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    SGD Pedia: Pruritus SGD Pedia: Pruritus: Amy Luz T. Corpuz, M.D. DPPS, MPH Amy Luz T. Corpuz, M.D. DPPS, MPH

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    NewbornMed FABELLA
    A 7-month-old boy presented with a 4-month history of pruritic rashes on his cheeks, around his mouth, trunk, and extremities that come and go. Physical examination revealed symmetric, ill-defined, erythematous, scaling pink patches consistent with the described rash locations. Differential diagnoses included atopic dermatitis, contact dermatitis, and scabies. Laboratory tests were ordered to rule out infections and establish the diagnosis. The final diagnosis was atopic dermatitis based on the characteristic rash presentation and history. Management included education on proper bathing, liberal use of emollients, avoidance of irritants, and topical steroids. The prognosis is generally

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    SGD Pedia: Pruritus SGD Pedia: Pruritus: Amy Luz T. Corpuz, M.D. DPPS, MPH Amy Luz T. Corpuz, M.D. DPPS, MPH

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    NewbornMed FABELLA
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    A 7-month-old boy presented with a 4-month history of pruritic rashes on his cheeks, around his mouth, trunk, and extremities that come and go. Physical examination revealed symmetric, ill-defined, erythematous, scaling pink patches consistent with the described rash locations. Differential diagnoses included atopic dermatitis, contact dermatitis, and scabies. Laboratory tests were ordered to rule out infections and establish the diagnosis. The final diagnosis was atopic dermatitis based on the characteristic rash presentation and history. Management included education on proper bathing, liberal use of emollients, avoidance of irritants, and topical steroids. The prognosis is generally

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    PRURITUS SGD

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    A 7-month-old boy presented with a 4-month history of pruritic rashes on his cheeks, around his mouth, trunk, and extremities that come and go. Physical examination revealed symmetric, ill-defined, erythematous, scaling pink patches consistent with the described rash locations. Differential diagnoses included atopic dermatitis, contact dermatitis, and scabies. Laboratory tests were ordered to rule out infections and establish the diagnosis. The final diagnosis was atopic dermatitis based on the characteristic rash presentation and history. Management included education on proper bathing, liberal use of emollients, avoidance of irritants, and topical steroids. The prognosis is generally

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    56 views14 pages

    SGD Pedia: Pruritus SGD Pedia: Pruritus: Amy Luz T. Corpuz, M.D. DPPS, MPH Amy Luz T. Corpuz, M.D. DPPS, MPH

    Uploaded by

    NewbornMed FABELLA
    A 7-month-old boy presented with a 4-month history of pruritic rashes on his cheeks, around his mouth, trunk, and extremities that come and go. Physical examination revealed symmetric, ill-defined, erythematous, scaling pink patches consistent with the described rash locations. Differential diagnoses included atopic dermatitis, contact dermatitis, and scabies. Laboratory tests were ordered to rule out infections and establish the diagnosis. The final diagnosis was atopic dermatitis based on the characteristic rash presentation and history. Management included education on proper bathing, liberal use of emollients, avoidance of irritants, and topical steroids. The prognosis is generally

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    SGD PEDIA: PRURITUS

    Amy Luz T. Corpuz, M.D. DPPS, MPH


    TRIGGER: PRURITUS
    CASE HISTORY:
    A.E. a 7 month old boy, from Dumaguete City ,
    was brought in your clinic by his mother due to
    pruritic rashes.

    Chief Complaint: pruritus


    4 months prior to consult, rashes were initially noted on
    his cheeks and around his mouth.

    Since that time, the rashes seem to come and go and


    now also intermittently affect his trunk and extremities.

    Patient frequently scratches the affected areas.

    His mother notes that the areas covered by his diaper


    are not involved. She has treated the condition with
    various "baby lotions" and is uncertain whether these
    help, hence the consultation.
    PAST MEDICAL HISTORY
    Prenatal: Mother had regular pre-natal check up and intake of
    multivitamins and FeSO4. No illnesses were incurred during
    the course of pregnancy. No illegal drug intake or exposure to
    radiation.
    Natal: Born fullterm to a 29 y G2P2 (2002) at the hospital with
    no complications.
    Postnatal: No other fetomaternal complications noted
    thereafter.
    Feeding: The patient was exclusively breastfed for 3 months
    and mixed feed by 3 months since mother had to go to work.
    Weaning was done at 5 month old with food mainly consist of
    mashed vegetables.
    Immunization: (+) BCG, (+) 2DPT, 2 OPV, 2 Hepa B.
    Developmental: Patient is at par with his developmental
    milestones.
    Past Illnesses: no serious illnesses incurred prior to this
    consultation.
    PERSONAL AND SOCIAL HISTORY
    Patient is the youngest among 4. Source of drinking water
    is mineral water. No pets in the house.
    FAMILY HISTORY
    Denies history of hypertension and diabetes. Father has a
    history of asthma.

    REVIEW OF SYSTEMS

    Constitutional: (-) loss of appetite, (-) weakness,


    SHEENT: no eye discharge, no ear discharge, no epistaxis
    Chest and Lungs: no pleuritic chest pains
    Cardiovascular: no cyanosis, no edema
    Gastrointestinal: no abdominal distention
    Genito-urinary: No gross hematuria, no discharge
    Endocrine: No jaundice, no polyuria, no polydypsia, no polyphagia
    Hematologic: No easy bruisability, no bleeding tendencies
    Neurologic: no loss of consciousness, no convulsions
    PHYSICAL EXAMINATION
    (at the time of consultation)
    GENERAL SURVEYS: The patient is attentive and appropriately
    interactive.

    VITAL SIGNS: CR –100 RR – 35’s cpm Temp – 36.8 C

    Skin: Cutaneous examination reveals symmetric, ill-defined, brightly


    erythematous, scaling, pink patches on his cheeks and similar, although
    milder, patches on his trunk and extremities.

    HEENT: anicteric sclera, no ear or nose discharge, no sunken eyeballs,


    pink palpebral conjunctivae, (-) CLAD,
    (-) NAD, no alar flaring

    Chest and Lungs: symmetric chest expansion, no subcostal retractions,


    clear breath sounds

    Heart: adynamic precordium, normal rate regular rhythm, no murmurs

    Abdomen: globular, normoactive bowel sounds, soft, no tenderness


    Extremities: grossly normal extremities, full and equal pulses, (-)edema
    TASKS:
    WHAT IS YOUR INITIAL IMPRESSION BASED ON THE HISTORY AND PHYSICAL
    EXAMINATION
    Support your answer based on the history and physical examinations

    SALIENT FEATURES:

    • On and off rashes


    • Area of rashes
    • Father has asthma
    • Active
    • No fever
    • Characteristic of rashes: Cutaneous examination reveals symmetric,
    ill-defined, brightly erythematous, scaling, pink patches on his cheeks
    and similar, although milder, patches on his trunk and extremities.
    TASKS:
    NAME 3 DIFFERENTIAL DIAGNOSES and How did to rule out
    those differential diagnoses
    DIAGNOSIS RULE IN RULE OUT
    TASKS:
    NAME 3 DIFFERENTIAL DIAGNOSES and How did to rule out
    those differential diagnoses
    TASKS:
    NAME 3 DIFFERENTIAL DIAGNOSES and How did to rule out
    those differential diagnoses
    TASK:
    WHAT ARE YOUR LABORATORY TESTS IN ORDER TO
    ESTABLISH THE DIAGNOSIS

    Laboratory Results:
    CBC: Hb: 12mg/dl Hct 36gm%: WBC : 7,000/cumm
    Lymphocyte 43%, Neutrophils 60% monocyte 1% eosinophils
    4% Basophils 1% platelet count 270T/cumm
    TASK:
    WHAT IS YOUR FINAL DIAGNOSIS ?
    DISCUSS YOUR MANAGEMENT

    Education and counseling


    Proper bathing techniques
    Liberal use of emollients
    Avoidance of irritants
    Treat infections if present
    Topical medications:-- steroids, topical immunomodulators, tar
    preparations. phototherapy
     
    TASK:
    WHAT IS THE PROGNOSIS AND WHAT PREVENTIVE
    MEASURES TO BE ADIVISED TO PARENTS?
    PROGNOSIS
    -more severe and persistent in young children
    - Periods of remission occur more frequently as patients grow older. -
    Spontaneous resolution of AD has been reported to occur after age 5 yr in
    40-60% of patients affected during infancy, particularly for mild disease.
    - Predictive factors of a poor prognosis for AD include widespread AD in
    childhood, filaggrin gene null mutations, concomitant allergic rhinitis and
    asthma, family history of AD in parents or siblings, early age at onset of
    AD, being an only child, and very high serum IgE levels.
    PREVENTION
    - Breastfeeding or a feeding with a hypoallergenic hydrolyzed formula may
    be beneficial.
    - Probiotics and prebiotics
    - infant with AD is diagnosed with food allergy, the breast feeding mother
    may need to eliminate the implicated food allergen from her diet.
    - Identification and elimination of triggering factors is the mainstay for
    prevention of flares as well as for the long-term treatment of AD.
    - Emollient therapy
    THANK YOU AND GOD BLESS

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