HWN Suggests

So Wonderful So Marvelous

As a parent, you see some weird stuff. This one though? Let me preface this by saying, I attempt to remain calm when the kids get sick, but this was so weird, it had me really concerned. All of the pictures were taken on my cell phone in the course of communication to Dave and my sister about just what the heck this might be. After we figured out what it was, I thought that other parents might benefit from seeing the weirdness while they are frantically Googling “toddler rash” or “changing rash” or “toddler hives” or “toddler rash after virus” or “WHAT THE HECK IS THIS RASH ON MY TODDLER aaaaahhhhhhh!” Because two weeks ago, that is what I was doing.

Finn, since he’s in the epicenter…

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 All That Forms Rings Is Not Erythema Multiforme

Acute annular urticaria (ring-shaped hives) is a benign cutaneous hypersensitivity reaction that occurs frequently in childhood. The condition is sometimes mistaken for other ring-shaped disorders — most often, erythema multiforme and less commonly, serum-sickness–like reactions. The value of renaming acute annular urticaria “urticaria multiforme,” as the authors propose, is debatable.

Articles of Interest

Rash, swelling in a 2-year-old febrile girl

A 2-year-old girl presents to your office with fever and rash. She has had fever (Tmax 101.6°F) for 2 days. The rash began the day before presentation. It started as “red spots” on the legs, then spread.

Urticaria Multiforme

Urticaria multiforme is a benign cutaneous hypersensitivity reaction seen in pediatric patients that is characterized by the acute and transient onset of blanchable, annular, polycyclic, erythematous wheals with dusky, ecchymotic centers inassociation with acral edema.

Resources

Steece's Pieces

As soon as the doc walked in he knew exactly what it was: Erythema multiforme (which I had NEVER heard of). One of his daughters even has it! I was SO relieved to find out what it was---its some type of virus that people pick up for no rhyme or reason. It is NOT contagious (thank you GOD!) and will disappear within 1-3 WEEKS! Note: The above diagnosis should be Urticaria Multiforme NOT Erythema multiforme - HWN

Consultant360

Five days after beginning treatment with oral amoxicillin for a positive rapid group A streptococcus test result, an 18-month-old girl presented with widespread, large, annular, itchy lesions, along with a fever and decreased oral intake.

DermNetNZ.org

Urticaria and urticaria-like conditions...

NEJM

Because of the annular nature of the rash, a frequently antecedent infection, and its often dramatic presentation, the condition is commonly misdiagnosed as erythema multiforme or other more serious cutaneous conditions.

The JAMA Network

Urticaria among children is more commonly associated with infectious rather than allergic etiologies.

VisualDx

Urticaria multiforme represents a morphologic subset of urticarial reactions. It is a common, benign hypersensitivity reaction mediated by histamine that predominantly affects children between 4 months and 4 years of age. This entity often manifests after a preceding illness, medication exposure, or vaccination. It can be mistaken for more concerning entities, namely erythema multiforme or serum sickness.