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Common Pediatric Skin and Soft Tissue Conditions
Dr.Md.Shahidul Islam
Assistant Professor,Dermatology
CBMCB
Erythema Toxicum Neonatorum
Impressive title - harmless skin condition
Erythematous macule with a central tiny papule, seen anywhere - except the palms and soles.
The lesions are packed with eosinophils, and there may be accompanying eosinophilia in the blood count.
The cause is unknown, and no treatment is required as the rash disappears after 1-2 weeks.
MiliariaPrickly heat, sweat rash
Many 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 condition
Sharply demarcated reddish to violaceous plaques or nodules
Etiology uncertain
Onset first few days- weeks of life
Cheeks, back, buttocks, arms, and thighs
Infantile Atopic DermatitisCause is unknownRed, itchy papules and plaques that ooze and crustSites of Predilection
Face in the youngExtensor surfaces of the arms and legs 8-10 mo.Antecubital and popliteal fossa , neck, face in older
Differential Diagnosis- Atopic Dermatitis
Seborrheic dermatitis
Contact dermatitis
Nummular eczema
Psoriasis
Scabies
Eczema- TreatmentAvoidance or elimination of predisposing factors
Hydration and lubrication of dry skin
Anti-pruritic agents
Topical steroids
Seborrheic DermatitisCommon, generally self-limitingIts cause remains ill-understoodThere is a genetic predisposition Most frequent between the ages of 1 to 6 mo.Greasy, salmon-colored scaling eruption Hair-bearing and intertriginous areasThe rash causes no discomfort or itching
Seborrheic Dermatitis-Treatment
Anti-seborrheic shampoo
Topical steroids
Pityriasis RoseaMild inflammatory exanthem of unknown cause, maybe viralBenign, self limited disorderOccasionally there are prodromal symptoms 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 show widespread erythema on the buttocks-beefy red color
There are also raised edge, sharp marginization and white scale at the border of lesions, with pinpoint pustulo-vesicular satellite lesions
Seborrheic DermatitisSalmon-colored greasy lesions with yellowish scale and predilection for intertriginous areas
Involvement of the scalp, face, neck, and post auricular and flexural areas
Irritant DermatitisRash confined to the convex surfaces of the buttocks,perineal area, lower abdomen, and proximal thighs, sparing the intertriginous creases Excessive heat, moisture, and sweat retentionHarsh soaps, detergents, and topical medications
Viral Exanthems
Smallpox- VariolaFatality 40 %
First invades upper respiratory tract
From lymph nodes it spreads via hematogenous spread
Chills, fever, headache, delirium, SZ
Face to upper arms and trunk, and finally to lower legs
Chickenpox-VaricellaHerpes virus varicellae
Incubation period 10-21 days
Fever, malaise, cough, irritability, pruritus
Papulesvesicles crusting
Spreads centripetally
VaricellaComplications:
Bacterial superinfection
CNS involvement
Pneumonia
Hepatitis, arthritis
Reye’s syndrome
VZIG
Varicella – TreatmentOral acyclovir- indications
Healthy nonpregnant teenagers and adultsChildren > 1 yr with chronic cutaneous or pulmonary conditionsPatients on chronic salicylate therapyPatients receiving short or intermittent courses of aerosolized corticosteroids
Dose: 80 mg/kg/day in four divided doses for 5 days
Varicella – Post exposure VZIG (1 vial/5 kg IM) :
Pts on high dose steroidsImmunocompromised without a history of CPPregnant womenNewborns exposed 5 days prior to birth and 2 days after deliveryNeonates born to nonimmune mothersHospitalized premature infants < 28 weeks’ gestation
MeaslesRubeola- paramyxovirus
Occurs in epidemics
Incubation 8-12 days
Fever, lethargy, Cough, coryza, conjunctivitis with clear discharge and photophobia
Koplik spots
Rash begins on the face and spreads to trunk 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 immunity
Live measles virus vaccine- contraindicationImmunocompromised- excluding HIV
Pregnancy
Allergy to eggs, or neomycin
RubellaGerman Measles
Epidemic nature
Winter-spring
Prodrome
Face neck trunk
Lymphadenopathy
Serologic testing
Hand-Foot-Mouth DiseaseEnteroviruses
coxsackieviruses A and B
echoviruses
Vesicular lesions, may be petechial
Associated with aseptic meningitis, myocarditis
Erythema InfectiosumFifth disease
Mildly contagious, parvovirus B-19
Pre-school and young school-age children
Prodrome: mild malaise
Rash: “slapped cheek”, circumoral pallor, peripheral mild macular distribution
Complication
Exanthem SubitumRoseola Infantum
Children 6-19 months
Abrupt onset of high fever
Febrile seizures
Rash develops after fever dissipates
Mainly on trunk
Infectious MononucleosisAcute, self limited illness
Epstein-Barr virus
Oral transmission – incubation 30-50 days
Fever, fatigue, pharyngitis, LA, splenomegaly, atypical lymphocytosis
Exanthem is seen in 10-15%
Erythematous, maculopapular, morbilliform, scarlatiniform, urticarial, hemorrhagic, or even nodular
Bacterial Exanthems
ImpetigoSuperficial infection of the dermis
Two types:Impetigo contagiosa
Bullous impetigo
EtiologyGroup A ß hemolytic streptococcus
Coagulase positive S. aureus
Treatment : Keflex, erythromycin, Bactroban
Scarlet FeverToxin producing strain of group A -hemolytic streptococcus
Strep pharyngitis with systemic complaints
Rash from neck to trunk to extremities
Sandpaper feel, erythema, warmth
White and red strawberry tongue
Petechiae in linear form
Complications
Treatment
Staphylococcal Scalded-Skin Syndrome
Generally in less than 5 years of age
Induced by exotoxin produced by staphylococci
Fever, papular erythematous rash starting around mouth- not involving oral mucosa
Positive Nikolsky’s sign
Diagnosis: Tzanck test, bacterial culture
Treatment
Complications
Meningococcemia
Usually sudden onset of fever, chills, myalgia, and arthralgiaRash is macular, nonpruritic, erythematous lesionsPetechial rash develops in 75% of casesNeisseria meningitidesFever, rash, hypotension, shock, DICTreatment: PCN G
Differential Diagnosis
Gonococcemia
HSP
Typhoid fever
Rickettsial disease
Erythema multiforme
Purpura fulminans
Rocky Mountain Spotted Fever
Most common rickettsial infection in USAbrupt fever, headache, and myalgiaRash from extremities towards trunkMaculespetechiaeTreatment
TetracyclineDoxycyclineChloramphenicol
CellulitisMost common organisms:
S. aureus
S. pyogenes
H. influenza type B (HIB)
Most common sites?
CBC, x-ray?
Cellulitis- TreatmentIV antibiotics in:
ImmunocompromisedIll appearingSuspected bacteremia<6 mo. Of ageWBC> 15KHigh feverRapidly progressing
Periorbital- Orbital CellulitisS. aureus, S. pneumoniae, and HIB
CBC, blood culture, CT
LP?
IV antibiotics
Admit
Fungal Infections
Henoch-Schnlein PurpuraNo clear etiologic agent, often post viral
2-10 years of age
Palpable purpura over the buttocks and LE
Transient migratory arthritis
Renal and GI involvement
Kawasaki SyndromeUnknown etiologyPeak incidence 18-24 monthsClinical findings:
Fever for at least five daysConjunctivitisPolymorphous rashOral cavity changesCervical adenopathy