TREAT PEDIATRIC SKIN CONDITIONS

1. TREAT PEDIATRIC SKIN CONDITIONS Unit 4: Part 3 Module 1

2. REFERENCES E.O. 021.08, 021:09 and 021:11 Nelson�s Essentials of Pediatrics Color Atlas/Synopsis of Clinical Dermatology Class Handout

3. OUTLINE Assessment Of Skin Problems Birth Marks Dermatitis Itchy Eruptions Bacterial Infections Steven�s- Johnson Syndrome Pediculosis

4. ASSESSMENT OF SKIN PROBLEMS Relevant History: - Onset, description of lesion/eruption at onset Duration, how has it changed over time, is today a typical day (better/worse), time of day worse Has lesion/eruption blistered, bled, or drained Distribution, spread Itchy, painful,known triggers Associated S&S- e.g. fever Aggravating/relieving factors- home remedies

5. ASSESSMENT OF SKIN PROBLEMS Past Medical History Prior episodes of this or other skin problems Hx. Of chronic infections e.g cutaneous, otits, sinusitis Atopy- Allergies- food, drugs, seasonal, environmental, asthma Family History Skin disease, skin cancers, Atopy Social - Others at home or school or daycare with similar S&S

6. BIRTH MARKS Mongolian Spots Caf�-au-lait spots Hemangiomas Capillary (strawberry) Cavernous Vascular malformations Transient macular stains (Salmon patches) Port wine stains

7. MONGOLIAN SPOTS Mongolian blue spots are flat bluish- to bluish-gray skin markings commonly appearing at birth or shortly thereafter They appear commonly at the base of the spine, on the buttocks and back and also can appear on the shoulders Mongolian spots are benign and are not associated with any conditions or illnesses Gradually disappear Seen commonly in Oriental. Inuit, Indian and Black childrenSeen commonly in Oriental. Inuit, Indian and Black children

8. MONGOLIAN SPOTS WWW. Google.ca- ImagesWWW. Google.ca- Images

9. CAF�-AU-LAIT SPOTS May be present at birth but most develop later in infancy Brown macule or patchy lesion Location variable-trunk Up to 5 lesions may be a normal variation 6 or more lesions (> 0.5 cm ) is suggestive of neurofibromatosis

10. CAF�-AU-LAIT SPOTS WWW.google.ca-ImagesWWW.google.ca-Images

11. HEMANGIOMAS These may begin as flat, pale white spots and later become larger and elevated, bright red, non compressible Range from few mm to several cm in size Usually solitary Predominate in females 3:1 55% present at birth, rest develop later Common soft tissue tumour in infancy Occurs in 5-10% of 1 year old Superficial ones reach maximal size at 6-8 months Deep hemagiomas can grow for 18-24 monthsCommon soft tissue tumour in infancy Occurs in 5-10% of 1 year old Superficial ones reach maximal size at 6-8 months Deep hemagiomas can grow for 18-24 months

12. HEMANGIOMAS Superficial -capillary (strawberry)hemangioma Deep ones - cavernous are soft warm masses that lie deeper in in skin with a slightly bluish discoloration Hemangiomas often go away (involute) spontaneously over 3-10 years A small number cause complications � functional and cosmetic disfigurement Oral systemic steroids are the mainstay of RX if complications arise Ulceration is complication- can lad to infection, hemorrhage and scarring Ulceration is complication- can lad to infection, hemorrhage and scarring

13. HEMANGIOMAS Worrisome Ones: Peri-orbital � risk to vision ( amblyopia) Ear � may decrease auditory conduction, speech delay Multiple cutaneous and large facial ones may be asssociated with visceral hemagiomas Subglottic hemangiomas � hoarseness, stridor, respiratory failure Extensive cervicofacial hemangiomas may be associated with multiple anomalies(PHACES syndrome) Lumbrosacral- suggests an occultspinal dysrahism with or without anorectal.urogenitial anomalies Noisy breathing in an infant with hemangioma involving the chin, lips, mandibular region and neck warrants direct visualization of airway Lumbrosacral � imaging of spine is indicated in all patients with midline cutaneous hemagiomaas in the lumbrosacral areaNoisy breathing in an infant with hemangioma involving the chin, lips, mandibular region and neck warrants direct visualization of airway Lumbrosacral � imaging of spine is indicated in all patients with midline cutaneous hemagiomaas in the lumbrosacral area

14. HEMANGIOMAS PHACES syndrome P- posterior fossa malformations H- hemangiomas A - arterial anomalies C- co-arctation of aorta/cardiac defects E- eye abnormalities Females affected 9:1 Developmental field defect that occurs in week 8-10 weeks of gestation Strokes are commonFemales affected 9:1 Developmental field defect that occurs in week 8-10 weeks of gestation Strokes are common

15. HEMANGIOMASCapillary (strawberry) www.google.ca/Imageswww.google.ca/Images

16. CAVERNOUS HEMANGIOMAS www.merck.com www.google/ca/Images ades.tmu.edu.tw www.merck.com www.google/ca/Images ades.tmu.edu.tw

17. CAVERNOUS HEMANGIOMAS www.google/ca/Images ades.tmu.edu.tw www.google/ca/Images ades.tmu.edu.tw

18. VASCULAR MALFORMATIONS Transient macular stains (Salmon patches) Present in up to 70% of newborns Found on eyelids, nape of neck, glabella Most fade by one year of age Those in nape of neck persist in 25% of adults

19. VASCULAR MALFORMATIONS Transient macular stains (Salmon patches)

20. VASCULAR MALFORMATIONS Port -Wine stain (nevus flammeus) Malformations of superficial capillaries of skin Facial lesions most common Present at birth and are permanent Variable in size Do not proliferate after birth, but enlarge as child grows

21. VASCULAR MALFORMATIONS Port -Wine stain (nevus flammeus) Lesions are pinkish/red macules, well defined edges in infancy Lesions darken to purple and may develop a pebbly or slightly thickened surface with time Laser therapy may help fade the lesion, best done in infancy Most are uncomplicated If lesion are around eye innervated by Branch1 of trigeminal nerve � need ophthalmology assessment /neuroimaging

22. VASCULAR MALFORMATIONS Port wine stains

23. DERMATITIS Tinea capitis Tinea corporous ( ringworm) Diaper dermatitis Seborrheic dermatits of scalp( cradle cap) Atopic ( eczema)

24. TINEA CAPITIS 

30. DIAPER DERMATITIS Erythema, edema with papular and pustular lesions +/- erosions, oozing, scaling at the margins of lesions Areas involved include the perigenital, perianal skin, inner aspects of thighs and buttocks Caused by contact irritation and candidiasis DDx: atopy, psoriasis, irritant dermatitis, seborrheic dermatitis

31. DIAPER DERMATITIS

32. DIAPER DERMATITIS

33. DIAPER DERMATITIS RX - Keep area dry � expose to air - Antifungal creams and suppositories until rash clears e.g. miconazole cream bid - Systemic antifungals e.g. nystatin- rarely

34. SCALP SEBORRHEIC DERMATITIS(Cradle Cap) Cradle cap is a crusting and scaling rash found on the scalps of many healthy babies The sebaceous glands in their skin are hyperactivated often because of mom�s hormones that crossed the placenta just before birth These glands pump out a greasy substance that keeps the old skin cells attached as it dries Cradle cap is a specific timing and location of seborrhea We are constantly making new skin cells at about the rate that we lose old, dry skin cells. The old skin falls off and we usually don't even notice the process. In many healthy infants, the skin cells on their scalp grow faster than they can fall off, leaving a layer of somewhat crusty, extra skin. We are constantly making new skin cells at about the rate that we lose old, dry skin cells. The old skin falls off and we usually don't even notice the process. In many healthy infants, the skin cells on their scalp grow faster than they can fall off, leaving a layer of somewhat crusty, extra skin.

35. SCALP SEBORRHEIC DERMATITIS(Cradle Cap) Cradle cap can occur in any baby, and most commonly begins sometime in the first 3 months Cradle cap is gone by 8 to 12 months and often long before that It is not common after the first year of life until the teen years when hormone levels rise and rapid growth returns Teens often have a similar scalp condition patchy scales and redness on the scalp, even though the early baby pictures showed beautiful baby skin. The scales may appear cracked, greasy, or even weeping.The same rash is often prominent around the ear or the eyebrows patchy scales and redness on the scalp, even though the early baby pictures showed beautiful baby skin. The scales may appear cracked, greasy, or even weeping.

36. SCALP SEBORRHEIC DERMATITIS(Cradle Cap) RX - Baby oil /olive oil to soften/loosen scales - Soft brush or dry terry cloth to brush away - Over 6 months may use medicated shampoo for seborrheic dermatitis e.g Ketoconazole (Nizoral) - Mild topical low potency steroid lotion if red/inflamed for short periods The gentlest treatment is to simply rub a small amount of baby oil or olive oil onto your baby's scalp. Wait several minutes for the oil to soften and loosen the scales, and brush them away with a soft brush or a dry terry-cloth washcloth.If the cradle cap is especially pronounced, or if baby is over six months old, wash the hair with a seborrhea shampoo, such as those containing selenium, salicylic acid, or tarIf the cradle cap is especially reddened or inflamed, a small amount of over-the-counter cortisone cream may helpThese measures may be needed, off and on, until the baby outgrows the condition The gentlest treatment is to simply rub a small amount of baby oil or olive oil onto your baby's scalp. Wait several minutes for the oil to soften and loosen the scales, and brush them away with a soft brush or a dry terry-cloth washcloth.If the cradle cap is especially pronounced, or if baby is over six months old, wash the hair with a seborrhea shampoo, such as those containing selenium, salicylic acid, or tar

40. ATOPIC ( ECZEMA) www.emedicine.comwww.emedicine.com

43. BACTERIAL INFECTIONS Impetigo Furuncle/carbuncle Cellulitis Staphylococcal scalded skin syndrome (SSSS)

45. IMPETIGO

50. STAPHYLOCOCCAL SCALDED SKIN SYNDROME (SSSS)

54. 

55. CELLULITIS Treatment: Antibiotics First line: cephalexin 50-10mg/kg/day, divided q6h PO Second line: cloxacilin or clindamycin PO for mild Cefuroxime IV for facial and Cefazolin IV +/- clindamycin for severe

56. Etiology: most commonly Staph aureus If recurrent: R/O diabetes or hidradenitis suppurativa (groin or axillae) Etiology: most commonly Staph aureus If recurrent: R/O diabetes or hidradenitis suppurativa (groin or axillae)

60. Sheet-like epidermal detachment in <10% mucous membrane involvement and blistering Atypical lesions��red circular patches with dark purple centers Sites: Generalized with prominent face and trunk involvement May have palm/sole sparing Sheet-like epidermal detachment in <10% mucous membrane involvement and blistering Atypical lesions��red circular patches with dark purple centers Sites: Generalized with prominent face and trunk involvement May have palm/sole sparing

61. STEVEN�S- JOHNSON SYNDROME http://www.imi.org.uk/dec1997/gary.jpghttp://www.imi.org.uk/dec1997/gary.jpg

62. STEVEN�S- JOHNSON SYNDROME http://www.uspharmacist.com/ce/stevensjohnson/SJS1.jpghttp://www.uspharmacist.com/ce/stevensjohnson/SJS1.jpg

63. High fever, irritability, anorexiaHigh fever, irritability, anorexia

65. HEAD LICE Treatment in Children Nix cream rinse under 6 years No Lindane based products Head Lice � Review 021.08

66. SCABIES Treatment in Children Permethrin 5% dermal cream � single application Safety under 3 months not established Benadryl 1.25mg.kg PO q4-6h prn ( mav. 300 mg day Topical steroids after scabicide Rx may be useful if rash/itch persist Review E.O. 021.08