Clubbed nails. Increased curvature of the nail plate may be due to a wide variety of causes. In this patient, the large, convex nails are a hereditary anomaly and were found to be present in both father and brother. Other causes of clubbing of the nails in children include cyanotic congenital heart disease, cystic fibrosis, and chronic inflammatory bowel disease.
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Measles. This picture shows the “measly” appearance of a child who clearly feels miserable. The disease is brief and self-limited for most children, and the treatment is entirely supportive. The incidence of complications is higher, however, than in other childhood exanthems. Otitis media is the most common. Serious complications include bronchopneumonia and encephalitis, which may cause permanent neurologic damage. Subacute sclerosing panencephalitis is a late sequela of measles.
Kawasaki's disease. Blotchy erythema on the trunk of a child with Kawasaki's disease.