Scribd Logo
Upload

Welcome to Scribd!

  • 45 views

    Cme 2012 Warren

    Uploaded by

    Mateen Shukri
    This document provides an overview of common pediatric dermatologic conditions and systemic illnesses that present with rashes. It begins with objectives of recognizing dermatologic conditions, expanding differentials, reviewing treatments, and identifying skin manifestations of systemic disease. It then presents three clinical cases. The first case involves a newborn with a splotchy rash and the likely diagnosis is erythema toxicum. The second case involves a 7-year-old boy with linear vesicles and blisters on his arms and legs, and the likely diagnosis is atopic dermatitis. The third case involves a 2-year-old female with fever, irritability, and a rash on her buttocks and hands, and the likely diagnosis

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Cme 2012 Warren

    Uploaded by

    Mateen Shukri
    45 views69 pages
    This document provides an overview of common pediatric dermatologic conditions and systemic illnesses that present with rashes. It begins with objectives of recognizing dermatologic conditions, expanding differentials, reviewing treatments, and identifying skin manifestations of systemic disease. It then presents three clinical cases. The first case involves a newborn with a splotchy rash and the likely diagnosis is erythema toxicum. The second case involves a 7-year-old boy with linear vesicles and blisters on his arms and legs, and the likely diagnosis is atopic dermatitis. The third case involves a 2-year-old female with fever, irritability, and a rash on her buttocks and hands, and the likely diagnosis

    Original Description:

    pediatric visual diagnosis

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document provides an overview of common pediatric dermatologic conditions and systemic illnesses that present with rashes. It begins with objectives of recognizing dermatologic conditions, expanding differentials, reviewing treatments, and identifying skin manifestations of systemic disease. It then presents three clinical cases. The first case involves a newborn with a splotchy rash and the likely diagnosis is erythema toxicum. The second case involves a 7-year-old boy with linear vesicles and blisters on his arms and legs, and the likely diagnosis is atopic dermatitis. The third case involves a 2-year-old female with fever, irritability, and a rash on her buttocks and hands, and the likely diagnosis

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    45 views69 pages

    Cme 2012 Warren

    Uploaded by

    Mateen Shukri
    This document provides an overview of common pediatric dermatologic conditions and systemic illnesses that present with rashes. It begins with objectives of recognizing dermatologic conditions, expanding differentials, reviewing treatments, and identifying skin manifestations of systemic disease. It then presents three clinical cases. The first case involves a newborn with a splotchy rash and the likely diagnosis is erythema toxicum. The second case involves a 7-year-old boy with linear vesicles and blisters on his arms and legs, and the likely diagnosis is atopic dermatitis. The third case involves a 2-year-old female with fever, irritability, and a rash on her buttocks and hands, and the likely diagnosis

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 69

    Pediatric Visual

    Diagnosis
    Lisa Warren, DO
    Department of Pediatrics
    Western University of Health Sciences

    Objectives
    Recognize common pediatric
    dermatologic conditions
    Expand differential diagnosis
    Review treatment plans
    Identify skin manifestations of systemic
    disease

    Question 1
    A one week old childs mother presents to
    your office with concerns that the child
    has a rash that has progressed since
    being discharged from the hospital.
    Birth history is unremarkable.
    Physical examine shows a splotchy
    erythema with a central clear pustule.

    Your likely diagnosis is?


    a.
    b.
    c.
    d.
    e.

    Erythema toxicum
    Neonatal pustular melanosis
    Staph folliculitis
    Milia
    Neonatal acne

    Erythema Toxicum

    Erythema Toxicum
    Also described as a flea bite
    Intense erythema with / a central papule
    or pustule.
    2-3 cm in diameter, on back, face, chest
    and extremities
    Usually in full term infants, appears
    usually beginning 24- 48 hours

    Erythema Toxicum
    Benign self limited with unknown
    etiology
    No treatment, it fades within 5-7 days.
    A smear of the pustule reveals
    numerous Eosinophils

    Transient Neonatal Pustular


    Melanosis

    Neonatal Pustular Melanosis


    1-2 mm of vesiculopustules or ruptured
    pustules
    Usually present at birth, but disappear
    quickly within 24-48 hours
    Leaves pigmented macules with a
    collaret of scale
    Fades within 3 weeks to 3 month
    Occurs anywhere on the body, but more
    common on neck, forehead, lower back,
    and the legs

    Neonatal Pustular Melanosis


    Unknown etiology, self limited.
    Gram stain shows neutrophils.
    Common concern is Staph aureus
    infection

    Staph Infection in Newborn

    Staph Infection in Newborn


    Lesions tend to appear in the later part of
    the first week of life or into the second
    week.
    Any body site may be involved with
    predilection to the diaper area.
    The bullae are flaccid, containing straw
    colored or turbid fluid, rupture easily
    leaving a moist denuded area.

    Management
    CBC, Blood cultures
    Gram stain and culture wound sites
    Hospitalization and treatment with a
    systemic appropriate antibiotic should be
    instituted particularly for lesions around the
    umbilicus.

    Miliaria Crystallina

    Milia
    Small, firm 1-2 mm in diameter
    Tiny thin-walled sweat-retention
    vesicles rupture readily, then quickly
    desquamate
    Commonly seen on the face on
    neonates
    Consist of epithelial lined cysts arising
    from hair follicles

    Milia
    Usually persistent, but may resolved
    within month to years.
    Usually appear with no apparent cause,
    but may also appear after skin injury.
    In the mouth it is called Epstein's pearls

    Miliaria Rubra (Heat rash)

    Milia Rubra
    Sweat duct obstruction in deeper
    epidermal or dermal layers.
    Erythematous papulopustular eruption
    Usually over the face, upper trunk, and
    Intertiginous area of the neck.
    It is usually as a result of tight fitting cloth
    or use of occlusive lubricants during hot,
    humid weather.

    Neonatal acne

    Neonatal Acne
    Occurs in 20% neonates
    Thought related to be caused by
    stimulation of sebaceous glands by
    maternal and endogenous androgens
    Proposed cause - inflammatory reaction
    to skin colonization with Malassezia
    species

    Neonatal acne
    Mean age 3 weeks
    Presence of inflammatory papules and
    pustules no comedones
    Distribution limited to face
    Treat with daily cleansing with soap and
    water
    Application 2% ketaconazole or 1%
    hydrocortisone

    Acne

    Infantile acne
    3 to 4 months of age
    Hyperplasia of sebaceous glands due to
    androgenic stimulation
    Inflammatory papules, pustules, and
    comedones
    Can treat with benzoyl peroxide, topical
    antibiotics, or topical retinoids
    No improvement consider endocrinopathy

    Question 2
    A 7-year-old boy is brought to the clinic for an itchy
    rash that has been present for 2 weeks. He has
    been healthy except for intermittent asthma, and
    his mother reports that he frequently has very dry
    patches of skin. He has numerous linear vesicles
    and blisters on his arms, with surrounding
    erythema and mild edema. He has a few similar
    lesions on his anterior legs. He scratches the
    lesions frequently during your examination.

    Your likely diagnosis is:


    A. Atopic dermatitis
    B. Scabies
    C. Tinea Corporis
    D. Pityrasis rosea

    Atopic Dermatitis

    3-5% of children 6 mo to 10 yr
    Described in 1935
    Ill-defined, red, pruritic, papules/plaques
    Diaper area spared
    Acute: erythema, scaly, vesicles, crusts
    Chronic: scaly, lichenified, pigment
    changes

    Atopic Dermatitis
    Hints to diagnosis
    Generalized dry skin
    Accentuation of skin markings on palms
    and soles
    Dennie-Morgan lines
    Fissures at base of earlobe
    Allergic history

    Diagnostic Criteria
    Major Criteria: At least 3 of the following:
    1. Pruritus
    2. Personal or family history of atopy
    (asthma, allergic rhinitis, atopic dermatitis)
    3. Chronic or chronically relapsing dermatitis
    4 Typical morphology and distribution

    Treatment

    Moisturize
    Baths only
    Anti-histamine
    Topical steroids to red and rough areas
    Immune modulators

    Avoidance of Triggers
    Perspiration and overheating
    Irritating clothes soft cotton
    Avoid harsh soaps, detergents, fabric
    softeners, products with fragrance, and
    bubble baths
    Exposure to tobacco
    IgE mediated food allergy
    Milk, eggs, soy, wheat, peanuts

    Complications
    Bacterial Secondary Infection
    Red and honey
    colored crusting
    Usually S. aureus
    More potent topical
    steroid
    Topical or oral
    antibiotics

    Eczema Herpeticum
    Widely scattered clusters
    of 1- mm excoriated red,
    papules, vesicles, and
    crusts
    Herpes simplex virus
    (HSV) infection
    Treatment
    acyclovir
    antihistamine

    Scabies
    Intense pruritus
    Diffuse, papular rash
    Between fingers, flexor aspects of wrists,
    anterior axillary folds, waist, navel

    May be vesicular in children < 2 years


    Head, neck, palms, soles
    Hypersensitivity reaction to protein of
    parasite

    Scabies
    Sarcoptes scabiei mite
    Pruritic burrows pathognomic (irregular,
    tortuous, and slightly scaly)
    In infants, burrows are widespread with
    involvement of trunk, scalp, extremities,
    palms and soles
    Consider in infants with widespread
    dermatosis that involves the palms and
    soles

    Scabies - Treatment
    5% permethrin cream for infants, young
    children, pregnant and nursing mother
    Kwellada-P or Nix
    Cover entire body from neck down
    Include head and neck for infants
    Wash after 8-14 hours

    Can use Lindane for older children

    Scabies - Treatment
    Not after a hot bath
    All family members at same time
    Whole body treatment inc, scalp, neck,
    face, ears and under nails
    Repeat week later
    Pruritis can last for weeks

    Tinea Corporis
    Contact with other individuals, domestic
    animals including young kittens and
    puppies
    Most common group of dermatophytes
    Trichophyton
    Microsporum
    Epidermophyton

    Invade keratin, the protein that forms the


    outermost epidermis, nails, and hair

    Tinea Corporis
    Face, trunk or limbs
    Pruritic, circular, slightly erythematous
    Well-demarcated with scaly, vesicular or
    pustular border
    Mistaken for atopic, seborrheic or
    contact dermatitis
    Treatment: Topical or oral antifungal

    Pityriasis Rosea
    Begins with herald patch
    Large, isolated oval lesion with
    central clearing
    More lesions 5-10 days later
    Christmas tree distribution
    Treatment: anti-histamines

    Question 3
    A 2 year old female presents to your clinic
    with a 3 day history of high fever up to 103
    and irritability. Mother reports that her
    throat seems to bother her because she
    refuses to eat and cries when she drinks her
    milk. She started developing a rash on her
    buttock and hands. Her immunizations are
    up to date.

    Your likely diagnosis is:


    a.
    b.
    c.
    d.
    e.

    Hand foot mouth disease


    Scarletina
    Erythema Infectiosum
    Roseola
    Herpes Simplex

    Hand-Foot-Mouth Disease
    Painful, shallow, yellow ulcers surrounded by
    red halos
    Found on buccal mucosa, tongue, soft palate,
    uvula and anterior tonsillar pillars
    Oral lesions without the exanthem =
    herpangina
    Exanthem involves palmar, plantar and
    interdigital surfaces of the hands and feet +/buttocks
    Due to Coxsackie A virus

    Streptococcal Scarlet fever

    Streptococcal Scarlet Fever


    Flushed face,
    Perioral pallor, and a
    Diffuse, blanching, erythematous rash that
    has a sandpapery consistency on palpation.
    Pastia lines
    Confirm with culture
    Treat with penicillin

    Erythema Infectiosum
    Fifth Disease

    Parvovirus B19
    Mostly preschool age
    Recognized by exanthem
    Contagious before rash
    Resolution between 3 and 7 days

    Erythema Infectiosum
    (Fifth Disease)
    On day 1, warm, erythematous, nontender,
    circumscribed patches appear over the
    cheeks.
    These fade on the following day, as an
    erythematous, lacy rash develops on the
    extensor surfaces of the extremities.
    No preceding symptoms
    No treatment needed

    Roseola
    6 to 36 months
    Human herpesvirus 6
    High fever without source and irritability
    for 3 days
    Rash develops as fever decreases

    Herpes Simplex
    Gingivostomatitis most common 1 infection
    in children
    Fever, irritability, cervical nodes
    Small yellow ulcerations with red halos on mucous
    membranes

    Involvement more diffuse easy to


    differentiate from herpangina and exudative
    tonsillitis
    Treatment: supportive

    Herpetic Whitlow
    Lesions on thumb usually 2 to
    autoinoculation
    Group, thick-walled vesicles on
    erythematous base
    Painful
    Tend to coalesce, ulcerate and then
    crust
    May require topical or oral acyclovir

    Conclusions
    Not all that itches is eczema
    Treatment is often supportive for viral
    exanthems
    Remember rashes as a sign of systemic
    illness

    You might also like