TY - JOUR T1 - Fifteen-minute consultation: the child with a non-blanching rash JF - Archives of disease in childhood - Education & practice edition JO - Arch Dis Child Educ Pract Ed SP - 236 LP - 240 DO - 10.1136/archdischild-2017-313998 VL - 103 IS - 5 AU - Thomas Waterfield AU - Emma M Dyer AU - Mark D Lyttle Y1 - 2018/10/01 UR - http://ep.bmj.com/content/103/5/236.abstract N2 - It’s 2am and you are called to review a ‘well-looking child’ in the emergency department who has presented with a new non-blanching rash. He has been hot at home with some coryzal symptoms. Mum is worried, she thinks the rash has spread in the last hour!In this article, we discuss the aetiology and initial assessment of non-blanching rashes in children.Non-blanching rash (NBR) is a term for any rash in which the colour is unchanged with direct pressure. The presence of a NBR is of concern to both parents and clinicians as it is associated with a wide range of underlying diagnoses, some of which are life threatening. The term is usually used to refer to the presence of petechiae/purpura (figure 1), and in this form it is a relatively common presentation to the emergency department (ED), accounting for around 2% of all attendances.1 2 Figure 1 Petechiae and purpura typical of invasive meningococcal disease. Petechiae are non-blanching spots that are <2 mm in size and are due to capillary haemorrhage. As more haemorrhages occurs the petechiae coalesce into purpura (>2 mm).  Images used with permission of the Meningitis Research Foundation.In this article, we discuss the aetiology and an initial assessment of NBR in children.The most common causes of NBR in children can be broadly classified as infective or mechanical. Other causes are less common and are classified as vasculitic, haematological and ‘other’1–6 (table 1).Infectious causesAny serious bacterial infection (SBI) can result in a NBR via disseminated intravascular coagulation (DIC). Some infections, however, feature a NBR as an early sign. The most common infections associated with a NBR as an earlier sign are as follows.Viral:Enterovirus and adenovirus are the most common infectious causes of NBR in children.3 BacterialStreptococcal infections1–4 Meningococcal disease (MD).6 Of … ER -