common pediatric skin and soft tissue conditions l.
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Common Pediatric Skin and Soft Tissue Conditions . Sirous Partovi, M.D. Erythema Toxicum Neonatorum. Impressive title - harmless skin condition Erythematous macule with a central tiny papule, seen anywhere - except the palms and soles.

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erythema toxicum neonatorum
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.
miliaria
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.
subcutaneous fat necrosis
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
infantile atopic dermatitis
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
differential diagnosis atopic dermatitis
Differential Diagnosis- Atopic Dermatitis
  • Seborrheic dermatitis
  • Contact dermatitis
  • Nummular eczema
  • Psoriasis
  • Scabies
eczema treatment
Eczema- Treatment
  • Avoidance or elimination of predisposing factors
  • Hydration and lubrication of dry skin
  • Anti-pruritic agents
  • Topical steroids
seborrheic dermatitis
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
seborrheic dermatitis treatment
Seborrheic Dermatitis-Treatment
  • Anti-seborrheic shampoo
  • Topical steroids
pityriasis rosea
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
candidal dermatitis
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
seborrheic dermatitis27
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
irritant dermatitis
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
smallpox variola
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
chickenpox varicella
Chickenpox-Varicella
  • Herpes virus varicellae
  • Incubation period 10-21 days
  • Fever, malaise, cough, irritability, pruritus
  • Papulesvesicles crusting
  • Spreads centripetally
varicella
Varicella
  • Complications:
    • Bacterial superinfection
    • CNS involvement
    • Pneumonia
    • Hepatitis, arthritis
    • Reye’s syndrome
  • VZIG
varicella treatment
Varicella – Treatment
  • Oral acyclovir- indications
    • Healthy nonpregnant teenagers and adults
    • 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 post exposure
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 < 28 weeks’ gestation
measles
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
measles post exposure
Measles – Post Exposure
  • Immunoglobulin 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- contraindication
    • Immunocompromised- excluding HIV
    • Pregnancy
    • Allergy to eggs, or neomycin
rubella
Rubella
  • German Measles
  • Epidemic nature
  • Winter-spring
  • Prodrome
  • Face  neck  trunk
  • Lymphadenopathy
  • Serologic testing
hand foot mouth disease
Hand-Foot-Mouth Disease
  • Enteroviruses
    • coxsackieviruses A and B
    • echoviruses
  • Vesicular lesions, may be petechial
  • Associated with aseptic meningitis, myocarditis
erythema infectiosum
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
exanthem subitum
Exanthem Subitum
  • Roseola Infantum
  • Children 6-19 months
  • Abrupt onset of high fever
  • Febrile seizures
  • Rash develops after fever dissipates
  • Mainly on trunk
infectious mononucleosis
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
impetigo
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
scarlet fever
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
staphylococcal scalded skin syndrome
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
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
differential diagnosis
Differential Diagnosis
  • Gonococcemia
  • HSP
  • Typhoid fever
  • Rickettsial disease
  • Erythema multiforme
  • Purpura fulminans
rocky mountain spotted fever
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
cellulitis
Cellulitis
  • Most common organisms:
    • S. aureus
    • S. pyogenes
    • H. influenza type B (HIB)
  • Most common sites?
  • CBC, x-ray?
cellulitis treatment
Cellulitis- Treatment
  • IV antibiotics in:
    • Immunocompromised
    • Ill appearing
    • Suspected bacteremia
    • <6 mo. Of age
    • WBC> 15K
    • High fever
    • Rapidly progressing
periorbital orbital cellulitis
Periorbital- Orbital Cellulitis
  • S. aureus, S. pneumoniae, and HIB
  • CBC, blood culture, CT
  • LP?
  • IV antibiotics
  • Admit
henoch schnlein purpura
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
kawasaki syndrome
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