pinpoint red dots on skin that fade when pressed on

#Pinpoint red dots on skin that fade when pressed on skin#

They may be admitted if unwell, or may be ambulated with ongoing doses either on PAU or in the community by our community nursing team. This may include petechiae in the SVC distribution (above the nipple line) where there is a history of forceful coughing or vomiting.Ĭhildren unwell with fevers and non-blanching rash will be initiated on IV antibiotics (usually ceftriaxone). If the child is well, and there is a clear history of a mechanical cause, then it may be decided that observation only is sufficient. They will be observed in the Paediatric Assessment Unit (PAU) to ensure the rash is not rapidly spreading.Ī diagnostic work up will help to identify the cause leading to non-blanching rash and a serious medical case can be identified and treated. They may be discharged if they remain well and investigations are normal, but some will require admission to the ward overnight.Ĭhildren with a non-blanching rash depending on the distribution and spread will require blood tests to check for possible causes (Usually FBC, clotting profile, infection screen if pyrexial). Musculoskeletal if symptomsHepatosplenomegalyAny suggestion of mediastinal mass Safeguarding concernsĪll children with a non-blanching rash and fever will require a period of observation in hospital. Respiratory: Orthopnea/ StridorCardiovascularHeadache/Irritability/drowsiness Is the child well or ill?Observations including capillary refill Please consider the following in the examination of a child with a non- blanching rash. Testicular painShortness of breathJoint pain/swelling Safeguarding concerns Vomiting and/or diarrhoeaPain on urinationEpistaxis/haematuria/gum bleed Characteristics of rashįatigue or lethargyPhotophobia or neck stiffness It is important to consider the following when taking a history of a non-blanching rash in children. Purpura are non-blanching, greater than 3mm in diameter, and are sometimes palpable. Petechiae are non-blanching pinpoint spots which are less than 3mm in diameter. It causes a rash of spots with dark centers and pale red rings that look like a target or bulls-eye.

#Pinpoint red dots on skin that fade when pressed on skin#

Non-blanching rashes occur from bleeding from small blood vessels in to the skin or mucosa. Erythema multiforme is an allergic reaction. All children with a non-blanching rash with or without fever require same-day assessment by the paediatric team in hospital unless there is a clear, accidental mechanical cause. It therefore is important to assess all children with a non-blanching rash promptly to enable early diagnosis and treatment. However, for a small number of children, a non-blanching rash can indicate a more significant underlying cause such as meningococcal sepsis or haematological malignancy. Other differentials include Henoch-Schonlein purpura (HSP), immune thrombocytopenic purpura (ITP) or mechanical causes including physical abuse. In many cases, a simple viral illness (often adenovirus) is the final diagnosis. Most children with a non-blanching rash who are well will not have a serious underlying cause. Non-blanching rashes are rashes which do not disappear with pressure, particularly using the ‘glass test’.