Listen to lecture takeaways from Jim Treat, MD's lecture , Pediatric Dermatologic Emergencies, at the 2nd Annual Elevate-Derm Alliance Summer Conference in Park City, Utah, at the Grand Hyatt Deer Valley.

In this video

Dr. Treat notes that measles is "back," and most clinicians weren't practicing when it was common. The challenge is that measles is morbilliform — literally "measles-like" — so it mimics nearly every viral rash. He points to the classic triad of cough, coryza, and conjunctivitis (runny eyes and nose), Koplik spots on the buccal mucosa, and a rash that spreads top to bottom. Because most of the population is vaccinated, he flags risk factors: an unvaccinated child, or one who couldn't be vaccinated due to immunosuppression or medication, presenting with fever and rash should raise suspicion for measles.

On DRESS, Dr. Treat stresses starting with the drug history — anticonvulsants, antibiotics, and sulfa drugs top the list, along with agents dermatology prescribes like minocycline, terbinafine, hydroxychloroquine, and dapsone. Fever and rash appearing one to three weeks after a high-risk drug should prompt a CBC and LFTs. These patients "look bad and feel bad," with an intense rash, facial, periorbital, lip, and hand/foot edema from third spacing, and a sense of impending doom. For staph scalded skin syndrome, he describes children under five who look sunburned (harder to detect in darker skin tones), peel specifically around the mouth, eyes, and nose while the mucosa is spared, and fear movement because it shears their skin.

  • Measles is morbilliform and mimics other viral rashes — look for cough, coryza, conjunctivitis, Koplik spots, and a top-to-bottom rash, especially in unvaccinated or immunosuppressed children.
  • In fever plus rash, always ask whether a high-risk drug was started one to three weeks earlier before assuming a virus — think DRESS.
  • DRESS patients "look bad and feel bad": intense rash, facial and extremity edema from third spacing, and a feeling of impending doom; confirm with CBC and LFTs, and follow closely since early cases can fool you.
  • Staph scalded skin is typically in children under five, looks like a sunburn (subtler in darker skin tones), and peels around the mouth, eyes, and nose with no mucosal involvement.
  • Pain with movement and fear of shearing the skin is a key clinical clue for staph scalded skin syndrome.