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Pedsskin

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Pedsskin

  1. 1. Common Pediatric Skin and Soft Tissue Conditions Sirous Partovi, M.D.
  2. 3. Erythema Toxicum Neonatorum <ul><li>Impressive title - harmless skin condition </li></ul><ul><li>Erythematous macule with a central tiny papule, seen anywhere - except the palms and soles. </li></ul><ul><li>The lesions are packed with eosinophils, and there may be accompanying eosinophilia in the blood count. </li></ul><ul><li>The cause is unknown, and no treatment is required as the rash disappears after 1-2 weeks. </li></ul>
  3. 5. Miliaria <ul><li>Prickly heat, sweat rash </li></ul><ul><li>Many red macules with central papules, vesicles or pustules are present. </li></ul><ul><li>These may be on the trunk, diaper area, head or neck. </li></ul>
  4. 7. Subcutaneous Fat Necrosis <ul><li>Self limited, benign condition </li></ul><ul><li>Sharply demarcated reddish to violaceous plaques or nodules </li></ul><ul><li>Etiology uncertain </li></ul><ul><li>Onset first few days- weeks of life </li></ul><ul><li>Cheeks, back, buttocks, arms, and thighs </li></ul>
  5. 9. Infantile Atopic Dermatitis <ul><li>Cause is unknown </li></ul><ul><li>Red, itchy papules and plaques that ooze and crust </li></ul><ul><li>Sites of Predilection </li></ul><ul><ul><li>Face in the young </li></ul></ul><ul><ul><li>Extensor surfaces of the arms and legs 8-10 mo. </li></ul></ul><ul><ul><li>Antecubital and popliteal fossa , neck, face in older </li></ul></ul>
  6. 11. Differential Diagnosis- Atopic Dermatitis <ul><li>Seborrheic dermatitis </li></ul><ul><li>Contact dermatitis </li></ul><ul><li>Nummular eczema </li></ul><ul><li>Psoriasis </li></ul><ul><li>Scabies </li></ul>
  7. 12. Eczema- Treatment <ul><li>Avoidance or elimination of predisposing factors </li></ul><ul><li>Hydration and lubrication of dry skin </li></ul><ul><li>Anti-pruritic agents </li></ul><ul><li>Topical steroids </li></ul>
  8. 16. Seborrheic Dermatitis <ul><li>Common, generally self-limiting </li></ul><ul><li>Its cause remains ill-understood </li></ul><ul><li>There is a genetic predisposition </li></ul><ul><li>Most frequent between the ages of 1 to 6 mo. </li></ul><ul><li>Greasy, salmon-colored scaling eruption </li></ul><ul><li>Hair-bearing and intertriginous areas </li></ul><ul><li>The rash causes no discomfort or itching </li></ul>
  9. 19. Seborrheic Dermatitis-Treatment <ul><li>Anti-seborrheic shampoo </li></ul><ul><li>Topical steroids </li></ul>
  10. 21. Pityriasis Rosea <ul><li>Mild inflammatory exanthem of unknown cause, maybe viral </li></ul><ul><li>Benign, self limited disorder </li></ul><ul><li>Occasionally there are prodromal symptoms including malaise, headache, sore throat, fatigue, and arthralgia. </li></ul><ul><li>Herald patch- pink in color and scaly-mimicking tinea corporis </li></ul>
  11. 22. Diaper Rash
  12. 24. Candidal Dermatitis <ul><li>Starts off in the deep flexures which show widespread erythema on the buttocks-beefy red color </li></ul><ul><li>There are also raised edge, sharp marginization and white scale at the border of lesions, with pinpoint pustulo-vesicular satellite lesions </li></ul>
  13. 27. Seborrheic Dermatitis <ul><li>Salmon-colored greasy lesions with yellowish scale and predilection for intertriginous areas </li></ul><ul><li>Involvement of the scalp, face, neck, and post auricular and flexural areas </li></ul>
  14. 29. Irritant Dermatitis <ul><li>Rash confined to the convex surfaces of the buttocks,perineal area, lower abdomen, and proximal thighs, sparing the intertriginous creases </li></ul><ul><li>Excessive heat, moisture, and sweat retention </li></ul><ul><li>Harsh soaps, detergents, and topical medications </li></ul>
  15. 32. Viral Exanthems
  16. 34. Smallpox- Variola <ul><li>Fatality 40 % </li></ul><ul><li>First invades upper respiratory tract </li></ul><ul><li>From lymph nodes it spreads via hematogenous spread </li></ul><ul><li>Chills, fever, headache, delirium, SZ </li></ul><ul><li>Face to upper arms and trunk, and finally to lower legs </li></ul>
  17. 36. Chickenpox-Varicella <ul><li>Herpes virus varicellae </li></ul><ul><li>Incubation period 10-21 days </li></ul><ul><li>Fever, malaise, cough, irritability, pruritus </li></ul><ul><li>Papules  vesicles  crusting </li></ul><ul><li>Spreads centripetally </li></ul>
  18. 37. Varicella <ul><li>Complications: </li></ul><ul><ul><li>Bacterial superinfection </li></ul></ul><ul><ul><li>CNS involvement </li></ul></ul><ul><ul><li>Pneumonia </li></ul></ul><ul><ul><li>Hepatitis, arthritis </li></ul></ul><ul><ul><li>Reye’s syndrome </li></ul></ul><ul><li>VZIG </li></ul>
  19. 38. Varicella – Treatment <ul><li>Oral acyclovir- indications </li></ul><ul><ul><li>Healthy nonpregnant teenagers and adults </li></ul></ul><ul><ul><li>Children > 1 yr with chronic cutaneous or pulmonary conditions </li></ul></ul><ul><ul><li>Patients on chronic salicylate therapy </li></ul></ul><ul><ul><li>Patients receiving short or intermittent courses of aerosolized corticosteroids </li></ul></ul><ul><li>Dose: 80 mg/kg/day in four divided doses for 5 days </li></ul>
  20. 39. Varicella – Post exposure <ul><li>VZIG (1 vial/5 kg IM) : </li></ul><ul><ul><li>Pts on high dose steroids </li></ul></ul><ul><ul><li>Immunocompromised without a history of CP </li></ul></ul><ul><ul><li>Pregnant women </li></ul></ul><ul><ul><li>Newborns exposed 5 days prior to birth and 2 days after delivery </li></ul></ul><ul><ul><li>Neonates born to nonimmune mothers </li></ul></ul><ul><ul><li>Hospitalized premature infants < 28 weeks’ gestation </li></ul></ul>
  21. 42. Measles <ul><li>Rubeola- paramyxovirus </li></ul><ul><li>Occurs in epidemics </li></ul><ul><li>Incubation 8-12 days </li></ul><ul><li>Fever, lethargy, Cough, coryza, conjunctivitis with clear discharge and photophobia </li></ul><ul><li>Koplik spots </li></ul><ul><li>Rash begins on the face and spreads to trunk and extremities </li></ul>
  22. 43. Measles – Post Exposure <ul><li>Immunoglobulin therapy- indications </li></ul><ul><ul><li>All susceptible contacts </li></ul></ul><ul><ul><li>Infants 5 mo. To 1 year of age </li></ul></ul><ul><ul><li>Immunocompromised </li></ul></ul><ul><ul><li>Pregnant women </li></ul></ul><ul><ul><li><5 mo. If mother without immunity </li></ul></ul><ul><li>Live measles virus vaccine- contraindication </li></ul><ul><ul><li>Immunocompromised- excluding HIV </li></ul></ul><ul><ul><li>Pregnancy </li></ul></ul><ul><ul><li>Allergy to eggs, or neomycin </li></ul></ul>
  23. 44. Rubella <ul><li>German Measles </li></ul><ul><li>Epidemic nature </li></ul><ul><li>Winter-spring </li></ul><ul><li>Prodrome </li></ul><ul><li>Face  neck  trunk </li></ul><ul><li>Lymphadenopathy </li></ul><ul><li>Serologic testing </li></ul>
  24. 46. Hand-Foot-Mouth Disease <ul><li>Enteroviruses </li></ul><ul><ul><li>coxsackieviruses A and B </li></ul></ul><ul><ul><li>echoviruses </li></ul></ul><ul><li>Vesicular lesions, may be petechial </li></ul><ul><li>Associated with aseptic meningitis, myocarditis </li></ul>
  25. 48. Erythema Infectiosum <ul><li>Fifth disease </li></ul><ul><li>Mildly contagious, parvovirus B-19 </li></ul><ul><li>Pre-school and young school-age children </li></ul><ul><li>Prodrome: mild malaise </li></ul><ul><li>Rash: “slapped cheek”, circumoral pallor, peripheral mild macular distribution </li></ul><ul><li>Complication </li></ul>
  26. 50. Exanthem Subitum <ul><li>Roseola Infantum </li></ul><ul><li>Children 6-19 months </li></ul><ul><li>Abrupt onset of high fever </li></ul><ul><li>Febrile seizures </li></ul><ul><li>Rash develops after fever dissipates </li></ul><ul><li>Mainly on trunk </li></ul>
  27. 52. Infectious Mononucleosis <ul><li>Acute, self limited illness </li></ul><ul><li>Epstein-Barr virus </li></ul><ul><li>Oral transmission – incubation 30-50 days </li></ul><ul><li>Fever, fatigue, pharyngitis, LA, splenomegaly, atypical lymphocytosis </li></ul><ul><li>Exanthem is seen in 10-15% </li></ul><ul><li>Erythematous, maculopapular, morbilliform, scarlatiniform, urticarial, hemorrhagic, or even nodular </li></ul>
  28. 53. Bacterial Exanthems
  29. 55. Impetigo <ul><li>Superficial infection of the dermis </li></ul><ul><li>Two types: </li></ul><ul><ul><li>Impetigo contagiosa </li></ul></ul><ul><ul><li>Bullous impetigo </li></ul></ul><ul><li>Etiology </li></ul><ul><ul><li>Group A ß hemolytic streptococcus </li></ul></ul><ul><ul><li>Coagulase positive S. aureus </li></ul></ul><ul><li>Treatment : Keflex, erythromycin, Bactroban </li></ul>
  30. 58. Scarlet Fever <ul><li>Toxin producing strain of group A  -hemolytic streptococcus </li></ul><ul><li>Strep pharyngitis with systemic complaints </li></ul><ul><li>Rash from neck to trunk to extremities </li></ul><ul><li>Sandpaper feel, erythema, warmth </li></ul><ul><li>White and red strawberry tongue </li></ul><ul><li>Petechiae in linear form </li></ul><ul><li>Complications </li></ul><ul><li>Treatment </li></ul>
  31. 60. Staphylococcal Scalded-Skin Syndrome <ul><li>Generally in less than 5 years of age </li></ul><ul><li>Induced by exotoxin produced by staphylococci </li></ul><ul><li>Fever, papular erythematous rash starting around mouth- not involving oral mucosa </li></ul><ul><li>Positive Nikolsky’s sign </li></ul><ul><li>Diagnosis: Tzanck test, bacterial culture </li></ul><ul><li>Treatment </li></ul><ul><li>Complications </li></ul>
  32. 62. Meningococcemia <ul><li>Usually sudden onset of fever, chills, myalgia, and arthralgia </li></ul><ul><li>Rash is macular, nonpruritic, erythematous lesions </li></ul><ul><li>Petechial rash develops in 75% of cases </li></ul><ul><li>Neisseria meningitides </li></ul><ul><li>Fever, rash, hypotension, shock, DIC </li></ul><ul><li>Treatment: PCN G </li></ul>
  33. 63. Differential Diagnosis <ul><li>Gonococcemia </li></ul><ul><li>HSP </li></ul><ul><li>Typhoid fever </li></ul><ul><li>Rickettsial disease </li></ul><ul><li>Erythema multiforme </li></ul><ul><li>Purpura fulminans </li></ul>
  34. 65. Rocky Mountain Spotted Fever <ul><li>Most common rickettsial infection in US </li></ul><ul><li>Abrupt fever, headache, and myalgia </li></ul><ul><li>Rash from extremities towards trunk </li></ul><ul><li>Macules  petechiae </li></ul><ul><li>Treatment </li></ul><ul><ul><li>Tetracycline </li></ul></ul><ul><ul><li>Doxycycline </li></ul></ul><ul><ul><li>Chloramphenicol </li></ul></ul>
  35. 67. Cellulitis <ul><li>Most common organisms: </li></ul><ul><ul><li>S. aureus </li></ul></ul><ul><ul><li>S. pyogenes </li></ul></ul><ul><ul><li>H. influenza type B (HIB) </li></ul></ul><ul><li>Most common sites? </li></ul><ul><li>CBC, x-ray? </li></ul>
  36. 68. Cellulitis- Treatment <ul><li>IV antibiotics in: </li></ul><ul><ul><li>Immunocompromised </li></ul></ul><ul><ul><li>Ill appearing </li></ul></ul><ul><ul><li>Suspected bacteremia </li></ul></ul><ul><ul><li><6 mo. Of age </li></ul></ul><ul><ul><li>WBC> 15K </li></ul></ul><ul><ul><li>High fever </li></ul></ul><ul><ul><li>Rapidly progressing </li></ul></ul>
  37. 70. Periorbital- Orbital Cellulitis <ul><li>S. aureus, S. pneumoniae , and HIB </li></ul><ul><li>CBC, blood culture, CT </li></ul><ul><li>LP? </li></ul><ul><li>IV antibiotics </li></ul><ul><li>Admit </li></ul>
  38. 72. Fungal Infections
  39. 77. Henoch-Schnlein Purpura <ul><li>No clear etiologic agent, often post viral </li></ul><ul><li>2-10 years of age </li></ul><ul><li>Palpable purpura over the buttocks and LE </li></ul><ul><li>Transient migratory arthritis </li></ul><ul><li>Renal and GI involvement </li></ul>
  40. 79. Kawasaki Syndrome <ul><li>Unknown etiology </li></ul><ul><li>Peak incidence 18-24 months </li></ul><ul><li>Clinical findings: </li></ul><ul><ul><li>Fever for at least five days </li></ul></ul><ul><ul><li>Conjunctivitis </li></ul></ul><ul><ul><li>Polymorphous rash </li></ul></ul><ul><ul><li>Oral cavity changes </li></ul></ul><ul><ul><li>Cervical adenopathy </li></ul></ul>

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