Differential Diagnosis for Maculopapular Rash and Itch in Paediatrics
Single Most Likely Diagnosis
- Atopic Dermatitis (Eczema): This is the most common chronic skin condition in children, characterized by dry, itchy, and inflamed skin. The maculopapular rash often starts in infancy and can persist into childhood, making it a prime consideration for this presentation.
Other Likely Diagnoses
- Viral Exanthems: Various viral infections (e.g., measles, rubella, roseola, and enterovirus) can cause maculopapular rashes in children. These are often accompanied by fever and other systemic symptoms.
- Allergic Contact Dermatitis: This condition occurs when the skin comes into contact with an allergen, leading to an itchy, maculopapular rash. Common allergens include nickel, certain plants, and chemicals in personal care products.
- Insect Bite Reactions: Reactions to insect bites can cause itchy maculopapular rashes. The pattern and distribution of the rash can sometimes help identify the culprit.
Do Not Miss Diagnoses
- Kawasaki Disease: Although less common, Kawasaki disease is a critical diagnosis to consider due to its potential for causing coronary artery aneurysms. It presents with fever, rash, conjunctivitis, and changes to the lips and oral cavity.
- Meningococcemia: This is a life-threatening infection caused by Neisseria meningitidis. The rash can be maculopapular initially but often progresses to petechiae or purpura. Early recognition is crucial for timely treatment.
- Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: These are severe skin and mucous membrane disorders, usually a reaction to medication or infection. They can present with a maculopapular rash that progresses to blistering and peeling of the skin.
Rare Diagnoses
- Pityriasis Rosea: Characterized by a herald patch followed by a widespread, symmetrical, maculopapular rash. It's thought to be related to viral infections and typically resolves on its own.
- Lichen Planus: A rare inflammatory condition that can affect the skin, mouth, and other areas. It presents with purplish, itchy, flat bumps.
- Juvenile Rheumatoid Arthritis (JRA): Now more commonly referred to as Juvenile Idiopathic Arthritis (JIA), this condition can sometimes present with a maculopapular rash, among other systemic symptoms like joint pain and fever.