A Crusty Kid

Author: Sobia Akhtar / Editor: Sarah Edwards / Codes: DC3, DC5, DP1, DP2, SLO5 / Published: 23/10/2024

Alfie is a 2-year-old boy who is brought to the Emergency Department (ED) by his mother. She tells you she went to Alfie’s room this morning and found his face covered in a red, blistery and sore-looking rash. On changing Alfie, his mum found his whole body was covered in the same rash.

Alfie has a background of eczema and is currently being treated for a flare up with emollients and topical steroids. His mum does not recall seeing the rash before. Alfie was a bit off his food this morning, and has been more tired than usual but has otherwise has had wet and dirty nappies as normal. Alfie was a term baby, born by vaginal delivery and did not require any neonatal support. He is up to date with immunisations. Alfie’s mum has hay fever and dad has well-controlled asthma.

At triage Alfie is noted to have a temperature of 38.5 degrees Celsius, a heart rate of 158 and respiratory rate of 37. He is coryzal and miserable when you examine him, with a widespread rash covering his face and body. The rash is mixture of clear vesicular and punched out crusted lesions approximately 2mm size, with evidence of excoriation to his flexural surfaces. There is no evidence of ocular involvement.