Common dermatology terms

Macule: circumscribed change in skin color without elevation or

depression.

Papule: solid elevated lesion usually <0.5 cm in diameter.

Plaque: raised lesion >0.5cm in diameter

Wheal (hive): rounded or flat-topped elevated lesion formed by local

dermal edema.

Purpura: non-blanching erythema or violaceous color due to

extravasation of blood.

Nodule: palpable solid lesion of varying size

Vesicle: circumscribed elevated lesion which contains free fluid and is

<0.5 cm in diameter

Bulla (blister): same as vesicle but with diameter >0.5 cm.

Cyst: sac containing liquid or semisolid material usually in the dermis.

Pustule: circumscribed elevated lesion which contains pus

Abscess: collection of pus in the dermis or subcutis.

Primary skin lesions

Erythema Toxicum Neonatorum

Huge 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. .

Erythema Toxicum Neonatorum

Prickly heat, sweat rash.

Many red macules with central papules, vesicl

es or pustules are present.

These may be on the trunk, diaper area, head

or neck.

Miliaria

Miliaria

Self 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.

Subcutaneous Fat Necrosis

Subcutaneous Fat Necrosis

Cause is unknown

Red, itchy papules and plaques that ooze and

crust

Sites of Predilection

Face in the young

Extensor surfaces of the arms and legs 8-10 mo.

Antecubital and popliteal fossa, neck, face in older

Infantile Atopic Dermatitis

Infantile Atopic Dermatitis

Infantile Atopic Dermatitis

Avoidance or elimination of predisposing

factors.

Hydration and lubrication of dry skin.

Anti-pruritic agents.

Topical steroids.

Eczema- Treatment

Common, generally self-limiting.

Its cause remains ill-understood.

There is a genetic predisposition.

Most frequent between the ages of 1:6 mo.

Greasy, salmon-colored scaling eruption.

Hair-bearing and intertriginous areas.

The rash causes no discomfort or itching.

Seborrheic Dermatitis

Seborrheic Dermatitis

Seborrheic Dermatitis

Anti-seborrheic shampoo

Topical steroids

Seborrheic Dermatitis-

Treatment

Starts off in the deep flexures which show wide

spread erythema on the buttocks-beefy red color.

There are also raised edge, sharp marginization

and white scale at the border of lesions, with pin

point pustulo-vesicular satellite lesions

Candidal Dermatitis

Salmon-colored greasy lesions with yellowish

scale and predilection for intertriginous areas.

Involvement of the scalp, face, neck, and post

auricular and flexural areas

Seborrheic Dermatitis

Rash confined to the convex surfaces of the

buttocks, perineal area, lower abdomen, and

proximal thighs, sparing the intertriginous

creases.

Excessive heat, moisture, and sweat retention.

Harsh soaps, detergents, and topical

medications

Irritant Dermatitis

Variola viruses ,Fatality 40 %.

First invades upper respiratory tract.

From lymph nodes it spreads via hematogenousspread.

Chills, fever, headache, delirium, SZ.

Face to upper arms and trunk, and finally to lower legs

Smallpox- Variola

Herpes virus varicellae

Incubation period 10-21 days

Fever, malaise, cough, irritability, pruritus

Papules vesicles crusting

Spreads centripetally

Chickenpox-Varicella

Complications:

Bacterial superinfection

CNS involvement

Pneumonia

Hepatitis, arthritis

Reye’s syndrome

VZIG

Varicella

Oral acyclovir- indications:

Children > 1 yr with chronic cutaneous or pulmonary conditions

Patients on chronic salicylate therapy

Patients receiving short or intermittent courses of aerosolized

corticosteroids

Dose: 80 mg/kg/day in four divided doses for 5 days

Varicella

Treatment

VZIG (1 vial/5 kg IM) :

Pts on high dose steroids

Immunocompromised

Pregnant women

Newborns exposed 5 days prior to birth and 2 days

after delivery

Neonates born to nonimmune mothers

Varicella

Post exposure

Rubeola- 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

Immunoglobulin therapy- indications

All susceptible contacts

Infants 5 mo. To 1 year of age

Immunocompromised

Pregnant women

Live measles virus vaccine- contraindication

Immunocompromised

Pregnancy

Allergy to eggs

Measles

Post exposure

German Measles.

Epidemic nature.

Winter-spring.

Prodrome.

Face neck trunk.

Lymphadenopathy.

Serologic testing.

Rubella

Enteroviruses

coxsackieviruses A and B

echoviruses

Vesicular lesions, may be petechial.

Associated with aseptic meningitis, myocarditis

Hand-Foot-Mouth Disease

Fifth 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

Erythema Infectiosum

Roseola Infantum(HHV-6B)

Children 6-19 months

Abrupt onset of high fever

Febrile seizures

Rash develops after fever dissipates

Mainly on trunk

Exanthem Subitum

Acute, 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

Infectious Mononucleosis

Superficial infection of the dermis

Two types:

Impetigo contagiosa

Bullous impetigo

Etiology

Group A ß hemolytic streptococcus

Coagulase positive S. aureus

Treatment : B-lactam ABs, erythromycin

Impetigo

Toxin 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

Treatment :penicillin or amoxicillin

Scarlet Fever

Usually sudden onset of fever,chills, myalgia,and

arthralgia

Rash is macular, nonpruritic, erythematous

lesions

Petechial rash develops in 75% of cases

Neisseria meningitides

Fever, rash, hypotension, shock, DIC

Treatment: PCN G

Meningococcemia

Most common rickettsial infection in US

Abrupt fever, headache, and myalgia

Rash from extremities towards trunk

Macules petechiae

Treatment

Tetracycline

Doxycycline

Chloramphenicol

Rocky Mountain Spotted Fever

No 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

Henoch-Schnlein Purpura

Unknown etiology

Peak incidence 18-24 months

Clinical findings:

Fever for at least five days

Conjunctivitis

Polymorphous rash

Oral cavity changes

Cervical adenopathy

Kawasaki Syndrome