Skin and Mucous Membranes
Several conditions in paediatrics involve the skin and mucous membranes. Some are multi-system diseases that includes musculoskeletal manifestations related with a connective tissue disorder. The Table is a quick guide to common mucocutaneous features in conditions such as Juvenile Idiopathic Arthritis, Juvenile Systemic Lupus Erythematosus, Juvenile Dermatomyositis, Vasculitis, Scleroderma, among others. More information about these conditions is available.
Changes can vary, be subtle and can be easily missed. There is also racial variation in how mucocutaneous features may appear and the following resources are useful.
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https://www.nottingham.ac.uk/research/groups/cebd/resources/skin-of-colour/index.aspx
|
Feature |
Description |
Related diseases |
|
Malar rash |
Butterfly red or violaceous erythema. It appears on the cheeks, bridge of the nose, but could extend to the forehead and chin. |
Juvenile Systemic Lupus Erythematosus |
|
Cutaneous lupus |
Round scaly plaques that appear on the face, could be present with hair loss and scarring. |
Juvenile Systemic Lupus Erythematosus Acute Rheumatic Fever |
|
Oral ulcers / vasculitis |
The most common variety are palatal erythematous ulcers, that are painless. |
Juvenile Systemic Lupus Erythematosus |
|
Vasculitis rashes |
A variety of rashes, the most classic is “palpable purpura” that usually appear in the limbs. |
IgA Vasculitis (Henoch-Schönlein purpura) ANCA-associated vasculitis Juvenile Systemic Lupus Erythematosus Antiphospholipid syndrome Other systemic vasculitides |
|
Heliotrope rash |
Bilateral red/purple discolouration of the upper eyelids, often with swelling of eyelids and skin around the eyes. |
Juvenile Dermatomyositis |
|
Gottron papules |
Erythematous to violaceous papules and plaques found over bony prominences, especially over metacarpophalangeal and interphalangeal joints. |
Juvenile Dermatomyositis |
|
Scleroderma |
The skin becomes unusually thick. Typically, a waxy shiny skin with loss of adnexa is seen. Morphoea is a common name to this condition. |
Juvenile Scleroderma |
|
Sclerodactyly |
Localized thickening and tightness of the skin of the fingers. |
Juvenile Systemic Sclerosis |
|
Livedo reticularis and racemosa |
A mottled or net-like violaceous skin pattern. |
Some vasculitides Juvenile Systemic Lupus Erythematosus Antiphospholipid syndrome Juvenile Systemic Sclerosis |
|
Erythema nodosum |
The usual presentation is as red tender nodules in the shins that gradually disappear leaving a bruising appearance or post-inflammatory hyperpigmentation. |
Inflammatory bowel disease Juvenile Systemic Lupus Erythematosus/Cutaneous Lupus Behçet's disease Sarcoidosis |
|
Psoriasis |
Scaly plaques predominantly on extensor surfaces and head. |
Juvenile Idiopathic Arthritis |
|
Raynaud’s phenomenon |
Usually symmetrical and affects digits of hands and feet but may also affect ears and nose. Pallor, cyanosis, and erythema but not all phases may be present. If the changes are unilateral then outflow syndromes must be considered (e.g., cervical rib). |
Juvenile Systemic Lupus Erythematosus Antiphospholipid syndrome Juvenile Systemic Sclerosis |
|
Nail fold capillary changes |
Erythema, oedema, and haemorrhages seen in the base of the nails. |
Juvenile Systemic Lupus Erythematosus Juvenile Systemic Sclerosis Juvenile Dermatomyositis |
|
Chilblains |
Erythematous or violaceous patches that appear after cold exposure. Usually appear in the fingers and toes and a feeling of burn of itch could be present. |
Juvenile Systemic Lupus Erythematosus |
