Common Pediatrics Rashes

1. Common Pediatrics Rashes

2. Primary skin lesions

3. Primary skin lesions • MaculeA macule is an area of color change less than 1.5 cm diameter. The surface is smooth. • PatchA patch refers to a large area of color change, with smooth surface. • PapulePapules are small palpable lesions. The usual definition is that they are less than 0.5 cm diameter, although some authors allow up to 1.5 cm. They are usually visibly raised above the skin surface, and may be solitary or multiple. • Papules may be sessile, pedunculated, filiform, or verrucous.

4. Primary skin lesions • PlaqueA plaque is a palpable flat lesion greater than 0.5 cm diameter. Most plaques are elevated, but a plaque can also be a thickened area without being visibly raised above the skin surface. • NoduleA nodule is an enlargement of a papule in three dimensions (height, width, length). • VesicleVesicles are small blisters less than 0.5cm diameter. They are fluid-filled papules, and may be single or multiple. • PustuleA pustule is a purulent vesicle. It is filled with neutrophils, and may be white, or yellow. Not all pustules are infected.

5. Primary skin lesions • BullaA bulla is a large fluid-filled blister. It may be a single compartment or multiloculated. • WhealA wheal is an edematous papule or plaque caused by swelling in the dermis. Whealing often indicates urticaria. • PurpuraPurpura is bleeding into the skin. This may be as petechiae (small red or brown spots), or as ecchymoses (bruises). • TelangiectasiaTelangiectasia is the name given to prominent cutaneous blood vessels.

6. Secondary skin lesions • ScalingScaling is an increase in the dead cells on the surface of the skin (stratum corneum). The scale can be psoriatic-type (large white or silver flakes), pityriasis-type (branny powdery scale), or lichenoid (tightly adherent to skin surface). • LichenificationLichenification is caused by chronic rubbing which results in palpably thickened skin with increased skin markings and lichenoid scale. It occurs in chronic eczema eg. atopic dermatitis or lichen simplex. • ExfoliationExfoliation is the stratum corneum peeling off, usually occurring after acute inflammation.

7. Secondary skin lesions • CrustingCrust occurs when plasma exudes through an eroded epidermis. It is rough on the surface and is yellow or brown in color. Bloody crust appears red, purple or black. • ExcoriationAn excoriation is a scratch mark. It may be a linear erosion or a picked scratch. Excoriations may occur in the absence of a primary dermatosis. • ErosionAn erosion is caused by loss of the surface of a skin lesion, it is a shallow moist or crusted lesion.

8. Secondary skin lesions • FissureA fissure is a thin crack within epidermis or epithelium, and is due to excessive dryness. • UlcerAn ulcer is full thickness loss of epidermis or epithelium. It may be covered with a dark-colured crust called an eschar. • ErythrodermaErythroderma is a term used to indicate red skin over the entire body.

9. A 10-year-old girl with atopic dermatitis reports itching that has recently become relentless, resulting in sleep loss. Her mother has been reluctant to treat the girl with topical corticosteroids, because she was told that they damage the skin, but she is exhausted and wants relief for her child. 1. What is atopic dermatitis? 2. What causes it? 3. What questions would you ask the parent? 4. How should the problem be managed?

10. Atopic dermatitis clustered lichenified follicular papules

11. Atopic dermatitis Scaly erythematous plaque

12. Atopic dermatitis uniform symmetric 2 mm hypopigmented follicular papules

13. Atopic dermatitis symmetric lichenified scaly red plaques

14. Atopic dermatitis symmetric red scaly crusted excoriated plaques

15. Atopic dermatitis symmetric red scaly crusted excoriated plaques

16. Atopic dermatitis acute red edematous annular scaly and crusted plaques

17. TOPICAL CORTICOSTEROID POTENCY Generic name -> Trade name and strength Class 1--superpotent Betamethasone dipropionate = Diprolene gel/ointment, 0.05%; Diflorasone diacetate = Psorcon ointment, 0.05% Clobetasol propionate = Temovate cream/ointment, 0.05%; Halobetasol propionate = Ultravate cream/ointment, 0.05% Class 2--potent Mometasone furoate = Elocon ointment, 0.1%; Amcinonide = Cyclocort ointment, 0.1%; Betamethasone dipropionate = Diprosone ointment, 0.05%; Desoximetasone = Topicort cream/ointment, 0.25%; gel 0.05%; Fluocinonide = Lidex cream/ointment, 0.05%; Halcinonide = Halog cream, 0.1% Class 3--upper mid-strength Betamethasone dipropionate = Diprosone cream, 0.05% Betamethasone valerate = Valisone ointment, 0.1% Diflorasone diacetate = Florone, Maxiflor creams, 0.05% Triamcinolone acetonide = Aristocort cream, 0.5% Fluticasone propionate = Cutivate ointment, 0.05% Class 4--mid-strength Mometasone furoate = Elocon cream, 0.1%; Desoximetasone = Topicort LP cream, 0.05%; Fluocinolone acetonide = Synalar-HP cream, 0.2%; Synalar ointment, 0.025%; Flurandrenolide = Cordran ointment, 0.05%; Triamcinolone acetonide = Aristocort, Kenalog ointments, 0.1% Class 5--lower mid-strength Betamethasone dipropionate = Diprosone lotion, 0.05%; Betamethasone valerate = Valisone cream/lotion, 0.1% Fluocinolone acetonide = Synalar cream, 0.025%; Flurandrenolide = Cordran cream, 0.05%; Hydrocortisone butyrate = Locoid cream, 0.1%; Hydrocortisone valerate = Westcort cream, 0.2%; Prednicarbate = Dermatop emollient cream, 0.1%; Triamcinolone acetonide = Kenalog cream/lotion, 0.1%; Fluticasone propionate = Cutivate cream, 0.05% Class 6--mild Alclometasone dipropionate = Aclovate cream/ointment, 0.05%; Triamcinolone acetonide = Aristocort cream, 0.1%; Desonide = DesOwen cream, 0.05%,Tridesilon cream, 0.05% Fluocinolone acetonide = Synalar cream/solution, 0.01%; Betamethasone valerate= Valisone lotion, 0.1% Class 7--least potent Hydrocortisone (0.5, 1.0, 2.5%) = Cortaid, Cortizone 10 (OTC), 2.5% (Hytone) is Rx only

18. A 3-month-old girl developed an asymptomatic scaly red eruption in the diaper area and the face. The lesions in the diaper area were well circumscribed and red-orange in color. 1. What is the rash? 2. What causes it? 3. How do you manage it?

19. Seborrheic dermatitis symmetric red scaly confluent plaques

20. Seborrheic dermatitis symmetric red scaly confluent plaques

21. Seborrheic dermatitis symmetric red greasy scaly patches

22. Seborrheic dermatitis thick tenacious scale with crust and underlying erythema

23. Seborrheic dermatitis confluent red papules extending from the creases

24. A 6-month-old boy presents with a diaper rash consisting of confluent, bright red papules and plaques with scattered pustules, overlying scale, and satellite lesions at the periphery. 1. What is the rash? 2. What causes it? 3. How do you manage it?

25. Candidal Diaper dermatitis confluent bright red papules and plaques with scattered pustules, overlying scale, and satellite lesions at the periphery

26. A mother describes to you a diaper rash that cleared rapidly with frequent application of a barrier paste and air drying after diaper changes. She wants to know why this happens. 1. What is the cause of this rash? 2. How do you manage it?

27. Irritant/Contact diaper dermatitis symmetric uniform 2-3 mm red eroded papules

28. A 2-month-old healthy boy developed a pustular eruption in the diaper area 2 days ago. A Gram stain showed neutrophils and Gram positive cocci. 1. What is the rash? 2. What causes it? 3. How do you treat it?

29. Staphylococcal pustulosis 3-5 mm pustules, some ruptured and drying with a collarette of scale

30. A 10-year-old boy developed asymptomatic relapsing and remitting hypopigmented minimally scaly patches on his facial cheeks. 1. What is the rash? 2. What causes it? 3. How do you manage it?

31. Pityriasis alba hypopigmented patch with fine scale

32. A healthy adolescent developed a large scaly red patch on the back followed a week later by a widespread papulosquamous eruption. The lesions were primarily truncal and only minimally pruritic. 1. What is the rash? 2. What causes it? 3. How do you mange it and what is the expected outcome?

33. Pityriasis rosea symmetric oval 0.5-3.0 cm red patches with central trailing scale

34. Pityriasis rosea multiple widespread round to oval 1-3 cm almost confluent plaques

35. An 18-year-old boy was evaluated for facial acne. He had multiple open and closed comedones and a few red papules and pustules on his malar and temporal areas. 1. What causes acne vulgaris? 2. What are the different types? 3. How do you manage it?

36. Acne vulgaris open and closed comedones

37. Acne vulgaris symmetric grouped uniform 2 mm papules with a central dark scaly core

38. Acne vulgaris multiple symmetric deep tender nodules, violaceous cysts, pustules, and comedones. BEFORE Rx (isotretinoin)

39. Acne vulgaris symmetric grouped uniform 2 mm papules with a central dark scaly core. AFTER

40. A 17-year-old boy complained of dry scaly sandpaper like papules on the extensor surfaces of his upper arms and thighs for as long as he could remember. His father had similar lesions. 1. What is the rash? 2. What causes it? 3. How do you manage it?

41. Keratosis pilaris symmetric sandpaper like follicular papules

42. Keratosis pilaris symmetric red sand paperlike follicular papules

43. An 8-year-old boy demonstrated an annular scaly plaque on the neck extending into the scalp with broken hairs and a prominent right occipital lymph node. 1. What is the rash? 2. What causes it? 3. How do you treat it?

44. Tinea capitis annular scaly plaque with occipital adenopathy

45. Tinea capitis

46. ID reaction / autoeczematization / Tinea capitis patches of scale and erythema over neck and trunk with pruritic pustules

47. Tinea capitis / kerion boggy occipital area

48. ID reaction

49. A 10-year-old boy developed an expanding annular plaque on the anterior neck. A potassium hydroxide preparation showed branching hyphae. 1. What is the rash? 2. What causes it? 3. How do you treat it?

50. Tinea corporis concentric red scaly annular plaques