Common Pediatric Skin and Soft Tissue Conditions

1
Common Pediatric Skin and Soft Tissue Conditions

• Sirous Partovi, M.D.

2
(No Transcript)
3
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.

4
(No Transcript)
5
Miliaria

• Prickly 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.

6
(No Transcript)
7
Subcutaneous Fat Necrosis

• 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

8
(No Transcript)
9
Infantile Atopic Dermatitis

• 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

10
(No Transcript)
11
Differential Diagnosis- Atopic Dermatitis

• Seborrheic dermatitis
• Contact dermatitis
• Nummular eczema
• Psoriasis
• Scabies

12
Eczema- Treatment

• Avoidance or elimination of predisposing factors
• Hydration and lubrication of dry skin
• Anti-pruritic agents
• Topical steroids

13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
Seborrheic Dermatitis

• Common, generally self-limiting
• Its cause remains ill-understood
• There is a genetic predisposition
• Most frequent between the ages of 1 to 6 mo.
• Greasy, salmon-colored scaling eruption
• Hair-bearing and intertriginous areas
• The rash causes no discomfort or itching

17
(No Transcript)
18
(No Transcript)
19
Seborrheic Dermatitis-Treatment

• Anti-seborrheic shampoo
• Topical steroids

20
(No Transcript)
21
Pityriasis Rosea

• Mild inflammatory exanthem of unknown cause,
  maybe viral
• Benign, self limited disorder
• Occasionally there are prodromal symptoms
  including malaise, headache, sore throat,
  fatigue, and arthralgia.
• Herald patch- pink in color and scaly-mimicking
  tinea corporis

22
Diaper Rash
23
(No Transcript)
24
Candidal Dermatitis

• Starts 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

25
(No Transcript)
26
(No Transcript)
27
Seborrheic 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

28
(No Transcript)
29
Irritant 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

30
(No Transcript)
31
(No Transcript)
32
Viral Exanthems
33
(No Transcript)
34
Smallpox- Variola

• Fatality 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

35
(No Transcript)
36
Chickenpox-Varicella

• Herpes virus varicellae
• Incubation period 10-21 days
• Fever, malaise, cough, irritability, pruritus
• Papules?vesicles ?crusting
• Spreads centripetally

37
Varicella

• Complications
• Bacterial superinfection
• CNS involvement
• Pneumonia
• Hepatitis, arthritis
• Reyes syndrome
• VZIG

38
Varicella Treatment

• Oral acyclovir- indications
• Healthy nonpregnant teenagers and adults
• Children gt 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

39
Varicella Post exposure

• VZIG (1 vial/5 kg IM)
• Pts on high dose steroids
• Immunocompromised without a history of CP
• Pregnant women
• Newborns exposed 5 days prior to birth and 2 days
  after delivery
• Neonates born to nonimmune mothers
• Hospitalized premature infants lt 28 weeks
  gestation

40
(No Transcript)
41
(No Transcript)
42
Measles

• 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

43
Measles Post Exposure

• Immunoglobulin therapy- indications
• All susceptible contacts
• Infants 5 mo. To 1 year of age
• Immunocompromised
• Pregnant women
• lt5 mo. If mother without immunity
• Live measles virus vaccine- contraindication
• Immunocompromised- excluding HIV
• Pregnancy
• Allergy to eggs, or neomycin

44
Rubella

• German Measles
• Epidemic nature
• Winter-spring
• Prodrome
• Face ? neck ? trunk
• Lymphadenopathy
• Serologic testing

45
(No Transcript)
46
Hand-Foot-Mouth Disease

• Enteroviruses
• coxsackieviruses A and B
• echoviruses
• Vesicular lesions, may be petechial
• Associated with aseptic meningitis, myocarditis

47
(No Transcript)
48
Erythema Infectiosum

• 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
• Complication

49
(No Transcript)
50
Exanthem Subitum

• Roseola Infantum
• Children 6-19 months
• Abrupt onset of high fever
• Febrile seizures
• Rash develops after fever dissipates
• Mainly on trunk

51
(No Transcript)
52
Infectious Mononucleosis

• 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

53
Bacterial Exanthems
54
(No Transcript)
55
Impetigo

• Superficial infection of the dermis
• Two types
• Impetigo contagiosa
• Bullous impetigo
• Etiology
• Group A ß hemolytic streptococcus
• Coagulase positive S. aureus
• Treatment Keflex, erythromycin, Bactroban

56
(No Transcript)
57
(No Transcript)
58
Scarlet Fever

• 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
• Complications
• Treatment

59
(No Transcript)
60
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 Nikolskys sign
• Diagnosis Tzanck test, bacterial culture
• Treatment
• Complications

61
(No Transcript)
62
Meningococcemia

• 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

63
Differential Diagnosis

• Gonococcemia
• HSP
• Typhoid fever
• Rickettsial disease
• Erythema multiforme
• Purpura fulminans

64
(No Transcript)
65
Rocky Mountain Spotted Fever

• Most common rickettsial infection in US
• Abrupt fever, headache, and myalgia
• Rash from extremities towards trunk
• Macules?petechiae
• Treatment
• Tetracycline
• Doxycycline
• Chloramphenicol

66
(No Transcript)
67
Cellulitis

• Most common organisms
• S. aureus
• S. pyogenes
• H. influenza type B (HIB)
• Most common sites?
• CBC, x-ray?

68
Cellulitis- Treatment

• IV antibiotics in
• Immunocompromised
• Ill appearing
• Suspected bacteremia
• lt6 mo. Of age
• WBCgt 15K
• High fever
• Rapidly progressing

69
(No Transcript)
70
Periorbital- Orbital Cellulitis

• S. aureus, S. pneumoniae, and HIB
• CBC, blood culture, CT
• LP?
• IV antibiotics
• Admit

71
(No Transcript)
72
Fungal Infections
73
(No Transcript)
74
(No Transcript)
75
(No Transcript)
76
(No Transcript)
77
Henoch-Schnlein Purpura

• 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

78
(No Transcript)
79
Kawasaki Syndrome

• Unknown etiology
• Peak incidence 18-24 months
• Clinical findings
• Fever for at least five days
• Conjunctivitis
• Polymorphous rash
• Oral cavity changes
• Cervical adenopathy