Pediatric skin & soft tissue conditions dr n.s.ramburn


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Pediatric skin & soft tissue conditions.
Dr. N.S.Ramburn

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Pediatric skin & soft tissue conditions dr n.s.ramburn

  1. 1. Common Pediatric Skin and Soft Tissue Conditions Dr. Nitee Sagar Ramburn MAURITIUS 1st Hospital Affiliated to D.M.U.
  2. 2. Erythema Toxicum NeonatorumImpressive title - harmless skin conditionErythematous macule with a central tiny papule,seen anywhere - except the palms and soles.The lesions are packed with eosinophils, andthere may be accompanying eosinophilia in theblood count.The cause is unknown, and no treatment isrequired as the rash disappears after 1-2 weeks.
  3. 3. MiliariaPrickly heat, sweat rashMany red macules with central papules,vesicles or pustules are present.These may be on the trunk, diaper area,head or neck.
  4. 4. Subcutaneous Fat NecrosisSelf limited, benign conditionSharply demarcated reddish toviolaceous plaques or nodulesEtiology uncertainOnset first few days- weeks of lifeCheeks, back, buttocks, arms, and thighs
  5. 5. Infantile Atopic DermatitisCause is unknownRed, itchy papules and plaques thatooze and crustSites of Predilection Face in the young Extensor surfaces of the arms and legs 8- 10 mo. Antecubital and popliteal fossa , neck, face in older
  6. 6. Differential Diagnosis- Atopic DermatitisSeborrheic dermatitisContact dermatitisNummular eczemaPsoriasisScabies
  7. 7. Eczema- TreatmentAvoidance or elimination ofpredisposing factorsHydration and lubrication of dry skinAnti-pruritic agentsTopical steroids
  8. 8. Seborrheic DermatitisCommon, generally self-limitingIts cause remains ill-understoodThere is a genetic predispositionMost frequent between the ages of 1 to 6mo.Greasy, salmon-colored scaling eruptionHair-bearing and intertriginous areasThe rash causes no discomfort or itching
  9. 9. Seborrheic Dermatitis- TreatmentAnti-seborrheic shampooTopical steroids
  10. 10. Pityriasis RoseaMild inflammatory exanthem ofunknown cause, maybe viralBenign, self limited disorderOccasionally there are prodromalsymptoms including malaise, headache,sore throat, fatigue, and arthralgia.Herald patch- pink in color and scaly-mimicking tinea corporis
  11. 11. Diaper Rash
  12. 12. Candidal DermatitisStarts off in the deep flexures which showwidespread erythema on the buttocks-beefy red colorThere are also raised edge, sharpmarginization and white scale at the borderof lesions, with pinpoint pustulo-vesicularsatellite lesions
  13. 13. Seborrheic DermatitisSalmon-colored greasy lesions withyellowish scale and predilection forintertriginous areasInvolvement of the scalp, face, neck,and post auricular and flexural areas
  14. 14. Irritant DermatitisRash confined to the convex surfacesof the buttocks,perineal area, lowerabdomen, and proximal thighs, sparingthe intertriginous creasesExcessive heat, moisture, and sweatretentionHarsh soaps, detergents, and topicalmedications
  15. 15. Viral Exanthems
  16. 16. Smallpox- VariolaFatality 40 %First invades upper respiratory tractFrom lymph nodes it spreads viahematogenous spreadChills, fever, headache, delirium, SZFace to upper arms and trunk, andfinally to lower legs
  17. 17. Chickenpox-VaricellaHerpes virus varicellaeIncubation period 10-21 daysFever, malaise, cough, irritability,pruritusPapules→vesicles →crustingSpreads centripetally
  18. 18. VaricellaComplications: Bacterial superinfection CNS involvement Pneumonia Hepatitis, arthritis Reye’s syndromeVZIG
  19. 19. Varicella – TreatmentOral acyclovir- indications Healthy nonpregnant teenagers and adults Children > 1 yr with chronic cutaneous or pulmonary conditions Patients on chronic salicylate therapy Patients receiving short or intermittent courses of aerosolized corticosteroidsDose: 80 mg/kg/day in four divideddoses for 5 days
  20. 20. Varicella – Post exposureVZIG (1 vial/5 kg IM) : Pts on high dose steroids Immunocompromised without a history of CP Pregnant women Newborns exposed 5 days prior to birth and 2 days after delivery Neonates born to nonimmune mothers Hospitalized premature infants < 28 weeks’ gestation
  21. 21. MeaslesRubeola- paramyxovirusOccurs in epidemicsIncubation 8-12 daysFever, lethargy, Cough, coryza, conjunctivitiswith clear discharge and photophobiaKoplik spotsRash begins on the face and spreads totrunk and extremities
  22. 22. Measles – Post ExposureImmunoglobulin therapy- indications All susceptible contacts Infants 5 mo. To 1 year of age Immunocompromised Pregnant women <5 mo. If mother without immunityLive measles virus vaccine- contraindication Immunocompromised- excluding HIV Pregnancy Allergy to eggs, or neomycin
  23. 23. RubellaGerman MeaslesEpidemic natureWinter-springProdromeFace → neck → trunkLymphadenopathySerologic testing
  24. 24. Hand-Foot-Mouth DiseaseEnteroviruses coxsackieviruses A and B echovirusesVesicular lesions, may be petechialAssociated with aseptic meningitis,myocarditis
  25. 25. Erythema InfectiosumFifth diseaseMildly contagious, parvovirus B-19Pre-school and young school-age childrenProdrome: mild malaiseRash: “slapped cheek”, circumoral pallor,peripheral mild macular distributionComplication
  26. 26. Exanthem SubitumRoseola InfantumChildren 6-19 monthsAbrupt onset of high feverFebrile seizuresRash develops after fever dissipatesMainly on trunk
  27. 27. Infectious MononucleosisAcute, self limited illnessEpstein-Barr virusOral transmission – incubation 30-50 daysFever, fatigue, pharyngitis, LA, splenomegaly,atypical lymphocytosisExanthem is seen in 10-15%Erythematous, maculopapular, morbilliform,scarlatiniform, urticarial, hemorrhagic, or evennodular
  28. 28. Bacterial Exanthems
  29. 29. ImpetigoSuperficial infection of the dermisTwo types: Impetigo contagiosa Bullous impetigoEtiology Group A ß hemolytic streptococcus Coagulase positive S. aureusTreatment : Keflex, erythromycin, Bactroban
  30. 30. Scarlet FeverToxin producing strain of group A β-hemolyticstreptococcusStrep pharyngitis with systemic complaintsRash from neck to trunk to extremitiesSandpaper feel, erythema, warmthWhite and red strawberry tonguePetechiae in linear formComplicationsTreatment
  31. 31. Staphylococcal Scalded-Skin SyndromeGenerally in less than 5 years of ageInduced by exotoxin produced by staphylococciFever, papular erythematous rash startingaround mouth- not involving oral mucosaPositive Nikolsky’s signDiagnosis: Tzanck test, bacterial cultureTreatmentComplications
  32. 32. MeningococcemiaUsually sudden onset of fever, chills,myalgia, and arthralgiaRash is macular, nonpruritic, erythematouslesionsPetechial rash develops in 75% of casesNeisseria meningitidesFever, rash, hypotension, shock, DICTreatment: PCN G
  33. 33. Differential DiagnosisGonococcemiaHSPTyphoid feverRickettsial diseaseErythema multiformePurpura fulminans
  34. 34. Rocky Mountain Spotted FeverMost common rickettsial infection in USAbrupt fever, headache, and myalgiaRash from extremities towards trunkMacules→petechiaeTreatment Tetracycline Doxycycline Chloramphenicol
  35. 35. CellulitisMost common organisms: S. aureus S. pyogenes H. influenza type B (HIB)Most common sites?CBC, x-ray?
  36. 36. Cellulitis- TreatmentIV antibiotics in: Immunocompromised Ill appearing Suspected bacteremia <6 mo. Of age WBC> 15K High fever Rapidly progressing
  37. 37. Periorbital- Orbital CellulitisS. aureus, S. pneumoniae, and HIBCBC, blood culture, CTLP?IV antibioticsAdmit
  38. 38. Fungal Infections
  39. 39. Henoch-Schnlein PurpuraNo clear etiologic agent, often post viral2-10 years of agePalpable purpura over the buttocks andLETransient migratory arthritisRenal and GI involvement
  40. 40. Kawasaki SyndromeUnknown etiologyPeak incidence 18-24 monthsClinical findings: Fever for at least five days Conjunctivitis Polymorphous rash Oral cavity changes Cervical adenopathy