Paediatrics: Purpuric rashes

Purpuric rashes

Causes

·Viral infections, most commonly enteroviral.

·Septicaemia, most commonly meningococcal.

·Thrombocytopenia, platelet, or clotting disorders.

·Vasculitis, e.g. HSP.

·Trauma, including NAI.

·Drug reactions.

·Vasomotor straining, e.g. strenuous coughing or isometric exercise.

Management

If the patient is well and there is an obvious benign cause, reassure as the rash will resolve spontaneously. If cause unclear, initial investigations should include:

·FBC.

·Blood film.

·Clotting studies.

·Blood cultures.

·Check BP, urinalysis, blood U&E and ASOT (if HSP likely).

·If sepsis possible, admit and start IV antibiotics.

·Stop any drug likely to be causative.

·Consider a skin biopsy if diagnosis remains unclear.