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

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Pediatric skin & soft tissue conditions.

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

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

  • Common Pediatric Skin and Soft Tissue Conditions Dr. Nitee Sagar Ramburn MAURITIUS 1st Hospital Affiliated to D.M.U.
  • 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.
  • 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.
  • Subcutaneous Fat NecrosisSelf limited, benign conditionSharply demarcated reddish toviolaceous plaques or nodulesEtiology uncertainOnset first few days- weeks of lifeCheeks, back, buttocks, arms, and thighs
  • 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
  • Differential Diagnosis- Atopic DermatitisSeborrheic dermatitisContact dermatitisNummular eczemaPsoriasisScabies
  • Eczema- TreatmentAvoidance or elimination ofpredisposing factorsHydration and lubrication of dry skinAnti-pruritic agentsTopical steroids
  • 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
  • Seborrheic Dermatitis- TreatmentAnti-seborrheic shampooTopical steroids
  • 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
  • Diaper Rash
  • 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
  • Seborrheic DermatitisSalmon-colored greasy lesions withyellowish scale and predilection forintertriginous areasInvolvement of the scalp, face, neck,and post auricular and flexural areas
  • 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
  • Viral Exanthems
  • 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
  • Chickenpox-VaricellaHerpes virus varicellaeIncubation period 10-21 daysFever, malaise, cough, irritability,pruritusPapules→vesicles →crustingSpreads centripetally
  • VaricellaComplications: Bacterial superinfection CNS involvement Pneumonia Hepatitis, arthritis Reye’s syndromeVZIG
  • 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
  • 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
  • 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
  • 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
  • RubellaGerman MeaslesEpidemic natureWinter-springProdromeFace → neck → trunkLymphadenopathySerologic testing
  • Hand-Foot-Mouth DiseaseEnteroviruses coxsackieviruses A and B echovirusesVesicular lesions, may be petechialAssociated with aseptic meningitis,myocarditis
  • Erythema InfectiosumFifth diseaseMildly contagious, parvovirus B-19Pre-school and young school-age childrenProdrome: mild malaiseRash: “slapped cheek”, circumoral pallor,peripheral mild macular distributionComplication
  • Exanthem SubitumRoseola InfantumChildren 6-19 monthsAbrupt onset of high feverFebrile seizuresRash develops after fever dissipatesMainly on trunk
  • 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
  • Bacterial Exanthems
  • ImpetigoSuperficial infection of the dermisTwo types: Impetigo contagiosa Bullous impetigoEtiology Group A ß hemolytic streptococcus Coagulase positive S. aureusTreatment : Keflex, erythromycin, Bactroban
  • 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
  • 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
  • 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
  • Differential DiagnosisGonococcemiaHSPTyphoid feverRickettsial diseaseErythema multiformePurpura fulminans
  • Rocky Mountain Spotted FeverMost common rickettsial infection in USAbrupt fever, headache, and myalgiaRash from extremities towards trunkMacules→petechiaeTreatment Tetracycline Doxycycline Chloramphenicol
  • CellulitisMost common organisms: S. aureus S. pyogenes H. influenza type B (HIB)Most common sites?CBC, x-ray?
  • Cellulitis- TreatmentIV antibiotics in: Immunocompromised Ill appearing Suspected bacteremia <6 mo. Of age WBC> 15K High fever Rapidly progressing
  • Periorbital- Orbital CellulitisS. aureus, S. pneumoniae, and HIBCBC, blood culture, CTLP?IV antibioticsAdmit
  • Fungal Infections
  • Henoch-Schnlein PurpuraNo clear etiologic agent, often post viral2-10 years of agePalpable purpura over the buttocks andLETransient migratory arthritisRenal and GI involvement
  • Kawasaki SyndromeUnknown etiologyPeak incidence 18-24 monthsClinical findings: Fever for at least five days Conjunctivitis Polymorphous rash Oral cavity changes Cervical adenopathy