep in mind it could be this painful Coxsackievirus that should be called Hand, Foot, Mouth and Butt! 

Just another part of the journey for all of us parents to suffer through. As I always say, regardless of the difficulties, I hope you enjoy the journey! 😉