CHILDHOOD DERMATOLOGYCHILDHOOD DERMATOLOGY

Dr. SATAM ALSHAMMARIDr. SATAM ALSHAMMARI

ASSISTANT PROFESSOR OF PEDIATRIC MEDICINE ASSISTANT PROFESSOR OF PEDIATRIC MEDICINE CONSULTANT OF PEDIATRIC PULMONOLOGY CONSULTANT OF PEDIATRIC PULMONOLOGY

MOH.KSAMOH.KSA

IntroductionIntroduction

-There are more than 3000 dermatologic -There are more than 3000 dermatologic diagnosesdiagnoses

-Approximately 5% of ED visits are for a -Approximately 5% of ED visits are for a dermatologic complaintdermatologic complaint

The The structurestructure and and functionfunction of the of the skinskin

EpidermisEpidermis DermisDermis Subcutaneous tissueSubcutaneous tissue

FunctionsFunctions Thermal control : regulates body temperature Thermal control : regulates body temperature Excretion : by regulating the volume and chemical content of Excretion : by regulating the volume and chemical content of

sweat.sweat. Makes vitamin D Makes vitamin D Immunity (Immunity (Defenses)Defenses) sensationsensation:: the widespread of the millions of different somatic the widespread of the millions of different somatic

sensory receptors that detect stimuli.sensory receptors that detect stimuli.

HistoryHistory AgeAge OnsetOnset Is the rash raised (papular) or flat (macular)?Is the rash raised (papular) or flat (macular)? Is the rash red?Is the rash red? Is the rash scaly?Is the rash scaly? Is the rash itchy?Is the rash itchy? When did the rash start?When did the rash start? Where did the rash start, and how did it spread?Where did the rash start, and how did it spread? DurationDuration Body locationBody location Any change of individual lesionsAny change of individual lesions Did the patient present with other symptoms Did the patient present with other symptoms

(Fever (Fever ,Pruritus ,Conjunctivitis, Swollen extremities, Sore throat, Abdominal pain),Pruritus ,Conjunctivitis, Swollen extremities, Sore throat, Abdominal pain) Involvement of palms and soles, mucous membranes, conjunctivaInvolvement of palms and soles, mucous membranes, conjunctiva Was the lesion caused by trauma/insect bite?Was the lesion caused by trauma/insect bite? Is there any associated discharge or odour?Is there any associated discharge or odour? What makes the skin condition better or worse?What makes the skin condition better or worse?

History (cont)History (cont)

Past Medical History Past Medical History (asthma, eczema) Family Medical History: Has the patient had close contact

with someone else with the same symptoms? Social History : Has the patient travelled recently?,

animals contact Immunizations History Allergies History MedicationsMedications History: Has the patient been exposed to new

topical applications

Physical ExamPhysical Exam General Appearance: (well, uncomfortable, toxic)General Appearance: (well, uncomfortable, toxic) Vital signs: (pulse, respiration, temperature, etc)Vital signs: (pulse, respiration, temperature, etc) Skin exam: (entire skin should be inspected, including mucous membranes, Skin exam: (entire skin should be inspected, including mucous membranes,

genital/anal regions).genital/anal regions). Remember SCALDA to describe a lesionRemember SCALDA to describe a lesion44

S Site/Size/Shape/texture (centripetal,centrifugal)(morbilliform,varicelliform)S Site/Size/Shape/texture (centripetal,centrifugal)(morbilliform,varicelliform) C Colour (Erythematous,Hypopigmented,Hyperpigmented,Depigmented)C Colour (Erythematous,Hypopigmented,Hyperpigmented,Depigmented) A Arrangement (Solitary, Grouped, Linear)A Arrangement (Solitary, Grouped, Linear) L Lesion type (primary, secondary)L Lesion type (primary, secondary) D Distribution(eg.Symmetrical, dermatomal,extensor surfaces,intertriginous D Distribution(eg.Symmetrical, dermatomal,extensor surfaces,intertriginous (between body folds), dependent areas, sun-exposed skin)(between body folds), dependent areas, sun-exposed skin) A Always check involvement of:A Always check involvement of:

nailsnails hair hair mucous membranesmucous membranes

feel the lesion raised or flat? wet or dry ,what dose it feel like? blanchable feel the lesion raised or flat? wet or dry ,what dose it feel like? blanchable

TerminologyTerminology

Macules, Papules, NodulesMacules, Papules, Nodules Patches and PlaquesPatches and Plaques Vesicles, Pustules, BullaeVesicles, Pustules, Bullae Erosions Erosions Ulcerations and excoriationsUlcerations and excoriations

Primary &Secondary LesionsPrimary &Secondary Lesions

Primary LesionsPrimary Lesions: : Those lesions that are the direct result of a pathologic Those lesions that are the direct result of a pathologic

processprocess

Secondary LesionsSecondary Lesions: : Lesions that are the result of alteration of a primary lesion Lesions that are the result of alteration of a primary lesion

(e.g. rubbing, scratching, infection)(e.g. rubbing, scratching, infection)

Common Primary LesionsCommon Primary Lesions

Profile <1 cm >1 cm

Flat Macule Patch

Elevated Papule Plaque

Palpable, deep Nodule Tumor

Fluid filled Vesicle Bulla

Common Primary LesionsCommon Primary Lesions

Common Primary LesionsCommon Primary Lesions

hemorrhages into the skin. hemorrhages into the skin. Not blanch on pressureNot blanch on pressure

petechiae (< 1-2 mm )petechiae (< 1-2 mm )Purpura spots (3-10 mm in diameter)Purpura spots (3-10 mm in diameter) palpable: vasculiticpalpable: vasculitic HSPHSP meningococcaemiameningococcaemia non-palpable: ITPnon-palpable: ITPecchymoses (>1 cm bruises). ecchymoses (>1 cm bruises).

Telangiectasia Telangiectasia is the name given to prominent cutaneous blood vessels. is the name given to prominent cutaneous blood vessels.

CommonCommon Primary LesionsPrimary Lesions

Secondary skin lesionsSecondary skin lesions• Scale:Scale: Flakes of keratin that can be fine or coarse; loose or Flakes of keratin that can be fine or coarse; loose or

adherent. adherent. Example: Dandruff Example: Dandruff

• Lichenification: Lichenification: thickened and rough epidermis with accentuation of skin thickened and rough epidermis with accentuation of skin

markings.markings.

• Excoriation:Excoriation: Traumatized or abraded skin, usually due to scratching or Traumatized or abraded skin, usually due to scratching or

rubbing.rubbing.

Secondary skin lesionsSecondary skin lesions

FissureFissure A fissure is a thin crack within epidermis or epithelium, A fissure is a thin crack within epidermis or epithelium, and is due to excessive drynessand is due to excessive dryness

Ulcer Ulcer Deep open wound extending into the dermis or Deep open wound extending into the dermis or subcutaneous tissue. May lead to scar formation. subcutaneous tissue. May lead to scar formation.

ErosionErosion Superficial open wound involving only epidermis or Superficial open wound involving only epidermis or mucosa. Does not extend into the underlying dermis, so mucosa. Does not extend into the underlying dermis, so healing occurs without scar formationhealing occurs without scar formation

SecondarySecondary skin lesionsskin lesions

Causes of maculopapular rashCauses of maculopapular rash

Remember blanch on pressureRemember blanch on pressureMeasles Measles Rubella (macular)Rubella (macular)Erythema infectiosum (fifth’s disease)Erythema infectiosum (fifth’s disease)Roseola HHV6/7 Roseola HHV6/7 Enrerovirus (coxsackie,echo,polio viruses) Enrerovirus (coxsackie,echo,polio viruses) -more 90% aysymptomatic-more 90% aysymptomatic -faecal oral route-faecal oral route -effective vaccine for polio-effective vaccine for polioScarlet feverScarlet feverKawasaki diseaseKawasaki diseaseDurgsDurgs

MeaslesMeasles

MeaslesMeasles

• Incubation period 8-14 daysIncubation period 8-14 days• Prodromal illness 3-4 days Fever, conjunctivitis, Prodromal illness 3-4 days Fever, conjunctivitis,

runny nose & coughrunny nose & cough• Koplik spots Koplik spots -white spot on buccal mucosa -white spot on buccal mucosa - 24-48 hours before rash- 24-48 hours before rash - pathognomonic- pathognomonic -difficult to see -difficult to see

Rash:Rash:◦ begins on face & behind ears begins on face & behind ears ◦ usually with onset high feverusually with onset high fever◦ spreads to bodyspreads to body◦ Usually spares palms/solesUsually spares palms/soles

MeaslesMeasles

ComplicationsComplications◦ Otitis mediaOtitis media◦ Febrile convulsionFebrile convulsion◦ BronchopneumoniaBronchopneumonia◦ Encephalitis (1/5000)Encephalitis (1/5000)◦ Myocarditis/pericarditis(ECG abnormalities)Myocarditis/pericarditis(ECG abnormalities)◦ SSPE (rare) after years SSPE (rare) after years ◦ Other hepatitis corneal ulcerationOther hepatitis corneal ulceration

MeaslesMeasles

Diagnosis Diagnosis IgG and IgM serologies, acute and convalescent titersIgG and IgM serologies, acute and convalescent titers

Treatment Symptomatic. Treatment Symptomatic. Antipyretics.Antipyretics. In severe disease, vitamin AIn severe disease, vitamin A in immunocompromised ribavirin in immunocompromised ribavirin Prevention - immunization at 1yearPrevention - immunization at 1year -10% failure of vaccine-10% failure of vaccine -at school age -at school age

RubellaRubella Mild disease Mild disease IP:14-21 daysIP:14-21 days Spread by respiratory routeSpread by respiratory route s/ss/s Fever low grade or none at allFever low grade or none at all Maculopapular rash first sign on face (Fade in 3-5 days)Maculopapular rash first sign on face (Fade in 3-5 days) LAP especially suboccipital and postauricularLAP especially suboccipital and postauricular Complication are rare Complication are rare Arthritis,Arthritis, Encephalitis,Encephalitis, Myocarditis,Myocarditis, ThrombocytopeniaThrombocytopenia Diagnosis by serologyDiagnosis by serology No effective anti viral No effective anti viral

Erythema InfectiosumErythema InfectiosumFifth DiseaseFifth Disease

known as ‘slapped cheek disease’ or 5known as ‘slapped cheek disease’ or 5thth disease diseaseFeaturesFeatures

◦ Parvovirus B19Parvovirus B19◦ Incubation period 4-14 daysIncubation period 4-14 days◦ Mostly preschool ageMostly preschool age◦ Fever in 15-30% for 1-2 daysFever in 15-30% for 1-2 days◦ Slapped cheek appearanceSlapped cheek appearance◦ Generalised maculopapular rash for 7-10 daysGeneralised maculopapular rash for 7-10 days◦ transmission is via respiratory secretiontransmission is via respiratory secretion

Management Management ◦ SupportiveSupportive

RoseolaRoseola

Roseola InfantumRoseola InfantumHuman herpesvirus 6Human herpesvirus 6Most Children are infected by 2 yearsMost Children are infected by 2 yearsAbrupt onset of high fever for 3 daysAbrupt onset of high fever for 3 daysFollowed by generalized macular Rash Followed by generalized macular Rash

which appears as the fever wanewhich appears as the fever wane Is common cause of Febrile seizuresIs common cause of Febrile seizuresRarely associated aseptic meningitis, Rarely associated aseptic meningitis,

hepatitis. hepatitis.

Scarlet feverScarlet feverCauseCause

◦Group A beta-haemolytic StreptococcusGroup A beta-haemolytic StreptococcusFeaturesFeatures

◦ Incubation 2-4 daysIncubation 2-4 days◦Bright red blanching rash (sandpaper)Bright red blanching rash (sandpaper)

First in axilae/groins, then widespreadFirst in axilae/groins, then widespread◦Red face with circumoral pallor Red face with circumoral pallor ◦Strawberry tongue (white then red)Strawberry tongue (white then red)

TreatmentTreatment◦Symptomatic relief Symptomatic relief ◦Penicillin V 7-10 daysPenicillin V 7-10 days

Kawasaki DiseaseKawasaki Disease

Affect children 6 months-4 yearsAffect children 6 months-4 yearsCause unknownCause unknownClinical diagnosisClinical diagnosisVasculitis affecting small and medium size Vasculitis affecting small and medium size

vesselsvesselsAffect coronary arteries about one thirdAffect coronary arteries about one thirdMortality 1%Mortality 1%

Kawasaki DiseaseKawasaki DiseaseDiagnostic CriteriaDiagnostic Criteria

Fever for 5 or more daysFever for 5 or more daysPresence of 4 of the following:Presence of 4 of the following:

1.1. Bilateral conjunctival injectionBilateral conjunctival injection2.2. Changes in the oropharyngeal mucous membranesChanges in the oropharyngeal mucous membranes3.3. Changes of the peripheral extremities Changes of the peripheral extremities 4.4. Rash Rash 5.5. Cervical adenopathyCervical adenopathy

Illness can’t be explained by other diseaseIllness can’t be explained by other disease

Kawasaki DiseaseKawasaki DiseaseLab FeaturesLab Features

WBCWBC ESR, positive CRPESR, positive CRP Mild Mild transaminases transaminases albuminalbumin Sterile pyuria, aseptic meningitisSterile pyuria, aseptic meningitis platelets by day 10-14platelets by day 10-14

Kawasaki DiseaseKawasaki DiseaseTreatmentTreatment

IV Ig 2 g/kg as single doseIV Ig 2 g/kg as single dose◦ Expect rapid resolution of feverExpect rapid resolution of fever◦ Decrease coronary artery aneurysms from 20% to < 5%Decrease coronary artery aneurysms from 20% to < 5%

ASA - reduce risk of thrombosis ASA - reduce risk of thrombosis - Repeat echocardiogram at 6 weeks- Repeat echocardiogram at 6 weeks

Causes of vesicular rashCauses of vesicular rash

Chickenpox Chickenpox ShinglesShinglesHerpes simplexHerpes simplexHand foot mouth diseseHand foot mouth disese

ChickenpoxChickenpoxCauses Causes

◦Varicella zoster virusVaricella zoster virusFeaturesFeatures

◦Very commonVery common◦ Incubation period 14-21 daysIncubation period 14-21 days◦Prodrome mild fever & malaiseProdrome mild fever & malaise◦Vesicles on erythematous baseVesicles on erythematous base

Change to maculeChange to macule→papule→vesicle→crust→papule→vesicle→crust Last 3-4 daysLast 3-4 days Mainly on trunkMainly on trunk Can appear in mouth/genital regionCan appear in mouth/genital region Usually no scarringUsually no scarring

◦ Infectious for 1-2 days before rash & 5 Infectious for 1-2 days before rash & 5 days afterwardsdays afterwards

ChickenpoxChickenpox ComplicationsComplications

◦ Always look carefully at child if fever persists Always look carefully at child if fever persists > 5 days after appearance rash> 5 days after appearance rash ?secondary bacterial infection ?secondary bacterial infection

staphlococcal,strptococcalstaphlococcal,strptococcal toxic shock syndrometoxic shock syndrome necrotising fascitisnecrotising fascitis

◦ PneumonitisPneumonitis◦ EncephalitisEncephalitis◦ Cerebellar ataxia(cerebelitis)Cerebellar ataxia(cerebelitis)◦ Eczema herpeticumEczema herpeticum

ManagementManagement◦ Supportive – fluids/paracetamol/calamine lotionSupportive – fluids/paracetamol/calamine lotion◦ Admit if complications suspectedAdmit if complications suspected

Herpes SimplexHerpes Simplex

Gingivostomatitis most common 1º Gingivostomatitis most common 1º infection in childreninfection in children

10 months – 3 years10 months – 3 yearsThere are Vesicular lesion on lips, gums , There are Vesicular lesion on lips, gums ,

ant surface of tonge and hard palate ant surface of tonge and hard palate progress to painful ulceration and bleedingprogress to painful ulceration and bleedingHigh Fever, irritability, miserable childHigh Fever, irritability, miserable childEating and drinking are painful lead to Eating and drinking are painful lead to

dehydrationdehydrationTreatment: supportiveTreatment: supportive severe (IVF,aciclovir)severe (IVF,aciclovir)

Herpetic WhitlowHerpetic Whitlow

Lesions on thumb usually 2Lesions on thumb usually 2° to ° to autoinoculationautoinoculation

Group, thick-walled vesicles on Group, thick-walled vesicles on erythematous baseerythematous base

PainfulPainfulTend to coalesce, ulcerate and then crustTend to coalesce, ulcerate and then crustMay require topical or oral acyclovirMay require topical or oral acyclovir

Coxsackie VirusCoxsackie VirusHand-Foot-and-MouthHand-Foot-and-Mouth

Painful, shallow, yellow ulcers Painful, shallow, yellow ulcers Found on buccal mucosa, tongue, soft Found on buccal mucosa, tongue, soft

palate, uvula and anterior tonsillar pillarspalate, uvula and anterior tonsillar pillarsExanthem involves palmar, plantar and Exanthem involves palmar, plantar and

interdigital surfaces of the hands and feet interdigital surfaces of the hands and feet +/- buttocks+/- buttocks

CauseCause◦Coxsackie viral infectionCoxsackie viral infection◦Can be complicated by aseptic meningitisCan be complicated by aseptic meningitis

ManagementManagement◦SupportiveSupportive

peticheal &purpuric rashpeticheal &purpuric rash

hemorrhages into the skin. hemorrhages into the skin. Not blanch on pressureNot blanch on pressure

petechiae (< 1-2 mm )petechiae (< 1-2 mm )Purpura spots (3-10 mm in diameter)Purpura spots (3-10 mm in diameter) palpable: vasculiticpalpable: vasculitic non-palpable: ITPnon-palpable: ITPecchymoses (>1 cm bruises). ecchymoses (>1 cm bruises).

Causes of purpuric & peticheal Causes of purpuric & peticheal rashrash

Meningococcal infection Meningococcal infection Idiopathic thrombocytopenia purpura Idiopathic thrombocytopenia purpura Henoch-Schonlein Purpura (HSP) Henoch-Schonlein Purpura (HSP) Viruses - particularly enterovirus infectionViruses - particularly enterovirus infectionLeukemiaLeukemiaExcessive vomitingExcessive vomitingExtreme cryingExtreme cryingViolent coughingViolent coughingTrauma or injuryTrauma or injuryDefect in blood clotting factorDefect in blood clotting factorDurgs Durgs

MeningococcemiaMeningococcemia

Caused by Neisseria meningitidesCaused by Neisseria meningitidesAlthough there are vaccines against groups Although there are vaccines against groups

A,C A,C No vaccine against group BNo vaccine against group BMeningococcal septicemia can kill children Meningococcal septicemia can kill children

in hoursin hoursAny febrile child with purpuric rash should Any febrile child with purpuric rash should

given given treatment immediatelytreatment immediatelyPetechial rash develops in 75% of casesPetechial rash develops in 75% of casesFever, rash, hypotension, shock, DICFever, rash, hypotension, shock, DIC

Henoch-Schonlein PurpuraHenoch-Schonlein Purpura

Usually occurs 3-10 years Usually occurs 3-10 years More common in boysMore common in boysOften Preceded by URTIOften Preceded by URTI

Clinical featuresClinical features Skin rash:Skin rash: Palpable purpura of extremitiesPalpable purpura of extremities cornerstone of the diagnosiscornerstone of the diagnosis Arthralgia or non-migratory arthritisArthralgia or non-migratory arthritis

◦ No permanent deformitiesNo permanent deformities◦ Mostly ankles and kneesMostly ankles and knees◦ Periarticular oedemaPeriarticular oedema

Abdominal painAbdominal pain◦ May develop intussusceptionMay develop intussusception

Renal involvementRenal involvement◦ Hematuria, hypertension, renal failure,NSHematuria, hypertension, renal failure,NS

MACULOPAPULAR RASHMACULOPAPULAR RASH

MACULOPAPULAR RASHMACULOPAPULAR RASH

Viral Exanthem - Measles, Rubella, Fifths, etc, self-limiting, Viral Exanthem - Measles, Rubella, Fifths, etc, self-limiting, supportive caresupportive care

Lyme Disease - Tick bite, erythema migrans, arthralgias, Lyme Disease - Tick bite, erythema migrans, arthralgias, headache, doxycyclineheadache, doxycycline

Pityriasis - scaly lesions, herald patch, Christmas tree pattern, Pityriasis - scaly lesions, herald patch, Christmas tree pattern, treatment includes: UV light, moisturizing lotion, oatmeal treatment includes: UV light, moisturizing lotion, oatmeal bathes, antihistaminesbathes, antihistamines

Stevens-Johnson Syndrome - mucosal involvement, remove Stevens-Johnson Syndrome - mucosal involvement, remove drug/treat illness, supportive therapy, hospital admissiondrug/treat illness, supportive therapy, hospital admission

EM = Erythema Multiforme - treat illness/stop drug, EM = Erythema Multiforme - treat illness/stop drug, supportive care, topical steroids and outpatient follow-up for supportive care, topical steroids and outpatient follow-up for minor casesminor cases

Meningiococcemia - ill appearing, mental status change, Meningiococcemia - ill appearing, mental status change, lumbar puncture,lumbar puncture,

ceftriaxone, isolation, treat close contacts, hospital admissionceftriaxone, isolation, treat close contacts, hospital admission RMSF = Rocky Mountain Spotted Fever - tick bite, endemic RMSF = Rocky Mountain Spotted Fever - tick bite, endemic

area, headache, arthralgias, doxycyclinearea, headache, arthralgias, doxycycline Scabies - excoriated burrows, itches worse at night, Scabies - excoriated burrows, itches worse at night,

permethrinpermethrin

PETECHIAL/PURPURIC RASHPETECHIAL/PURPURIC RASH

PETECHIAL/PURPURIC RASHPETECHIAL/PURPURIC RASH Meningiococcemia - ill appearing, mental status change, Meningiococcemia - ill appearing, mental status change,

lumbar puncture,lumbar puncture, ceftriaxone, isolation, treat close contacts, admissionceftriaxone, isolation, treat close contacts, admission Disseminated GC= Gonococcemia - purple vesicles, sparse, Disseminated GC= Gonococcemia - purple vesicles, sparse,

peripheral, associated urethritis/cervicitis/septic arthritis, peripheral, associated urethritis/cervicitis/septic arthritis, ceftriaxoneceftriaxone

Endocarditis – new murmur, vegetations on valves, positive Endocarditis – new murmur, vegetations on valves, positive blood culturesblood cultures

RMSF = Rocky Mountain Spotted Fever - tick bite, endemic RMSF = Rocky Mountain Spotted Fever - tick bite, endemic area, headache, arthralgias, doxycyclinearea, headache, arthralgias, doxycycline

HSP = Henoch Schonlein Purpura – children, associated HSP = Henoch Schonlein Purpura – children, associated arthralgias, hematuria andGI symptoms, supportive therapyarthralgias, hematuria andGI symptoms, supportive therapy

TTP= Thrombotic Thrombocytopenic Purpura - low platelet TTP= Thrombotic Thrombocytopenic Purpura - low platelet count, fever, neuro sx, hemolytic anemia, renal failure, ICU count, fever, neuro sx, hemolytic anemia, renal failure, ICU admission, treat underlying cause,admission, treat underlying cause,

plasmapheresis, splenectomy, selective transfusion, NO plasmapheresis, splenectomy, selective transfusion, NO plateletsplatelets

Vasculitis – treat the underlying process if possible, may Vasculitis – treat the underlying process if possible, may require steroidsrequire steroids

ITP – Idiopathic Thrombocytopenic Purpura - transfuse ITP – Idiopathic Thrombocytopenic Purpura - transfuse platelets if bleeding or less than 5000/mm3 – 10000/mm3, platelets if bleeding or less than 5000/mm3 – 10000/mm3, emergent Hematology consultationemergent Hematology consultation

VESICULO-BULLOUS RASHVESICULO-BULLOUS RASH

VESICULO-BULLOUS RASHVESICULO-BULLOUS RASH Varicella/Chicken Pox – excoriated lesions in multiple stages, Varicella/Chicken Pox – excoriated lesions in multiple stages,

starts centrally,isolate, rare hospitalization, symptomatic starts centrally,isolate, rare hospitalization, symptomatic treatment, antipyretics (not Aspirin)treatment, antipyretics (not Aspirin)

Small Pox – all lesions in one stage, more peripheral distribution, Small Pox – all lesions in one stage, more peripheral distribution, isolate, notify office of public health and CDCisolate, notify office of public health and CDC

Disseminated GC= Gonococcemia - purple vesicles, sparce, Disseminated GC= Gonococcemia - purple vesicles, sparce, peripheral, associated urethritis/cervicitis/septic arthritis, peripheral, associated urethritis/cervicitis/septic arthritis, ceftriaxoneceftriaxone

Purpura Fulminans/DIC = Disseminated Intervascular Coagulation - Purpura Fulminans/DIC = Disseminated Intervascular Coagulation - treat the underlying cause, fresh frozen plasma, platelet treat the underlying cause, fresh frozen plasma, platelet transfusions, ICU admissiontransfusions, ICU admission

Necrotizing Fasciitis – surgical emergency, debridement, IV anti-Necrotizing Fasciitis – surgical emergency, debridement, IV anti-streptococcal broad spectrum antibiotic, hyperbaric oxygen streptococcal broad spectrum antibiotic, hyperbaric oxygen therapytherapy

Hand, Foot and Mouth Disease – children, vesicles on palms, soles Hand, Foot and Mouth Disease – children, vesicles on palms, soles and in mouth,self-limited, symptomatic treatmentand in mouth,self-limited, symptomatic treatment

Bullous Pemphigus -chronic autoimmune blistering, elderly, Bullous Pemphigus -chronic autoimmune blistering, elderly, usually benign, steroidsusually benign, steroids

Pemphigus Vulgaris – mucous membrane involvement, much Pemphigus Vulgaris – mucous membrane involvement, much higher mortality than Bullous Pemphigus, steroids, admissionhigher mortality than Bullous Pemphigus, steroids, admission

Zoster – acyclovir, analgesia, steroidsZoster – acyclovir, analgesia, steroids Contact Dermatits - symptomatic treatment, long taper of steroids Contact Dermatits - symptomatic treatment, long taper of steroids

for severe casesfor severe cases

Causes of napkin rashCauses of napkin rash

Irritant(contact dermatitis) Irritant(contact dermatitis) flexure are sparedflexure are spared

Seborrhoeic dermatitisSeborrhoeic dermatitis

Candida infectionCandida infection

Napkin dermatitisNapkin dermatitis

FeaturesFeatures◦ Usually due to irritant contact dermatitis which Usually due to irritant contact dermatitis which spares spares

groinsgroins◦ Treat with barrier cream, frequent nappy changesTreat with barrier cream, frequent nappy changes

Napkin rashNapkin rash

Satellite lesions and skin-fold Satellite lesions and skin-fold involvement may indicate candidainvolvement may indicate candida

Look for mouth lesions as wellLook for mouth lesions as well Treat with anti-fungal creamTreat with anti-fungal cream

Atopic DermatitisAtopic Dermatitis

superficial inflammation of the skin superficial inflammation of the skin

characterized bycharacterized by rednessrednessedemaedemaoozingoozingcrustingcrustingscalingscaling(vesicles)(vesicles)

Atopic DermatitisAtopic Dermatitis

12-26% of children 12-26% of children Onset usually in first yearOnset usually in first year Uncommon in first 2 monthsUncommon in first 2 months Diaper area sparedDiaper area spared Sites of PredilectionSites of Predilection

◦ Face in the youngFace in the young◦ Extensor surfaces of the arms and legs 8-10 mo.Extensor surfaces of the arms and legs 8-10 mo.◦ Antecubital and popliteal fossa , neck, face in olderAntecubital and popliteal fossa , neck, face in older

Atopic DermatitisAtopic Dermatitis

The The diagnosis is made clinicallydiagnosis is made clinicallyThe patient must have each of the followingThe patient must have each of the following1-pruritis1-pruritis2-Typical morphology and distribution 2-Typical morphology and distribution Facial and extensor involvement in infant and childrenFacial and extensor involvement in infant and children Flexural in adultFlexural in adult3-Tendency toward chronic and relapsing3-Tendency toward chronic and relapsing

complicationscomplications

Flare-up are commonFlare-up are common Infection (strep,staph,herpes)Infection (strep,staph,herpes) lymphadenopathylymphadenopathy

TreatmentTreatment

Avoidance or elimination of predisposing Avoidance or elimination of predisposing factorsfactors

(nylon,long nail. Cow milk)(nylon,long nail. Cow milk) Hydration and lubrication of dry skinHydration and lubrication of dry skin Anti-pruritic agentsAnti-pruritic agents Topical steroidsTopical steroids Antibiotic or antiviralAntibiotic or antiviral Dietary elimination (egg , cow milk)Dietary elimination (egg , cow milk) occurs in 6% of infant occurs in 6% of infant

with eczymawith eczyma 4-6 weeks required to 4-6 weeks required to

detect responsedetect response

Seborrheic DermatitisSeborrheic Dermatitis Its cause remains unknown Its cause remains unknown Most frequent present in first 2 months of Most frequent present in first 2 months of

life.life.erythamatous scaling eruption erythamatous scaling eruption The scales form thick yellow adherent layer The scales form thick yellow adherent layer

(cradle cap) (cradle cap) The rash causes no discomfort or itching The rash causes no discomfort or itching

like eczemalike eczema• Treatment -mild case resolve with Treatment -mild case resolve with

emollientemollient -scales treated with ointment -scales treated with ointment

contain sulphur and salicylic acid contain sulphur and salicylic acid -Topical steroids-Topical steroids

UrticariaUrticaria

Transient, well-demarcated wheelsTransient, well-demarcated wheels PruriticPruritic Due to increase premeablity of capillaries and Due to increase premeablity of capillaries and

venulesvenules May involve deep tissue to produce angioedemaMay involve deep tissue to produce angioedema Etiology are Etiology are - idiopathic common- idiopathic common - drugs penicillin's, cephalosporin's- drugs penicillin's, cephalosporin's - food egg ,cheese, strawberries, fish, - food egg ,cheese, strawberries, fish,

peanutpeanut - physical agent heat,cold pressure- physical agent heat,cold pressure

ImpetigoImpetigo Localized ,highly contagious Localized ,highly contagious Common in infant Common in infant It is common where underlying skin disease It is common where underlying skin disease

eczemaeczema Strep or StaphStrep or Staph Honey-coloured crustHoney-coloured crust Mostly face, extremities, hands and neckMostly face, extremities, hands and neck Treatment: topical (mild) Treatment: topical (mild) systemic antibiotics systemic antibiotics

flucloxacillin,erythromycin.(severe)flucloxacillin,erythromycin.(severe) Nasal carriage is important source of infection Nasal carriage is important source of infection

chlorhexidine,neomycin,mupirocine (cream)chlorhexidine,neomycin,mupirocine (cream)

Thank youThank you