This document provides information on several common pediatric dermatologic conditions seen in newborns and children, including: - Epstein pearls, which are cysts that form in the mouth of newborns and disappear within 1-2 weeks. - Stork bites (nevus simplex), a common pink birthmark seen in one third of newborns that usually fades within 18 months. - Erythema toxicum, a self-limiting rash seen in 50% of newborns characterized by small papules. - Milia, tiny white skin-colored bumps on the face of newborns that disappear within weeks without treatment. It

1. Pediatric Dermatology
Dr. J. Steele-Duncan.
Vasha Ramgobin.
Neil Roopchan.
Valmiki Seecheran.
Year V MBBS.

2. Objectives.
• To appreciate and elucidate key features of
common dermatologic conditions seen in
pediatric patients.

4. Epstein Pearls.
• Epstein pearls are whitish-yellow cysts that form on the gums and roof of the
mouth in a newborn baby.
• Epstein pearls occur only in the newborn and are very common. They are seen in
approximately 80% of newborns.
• They are caused during the development of the palate by entrapped epithelium.
• Whitish-yellow nodules appear on the gums or the roof of the mouth in a
newborn. They sometimes look like emerging teeth.
• Examination of the infant confirms that these are Epstein pearls and not teeth
present at birth.
• No treatment is necessary. The condition is harmless.
• Epstein pearls disappear within 1 to 2 weeks of birth.

5. Epstein Pearls.

6. Stork Bite.
• Common type of birthmark seen in a newborn. It is most often temporary.
• The medical term for a stork bite is nevus simplex. It is also called a salmon patch .
• Occurs in about one third of all newborns.
• It is due to a stretching (dilation) of certain blood vessels. It may become darker when the child
cries or the temperature changes. It may fade when pressure is put on it.
• Looks pink and flat. A baby may be born with a stork bite. It may also appear in the first months
of life. It is found on the forehead, eyelids, nose, upper lip, or back of the neck.
• A doctor can diagnose a stork bite simply by looking at it. No tests are needed.
• No treatment is needed. If a stork bite lasts longer than 3 years, it may be removed with a laser
to improve the person's appearance. Most go away completely in about 18 months.

7. Stork Bite.

8. Erythema Toxicum.
• Common, noncancerous skin condition seen in newborns.
• It may appear in 50 percent or more of all normal newborn infants. Its cause is unknown.
• The condition may be present in the first few hours of life, generally appears after the first
day, and may last for several days. It is normally harmless, but can be of concern to the
parent.
• The main symptom is a rash of small, yellow-to-white-colored papules surrounded by red
skin. There may be a few or several papules. They usually appear on the face and middle of
the body, but may also be seen on the upper arms and thighs.
• The rash can change rapidly, appearing and disappearing in different areas over hours to
days.
• The large red splotches typically disappear without any treatment.
• The rash usually clears within 2 weeks. It is usually completely gone by age 4 months.

9. Erythema Toxicum.

10. Milia.
• Milia are tiny white bumps that most commonly appear across a baby's
nose, chin or cheeks.
• Although milia can develop at any age, these tiny white bumps are
common among newborns. In fact, up to half of all babies develop milia.
• Milia develop when tiny skin flakes become trapped in small pockets near
the surface of the skin.
• Milia are easy to see on a baby's skin. No specific testing is needed.
• Milia typically disappear on their own within several weeks, and no
medical treatment is recommended.

11. Milia.

12. Mongolian Blue Spots.
• Mongolian spots are flat, blue, or blue-gray skin markings near the buttocks that appear at
birth or shortly thereafter. It is not cancerous or associated with a disease.
• Common among persons who are of Asian, East Indian, and African descent.
• Mongolian blue spots are sometimes mistaken for bruises. This can raise a question about
possible child abuse.
• The marking are usually: (i) Blue or blue-gray spots on the back, buttocks, base of spine,
shoulders, or other body areas (ii) Flat with irregular shape and unclear edges (iii) Normal in
skin texture (iv) 2 to 8 centimeters wide
• No tests are needed for diagnosis.
• No treatment is necessary or recommended.
• The spots often fade in a few years and are almost always gone by adolescence.

13. Mongolian Blue Spots.

14. Port Wine Stain.
• A port-wine stain is a birthmark in which swollen blood vessels create a
reddish-purplish discoloration of the skin. It occurs in about 3 out of 1,000
people.
• Flat and pink in appearance. As the child gets older, the color may deepen to a
dark red or purplish color. They occur most often on the face . Over time, the
area can become thickened and take on a cobblestone-like appearance.
• Usually diagnosed by looking at the skin. No test required.
• Many treatments have been tried for port-wine stains, including freezing,
surgery, radiation, and tattooing.
• Laser therapy is most successful in eliminating port-wine stains. It is the only
method that can destroy the tiny blood vessels in the skin without significantly
damaging the skin.

15. Port Wine Stain.

16. Strawberry Naevus.
• Haemangioma which occurs in infancy, usually on the
face.
• May be present at birth, or may develop in the first few
weeks after birth.
• They may begin as a small flat red area, but usually
develop into a raised dimpled (strawberry-like) lesion.
• Strawberry naevi are very common, occurring in about
3-5% of babies.
• Usually, no investigations will be required
• Self-limiting.
• Intralesional corticosteroids slow proliferation.
• Those who fail to respond to steroids may respond
to interferon-alfa 2a.

17. Strawberry Naevus.

18. Bullous Impetigo.
• Cutaneous condition that characteristically occurs in the newborn, and is caused
by a bacterial infection, presenting with bullae.
• Bullous Impetigo can cause deaths in fewer than 3% of infected children.
• Staphylococcus aureus, which produces exfoliative toxin A.
• Bullous impetigo can appear around the diaper region, axilla, or neck. The bacteria
causes a toxin to be produced that reduces cell-to-cell stickiness (adhesion),
causing for the top layer of skin (epidermis), and lower layer of skin (dermis) to
separate. Vesicles rapidly enlarge and form the bullae.
• Long term effects: Once the scabs on the bullous have fallen off scarring is
minimal. Possible long term effects are kidney disease.
• After 48 hours the disease is considered no longer contagious assuming the proper
antibiotic treatments have been administered. Antibiotic treatment typically last
7–10 days.
• Antibiotic creams are the preferred treatment for mild cases of impetigo e.g.
Fusidic acid.

19. Bullous Impetigo.

20. Giant Congenital Nevus.
• A congenital pigmented or melanocytic nevus is a dark-colored, often hairy patch of skin. A congenital nevus is present at
birth or appears in the first year of life.
• These marks are thought to be caused by problems that develop as a baby grows in the womb.
• A nevus will appear as dark-colored patch with any of the following:
– (i) Brown to bluish-black color
– (ii) Hair
– (iii) Regular or uneven borders
– (iv) Small satellite areas (maybe)
– (v) Smooth, irregular, or wart-like skin surface
• Nevi are commonly found on the upper or lower parts of the back or the abdomen. They may also be found on other areas.
• A skin biopsy may needed to check for cancer cells.
• An MRI of the brain might be done if the nevus is over the spine.
• Surgery to remove the nevus is be done if possible. Skin grafting is also done when needed.
• Treatment may be helpful if the birthmark causes emotional problems because of how it looks.
• Skin cancer may develop in about 1 in 6 people with large or giant nevi.

21. Giant Congenital Nevus.

22. Rashes of Infancy.

23. Diaper Rash.
• A diaper rash is a skin problem that develops in the area beneath an infant's diaper.
• Diaper rashes are common in babies between 4 and 15 months old.
• Diaper rashes caused by infection with a yeast (fungus) called Candida are very common in
children. Candida grows best in warm, moist places, such as under a diaper.
• Features.
– (i) Bright red rash that gets bigger
– (ii) Very red and scaly areas on the scrotum and penis in boys
– (iii) Red or scaly areas on the labia and vagina in girls (iii) Pimples, blisters, ulcers, large bumps, or sores filled
with pus
– (iv) Smaller red patches (called satellite lesions) that grow and blend in with the other patches
– (v) Older infants may scratch when the diaper is removed.
• Diaper rashes usually do not spread beyond the edge of the diaper.
• A KOH test can confirm if it is Candida.
• Hygienic treatment.
• Nystatin, miconazole, clotrimazole, and ketaconazole are commonly used medicines for yeast
diaper rashes

24. Diaper Rash.

25. Cradle Cap.
• Cradle cap is an oily, yellow scaling or crusting on a baby's scalp. It is
common in babies and is easily treated. Cradle cap is not a part of any
illness and does not imply that a baby is not being well cared for.
• Cradle cap is the normal build-up of sticky skin oils, scales, and sloughed
skin cells.
• Self-limiting.
• An hour before shampooing, rub your baby's scalp with baby oil, mineral
oil, or petroleum jelly to help lift the crusts and loosen scales.
• Scrub scalp with a gentle scrub.

26. Cradle Cap

27. Infant Acne Vulgaris.
Baby acne is usually seen on the cheeks, chin, and forehead.
It can be present at birth but usually develops around 3 to 4 weeks of
age.
Baby acne occurs when hormonal changes in the body stimulate oil
glands in the baby's skin. T
he condition can look worse when the baby is crying or fussy, or any
other instance that increases blood flow to the skin.
acne is harmless and usually resolves on its own within several weeks.

28. Infant Acne Vulgaris

29. Atopic dermatitis.
• Dermatitis.
• Inflammatory, relapsing, non contagious and
itcy.
• Dry and scaly – crack, swell and crust.
• History of atopy.
• Moisturisers.
• Topical corticosteroids – hydrocortisone.
• Lukewarm baths.

30. Atopic dermatitis.

31. Viral Infections

32. Chickenpox.
• Highly contagious.
• Varicella zoster. – Vesicular skin rash.
• Itchy, raw pockmarks.
• Vesicular fluid can be examined by a Tzanck
smear or Direct fluorescent antibody.
• Quarantine measurements.
• Varicella zoster vaccine.
• Anti-histamine & calamine lotion (zinc oxide).
• Acyclovir can be helpful – reduces the duration of
condition.

33. Chickenpox.

34. Measles.
• Infection of respiratory system, immune system
and skin.
• Paramyxovirus.
• Maculopapular, erythematous.
• Koplik’s spots. – diagnostic.
• +ve measles IgM antibodies.
• MMR vaccine.
• Self-limiting – supportive care.
• Complications – pneumonia, bronchitis,
encephalitis and ear infections.

35. Measles.

36. Viral Warts.
• These are caused by the HPV.
• Common in Children, usually on the fingers
and soles.
• Most disappear spontaneously over a few
months or years. Treatment is only indicated if
the lesion is painful or for cosmetic reasons.
• Treatment- salicylic acid and lactic acid paint
or glutaraldehyde can be used.
• Cryotherapy can also be used.

37. Viral Warts.

38. Molluscum Contagiosum.
• This is caused by the poxvirus.
• The lesions are small, skin coloured, pearly
papules with central umbilication.
• Lesions are often widespread but tend to
disappear spontaneously within a year.
• If necessary a topical antibacterial can be
applied to prevent or treat secondary bacterial
infections.
• Cryotherapy can be used in older children.

39. Molluscum Contagiosum.

40. Fungal Infections

41. Tinea Capitis
• Tinea capitis is a fungal infection of the scalp. It is also called ringworm of the scalp.
• Tinea capitis is caused by mold-like fungi called dermatophytes. The fungi grow well in warm, moist areas.
• Tinea capitis or ringworm can spread easilyYou can catch tinea capitis if you come into direct contact with
an area of ringworm on someone else's body. You can also get it if you touch items such as combs, hats, or
clothing that have been used by someone with ringworm. The infection can also be spread by pets.
• Areas that are infected appear bald with small black dots, due to hair that has broken off. You may have
round, scaly areas of skin that are red or swollen (inflamed). You may also have pus-filled sores called
kerions.You may have a low-grade fever of around 100 - 101 °F or swollen lymph nodes in the neck.
• There is almost always itching of the scalp.Tinea capitis may cause hair loss and lasting scars.
• A special lamp called a Wood's lamp test can help diagnose a fungal scalp infection.
• Griseofulvin, terbinafine, and itraconazole are the types of medicine used to treat this condition.You will
need to take the medicine for 4 - 8 weeks.
• Wash with a medicated shampoo, such as one that contains ketoconazole or selenium sulfide.

42. Tinea Capitis

43. Parasitic Infections

44. Scabies.
• Sarcoptes scabei.
• Parasite that burrows under host’s skin.
• Intense itching – allergic reaction to mite
proteins.
• Hands, feet, wrists, elbows, back, buttocks and
external genitals.
• Dermatitis, syphilis, urticaria.
• Topical permethrin or oral ivermectin.

45. Scabies.

46. Pediculosis Capitis
• Head lice are tiny insects that live on the skin covering the top of your head (scalp). Head lice may also be found in eyebrows and eyelashes. Lice can
be spread by close contact with other people.
• Head lice infect hair on the head. Tiny eggs on the hair look like flakes of dandruff. However, instead of flaking off the scalp, they stay put.Head lice
can live up to 30 days on a human. Their eggs can live for more than 2 weeks.Head lice spread easily, particularly among school children. Head lice
are more common in close, overcrowded living conditions.
• You can get head lice if you:
• Come in close contact with a person who has lice or in contact with a surface that has it. Eg brushes or towels.
• Symptoms of head lice include: Very bad itching of the scalp
• Small, red bumps on the scalp, neck, and shoulders (bumps may become crusty and ooze)
• Tiny white specks (eggs, or nits) on the bottom of each hair that are hard to get off
• Head lice can be hard to see. You need to look closely. Use disposable gloves and look at the person's head under a bright light. Full sun or the
brightest lights in your home during daylight hours work well. A magnifying glass can help.
•
• Treatment
• Lotions and shampoos containing 1% permethrin (Nix) often work well. If these products do not work, a doctor can give you a prescription for
stronger medicine.
• To use the medicine shampoo:
• Rinse and dry the hair.Apply the medicine to the hair and scalpWait 10 minutes, then rinse it off.Check for lice and nits again in 8 -12 hours.
• You also need to get rid of the lice eggs (nits) to keep lice from coming back.
• Remove the eggs with a nit comb. Before doing this, rub olive oil in the hair or run the metal comb through beeswax. This helps make the nits easier
to remove.
• When treating lice, wash all clothes and bed linens in hot water with detergent. This also helps prevent head lice from spreading to others during the
short period when head lice can survive off the human body.

47. Pediculosis Capitis

48. Other Childhood Skin Disorders

49. Psoriasis
• Rarely presents before age 2yr
• The guttate type is common in children and
follows a streptococcal or viral infection.
• Leisions are small, raindrop like, round or oval
erythematous scaly patches on the trunk or
upper limbs.
• It usually resolves over 3-4 months, with
reoccurrence within 3-5 yrs.
• Usually, this type of psoriasis goes away without
treatment.

50. Guttate Psoriasis

51. Pityriasis rosea.
• ‘’Herald patch’’ lesion.
• Pink, flaky, oval shaped rash – torso.
• Cause not defined - Viral infection – RTI.
• Lyme disease, ringworm, discoid eczema, drug
eruptions.
• Biopsy shows extravasated erythrocytes within
dermal papillae within the dermis.
• Oral antihistamines and steroids.
• Direct sunlight/ UV therapy.

52. Pityriasis rosea.

53. Granuloma Annulare
• Granuloma annulare is a chronic skin disease consisting of a rash with reddish bumps arranged in a circle
or ring.
• Granuloma annulare most often affects children and young adults. It is slightly more common in females.
• The condition is usually seen in otherwise healthy people. Occasionally, it may be associated with diabetes
or thyroid disease. Its causes is unknown.
• Granuloma annulare usually causes no other symptoms, but the rash may be slightly itchy.
• Patients usually notice a ring of small, firm bumps (papules) over the backs of the forearms, hands, or feet.
Occasionally, they may find a number of rings.
• Rarely, granuloma annulare may appear as a firm nodule under the skin of the arms or legs. In some cases,
the rash may spread all over the body.
• Your health care provider may think you have a fungal infection when looking at your skin. A skin scraping
and KOH test can be used to tell the difference between granuloma annulare and a fungal infection.
• You may also need a skin biopsy to confirm the diagnosis of granuloma annulare.
• Because granuloma annulare usually causes no symptoms, you may not need treatment except for
cosmetic reasons.
• Very strong steroid creams or ointments are sometimes used to clear up the rash more quickly. Injections
of steroids directly into the rings may also be effective. Some health care providers may choose to freeze
the bumps with liquid nitrogen.

54. Granuloma Annulare

55. Rashes and Systemic Disease

56. Urticaria
• Hives are raised, often itchy, red bumps (welts) on the surface of the skin. They are usually an allergic reaction to food or
medicine.
• When you have an allergic reaction to a substance, your body releases histamine and other chemicals into the blood. This
causes itching, swelling, and other symptoms. Hives are a common reaction. Persons with other allergies, such as hay fever,
often get hives.
• When swelling or welts occur around the face, especially the lips and eyes, it is called angioedema. Swelling can also occur
around your hands, feet, and throat. There are many triggers for hives.
• Itching may present. Swelling of the surface of the skin into red- or skin-colored welts (called wheals) with clearly defined
edges.Wheals may get bigger, spread, and join together to form larger areas of flat, raised skin. Wheals can also change
shape, disappear, and reappear within minutes or hours.You know you have hives when you press the center of a wheal, it
turns white. This is called blanching.
• Your doctor can tell if you have hives by looking at your skin. If you have a history of an allergy, then the diagnosis is even
more obvious.
• Treatment may not be needed if the hives are mild. They may disappear on their own. To reduce itching andswelling:
• Do not wear tight-fitting clothing, which can irritate the area.
• Your health care provider may suggest that you take an antihistamine such as diphenhydramine (Benadryl).
• If your reaction is severe, especially if the swelling involves your throat, you may require an emergency shot of epinephrine
(adrenaline) or a steroid. Hives in the throat can block your airway, making it difficult to breathe.

57. Urticaria

58. Stevens-Johnson syndrome.
• Toxic epidermal necrolysis.
• Widespread, confluent, macules or flat vesicles/bullae – torso.
• Epidermis separates from dermis.
• Hypersensitivity complex that affects skin and mucous membranes.
• Disorder of the immune system – drugs (sulfonamides, penicillin,
phenytoin, barbiturates) or infections ( HSV, AIDS, EBV, Coxsackie,
Hepatitis, Mumps, Group A Strep, Diptheria, Brucellosis,
Mycoplasma, Histoplasmosis).
• Supportive care.
• Corticosteroids – controversial.
• IVIG may be useful.

59. Stevens-Johnson syndrome.

60. Erythema nodosum.
• Inflammation of the fat cells under the skin.
• Tender red nodules or lumps.
• 12-20 years.
• Idiopathic (up to 50%), Infection (Streptococcal, Mycoplasma, TB),
Autoimmune (IBD, Sarcoidosis), Medications (Sulfoamides,
Pencillins).
• Delayed hypersensitivity due to variety of antigens.
• Biospy – microscopically – radial granulomas.
• ESR, CRP, Anti-streptolysis (ASO) titres, throat culture, urinalysis,
tuberculin test.
• Self-limiting (3-6 weeks).
• Bed rest, leg elevation, compressions, wet dressings and NSAIDS.
• Potassium iodide for persistent lesions.

61. Erythema nodosum.

62. Erythema multiforme.
• Mediated by deposition of IgM in the superficial
microvasculature of the skin and mucous
membranes – infection/ drug exposure.
• Infections: Streptococci, Legionellosis, N.
meningitidis, mycobacterium, mycoplasma.
• Viral: HSV.
• Drug Reactions: Sulphaoamdies, pencillin,
phenytoin, aspirin.
• Self limiting and requires no treatment.
• Glucorticoid therapy – controversial.

63. Erythema multiforme.

64. Thank you.