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  • Writer's pictureThe Review Course in Family Medicine

“I have purple dots all over my body…”

By Dr. Jemy Joseph MD CCFP

Dangerous Rashes in a Pediatric Population

Real Clinical Scenario

History of Presenting Illness

A 10-year-old boy developed a rash that is blueish-purple two days ago. It began on his torso, but now has spread to both arms and legs. On his face, it presents only on his tongue. No recent bleeding or trauma.

  • Past medical history: unremarkable; normal growth and development to date

  • Medications: none

  • Allergies: none

  • Immunizations: none

  • Recent travel or antibiotics: none

  • Social History: Grade school; lives at home with both parents and two siblings - all healthy

  • Family History: no major illnesses in first degree relatives

On Exam

Patient in no apparent distress. Vital signs normal: T 36.9; RR 12; HR 70; BP 104/63; O2 sat 99% room air

  • Head and neck exam was unremarkable except for rash on tongue

  • Heart sounds were normal and regular; no murmurs

  • Respiratory exam revealed no distress; patient did not have any audible or auscultated wheeze

  • There was no use of accessory muscles

  • Abdominal exam was benign; no masses or tenderness

  • Neurologically: normal tone and movement of all limbs

  • Rheumatological: no joint swelling or redness

  • Dermatological exam revealed blueish-purple, non-blanchable macular lesions, each <0.2 cm, circular, and all over his body but sparing his face

Impression: Petechiae NYD

Investigations: extensive bloodwork revealed a platelet count of 5 Diagnosis: Immune Thrombocytopenia (ITP)

Treatment: Short-course steroids and monitoring of platelet count until it improves. No blood-thinners or NSAIDs. Avoid intense physical activity or contact sports due to increased risk of bleeding.


Pediatric rashes are extremely common and many are benign. In this brief post we won’t go into common rashes. However, as a primary care provider, it is important to recognize the ‘bad’ rashes / rashes that require further work-up / rashes that can resolve with treating underlying illness. Here are some signs to watch out for:

  • Non-blanching rashes

  • Petechiae / Purpura (blueish purple and non-blanchable)

  • Skin layers peeling away (e.g. Stevens-Johnson Syndrome / Toxic epidermal necrolysis)

  • Vesicular rash (e.g. herpes, chicken pox)

  • Clear or pus discharge from rashes (e.g. cellulitis)

  • Fever and rash (e.g. Kawasaki’s)

  • Rash in a non-immunized child (e.g. Measles, rubella)

  • Significant pruritus (e.g. lice, scabies)

  • Target shaped rashes (e.g. tick bites, Lyme disease)

  • Rash that is not improving within a few days



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