This document provides information on several common pediatric skin disorders: - Atopic eczema is a chronic, inflammatory skin condition characterized by an itchy red rash that favors skin creases. Its cause involves genetic and environmental factors. - Seborrheic dermatitis causes flaky, greasy, red rashes in areas with many oil glands. Its cause may involve skin yeasts but it is not contagious. - Psoriasis causes raised red patches and silvery scales, and has genetic and environmental triggers. It has several clinical forms that vary in appearance and location on the body.

1. PAEDIATRIC
SKIN DISORDERS
Richie Chacko
Paediatric & Nonatal Nursing

2. ATOPIC ECZEMA/DERMATITIS
Definition
Atopic Eczema/ dermatitis is a chronic,
relapsing, inflammatory skin condition
characterised by an itchy red rash that
favours the skin creases such as the folds
of the elbows or behind the knees.

4. ETIOLOGY
• Unknown
• combination of genes and environmental
triggers
• families with a history of atopic dermatitis,
asthma, or hay fever (known as the atopic
triad) are more likely to develop AD.
• Immune response.

5. What’s the difference between eczema
and AD?
• Atopic dermatitis is one of the most common
types of eczema. Both AD and other forms of
eczema are conditions that infants, toddlers
and older children can develop. Symptoms
include skin redness and itch. Atopic
dermatitis is considered a chronic condition
and may last into the child’s teenage years and
beyond.

6. Some of the most common eczema
triggers, include:
• Dry skin
• Irritants
• Stress
• Heat and sweating
• Infection
• Allergens
• Abrasive fabrics
• Food allergy
• Inhaled allergens
• Hormonal changes in women

7. Symptoms
• A tendency to dry skin
• Acute flare-ups vary in appearance from vesicles
• areas of poorly demarcated redness
• Repeated scratching often leads to thickening of
chronic lesions.
• localised to the flexure of the limbs.
• Bacterial infection is suggested by:Crusting,
weeping, pustulation and/or
surrounding cellulitis with erythema of otherwise
normal-looking skin.
• Clustered blisters
• Punched-out erosions usually 1-3 mm that are
uniform in appearance
• Possible fever, lethargy or distress.

8. Diagnostic criteria
• Must have an itchy skin condition plus History
of itchiness in skin creases such as folds of the
elbows, behind the knees, fronts of ankles, or
around the neck.
• Estimation of immunoglobulin E (IgE) and
specific radioallergosorbant tests (RASTs) only
confirm the atopic nature of the individual.
• Swabs for bacteriology test

9. Management
• Emollients: emollients should be every 4 hours or
at least 3-4 times per day. 250 g/week for a child.
• Topical steroids: once or twice daily.
• Bacterial infection: 14-day course should be
given. Oral flucloxacillin
• Exudative eczema: Potassium permanganate
solution (1 in 10,000) can be used in exudative
eczema, for its antiseptic and astringent effect.

10. • Diet: hydrolysed formulas for the
treatment atopic eczema
• Managing flare-ups: Settle inflammation with
topical corticosteroids.
• Other Rx includes:
• Bandaging (eg, use of wet wraps).
• Phototherapy.
• Initiation and monitoring of a systemic
immunosuppressant.

11. Complications
• Infection
• Psychosocial impact
• Disturbed sleep patterns.
• Reduced self-esteem because of chronic visible
disease.
• Isolation from other children - eg, when they are
unable to swim.
• Adverse effects on a child's behaviour and
development: poor sleep, reduced self-esteem
and social isolation.

12. Prognosis
• Atopic eczema can be expected to clear in 60-
70% of children by their early teens, although
relapses may occur.

13. SEBORRHOEIC DERMATITIS
DEFINITION
• Dermatitis means inflammation of the skin,
and seborrhoeic means it affects the areas
where there are sebaceous glands. These are
the glands that make the oil (sebum) for the
skin.

15. ETIOLOGY
• The exact cause of seborrhoeic dermatitis is not
known.
• It is thought that yeast germs from
the Malassezia species may be involved.
• it is not contagious
• immune system problems
• emotional stress
• a lack of cleanliness does not cause seborrhoeic
dermatitis.
• Endocrine disease that leads to obesity, such as
diabetes
• Some medications

16. PATHOPHYSIOLOGY
• The germs live in the sebum of human skin
• most people they do no harm.
• some people may react to these yeast germs,
making the skin become inflamed.

17. SYMPTOMS
• The areas of the body that tend to be affected are
those where there are the most skin glands which
make the oil (sebum).
• Dandruff is scaling of the scalp
• Mild patches of flaky skin may also develop on
the face.
• a rash also develops.
• round or oval patches of red, scaly, greasy skin.
• Yellow-brown crusts may form
• rash may be itchy and feel slightly raised
• inflammation of the outer ear canal and/or of the
eyelids.

18. INVESTIGATIONS
• In most cases, no investigations are needed
and seborrhoeic dermatitis is diagnosed by
the typical symptoms and rash.

19. MANAGEMENT
• An anti-yeast (antifungal) shampoo such as
Ketoconazole
• An antifungal cream: clotrimazole,econazole
• A scale softener
• A mild steroid cream and/or steroid scalp
lotion: hydrocortisone, betamethasone
• Light treatment (phototherapy) with
ultraviolet B is sometimes used in severe
cases.

20. PREVENTION
• antifungal shampoo
• daily washing with soap and water helps to
remove the greasy sebum from the body. This
helps to keep the number of fungal germs to a
minimum.
• antifungal cream 1-2 times a week.
• discuss with your doctor the best preventative
treatment for you.

21. PSORIASIS
• Psoriasis is a disease which affects the skin
and joints.
• It commonly causes red scaly patches to
appear on the skin.
• The scaly patches caused by psoriasis, called
psoriatic plaques, are areas of inflammation
and excessive skin production.
• Skin rapidly accumulates at these sites and
takes a silvery-white appearance.
• Plaques frequently occur on the skin of the
elbows and knees, but can affect any area
including the scalp and genitals.

24. ETIOLOGY
• The exact cause of psoriasis is not known.
• believed to have a genetic component.
• Several factors are thought to aggravate
psoriasis. These include stress, excessive
alcohol consumption, and smoking.
• Certain medicines, including lithium salt and
beta blockers, have been reported to trigger
or aggravate the disease.

25. There are two main hypotheses about
the process that occurs in the
development of the disease.
• The first considers psoriasis as primarily a
disorder of excessive growth and reproduction
of skin cells.
• The second hypothesis sees the disease that
being an immune-mediated disorder in which
the excessive reproduction of skin cells takes
place.

26. Types of Psoriasis
• Plaque psoriasis: It affects 80 to 90% of
people with psoriasis. Plaque psoriasis
typically appears as raised areas of inflamed
skin covered with silvery white scaly skin.
These areas are called plaques.

27. • Flexural psoriasis: It occurs in skin folds,
particularly around the genitals (between the
thigh and groin), the armpits, under an
overweight stomach (pannus), and under the
breasts (inframammary fold). It is aggravated
by friction and sweat, and is vulnerable to
fungal infections.

28. • Guttate psoriasis is characterized by
numerous small oval (teardrop-shaped) spots.
These numerous spots of psoriasis appear
over large areas of the body, such as the
trunk, limbs, and scalp. Guttate psoriasis is
associated with streptococcal throat infection

29. • Pustular psoriasis appears as raised bumps
that are filled with non-infectious pus
(pustules). The skin under and surrounding
pustules is red and tender. Pustular psoriasis
can be localised, commonly to the hands and
feet , or generalised with widespread patches
occurring randomly on any part of the body.

30. • Nail psoriasis produces a variety of changes in
the appearance of finger and toe nails. These
changes include discolouring under the nail
plate, pitting of the nails, lines going across
the nails, thickening of the skin under the nail,
and the loosening and crumbling of the nail.

31. • Erythrodermic psoriasis involves the
widespread inflammation and exfoliation of
the skin over most of the body surface.

32. • Scalp psoriasis (thick scales found on
areas of the scalp)

33. SYMPTOMS
• raised red patches of skin that can have silvery
scales on them.
• dry, cracked skin that may bleed at times.
• itching, soreness, or a burning sensation in the
affected area.
• thick, pitted fingernails.

34. DIAGNOSIS
• A diagnosis of psoriasis is usually based on the
appearance of the skin. There are no special
blood tests or diagnostic procedures for
psoriasis. Sometimes a skin biopsy, or
scraping, may be needed to rule out other
disorders and to confirm the diagnosis.
• Another sign of psoriasis is that when the
plaques are scraped, one can see pinpoint
bleeding from the skin below (Auspitz's sign).

35. MANAGEMENT
• Topical therapy: Vitamin D analogues such as
Calcipotriol , Topical corticosteroids
• Coal Tar
- Prefered for limited or scalp psoriasis
- Can be effective in widespread psoriasis
- Antimitotic, anti-pruritic
- No quick onset but longer remission
- Often combined with SA, UV light therapy
- 2 types: Crude coal tar and Liquor picis carbonis

36. • Phototherapy: Narrowband UV phototherapy
• Methotrexate
• Immunomodulators:
- Cyclosporin, methotrexate commonly used
• Antibiotics in case of secondary bacterial
infections

37. MILIA
• Milia are benign, keratinous cysts that
commonly manifest as tiny white bumps on
the face of the newborn (see the image
below). When present on the gum margin and
midline palate they are referred to as Bohn
nodules and Epstein pearls, respectively.

39. • primary milia is congenital milia in newborns.
• Secondary milia may be associated with an
underlying skin disease, medications, or
trauma.

40. ETIOLOGY
• Milia occur when dead skin becomes trapped
in tiny pockets near the surface of your baby's
skin. When the surface of the bump wears
away, the dead skin is sloughed off and the
bump disappears
• triggered by hormones from the mother.

41. RISK FACTORS
• Milia are so common in newborn babies (occurring in
up to 50% of them) that they are considered normal.
• Secondary milia may appear in affected skin of people
with the following:
1. Blistering injury (trauma) to skin, such as poison ivy
2. Burns
3. Blistering skin disorders, such as epidermolysis
bullosa or porphyria
4. Following long-term use of topical steroids

42. TYPES OF MILIA
• Neonatal Milia (develops in newborns)
• Juvenile Milia (genetic disorders)
• Primary Milia in Children (keratin trapped
beneath the skin surface)
• Milia en Plaque (autoimmune skin disorders)
• Multiple Eruptive Milia(itchy areas on the face,
upper arms, and torso)
• Traumatic Milia(occur where injury to the skin
has occurred)
• Milia Associated with Drugs(steroid creams can
lead to milia)

43. SIGNS AND SYMPTOMS
The most common locations for primary milia include:
• Around the eye (periorbital area) in children and
adults
• Around the nose, especially in infants
The most common locations for secondary milia
include:
• Anywhere on the body, where another skin condition
exists
• On the faces of people who have had a lot of damage
from sun exposure
• A single lesion (milium) appears as a small (1–2 mm),
white-to-yellow, dome-shaped bump on the outer
surface of the skin.

44. DIAGNOSIS
• Physical examination of skin and can
determine if you have the condition
based on the appearance of the
cysts.

45. MANAGEMENT
• deroofing, or using a sterile needle to pick out
the contents of the cyst
• medications, such as topical retinoids
• laser ablation
• diathermy, which involves using extreme heat
to destroy the cysts
• destruction curettage, which involves surgical
scraping and cauterization to destroy the cysts
• cryotherapy, which involves freezing and is the
most frequently used method to destroy the
cysts

46. PROGNOSIS
• Milia are benign cysts with a tendency
for spontaneous resolution without
scarring.
• Patient Education: Educate the family
about the benign course of milia and
tendency towards spontaneous
resolution without scarring.

47. ERYTHEMA TOXICUM
• Erythema toxicum neonatorum (also known
as erythema toxicum, urticaria
neonatorum and toxic erythema of the
newborn) is a common rash in neonates. It
appears in up to half of newborns carried to
term, usually between day 2–5 after birth; it
does not occur outside the neonatal period.

49. ETIOLOGY
• Idiopathic
• activation of the immune system.
• hypersensitivity to detergents in bedsheets
and clothing is sometimes suspected.
• It is thought to be a benign condition that
causes no discomfort to the infant. The rash
will generally disappear spontaneously in
about 2 weeks.

50. • The etiology remains uncertain; however,
more recent hypotheses explaining the
appearance of this eruption include the
following:
1. Self-limited, acute, cutaneous reaction
caused by maternal lymphocytes in the
relatively immuno suppressed neonate.
2. An innate immunologic response to stop
microbes within hair follicle.
3. An inflammatory response.

51. INCIDENCE/
RISK FACTORS
• Erythema toxicum may appear in 50 percent
or more of all normal newborn infants.
• The condition may be present in the first few
hours of life, generally appears after the first
day, and may last for several days. Although
the condition is harmless, it can be of great
concern to the new parent.

52. SYMPTOMS
• few or several rash of small, yellow-to-white-
coloured papules surrounded by red skin.
• appear on the face and middle of the body,
also be seen on the upper arms and thighs.
• The rash can change rapidly, appearing and
disappearing in different areas over hours to
days.

53. DIAGNOSIS
• Physical Examination is usually
sufficient to make the diagnosis. No
testing is usually needed.

54. MANAGEMENT
• The large red rashes typically
disappear without any treatment or
changes in skin care.

55. PATIENT EDUCATION
• Parents with older children often are not
concerned by the appearance of erythema
toxicum neonatorum, but first-time parents
should be informed in the perinatal period
that an rash is likely to appear within the first
2 weeks of life. They should be reassured
regarding the benign, self-limited,
asymptomatic nature of this and other
eruptions.