Dermatological disorders in children

1. Dermatological disorders in children • Debbie King NP

2. Roseola • High Human herpes virus 6 • fever • Followed by rash • Age 6mo-4yr • Lasts 6 days • Supportive care

3. Roseola

4. Fifths Disease

5. Fifths Disease • Parvovirus B19 • Ages 5yr-14yr • Slapped cheeks • Fever, malaise, itching, joint pain • Fishnet like body rash • Risks • No TX • Rash comes and goes

6. Scarlatina

7. Scarlatina • Strep rash • Sandpaper feel • Pastia’s lines • Also known as scarlet fever

8. Impetigo

9. Impetigo • Common • Contagious • Staph or strep • Golden crusty scabs • TX- review Bactroban or Keflex

10. MRSA- in the community • March 26, 2010 (Atlanta, Georgia) — Nasal application of 2% mupirocin and bleach baths were found to be more effective at eradicating Staphylococcus aureus colonization than other interventions, according to the findings of a randomized trial. • Bernard C. Camins, MD, from the Division of Infectious Diseases at the Washington University School of Medicine in St. Louis, Missouri, reported the findings here at the Fifth Decennial International Conference on Healthcare-Associated Infections 2010.

11. Bleach Bath • Start by adding lukewarm water to fill a tub for a normal bath (about 40 gallons). • 2. Put 1/4 to 1/2 cup of common liquid bleach (for example, Clorox) into the bath water. Check the bleach bottle to make sure that the concentration of bleach (also known as sodium hypochlorite) is about 6%. • 3. Completely mix the added bleach in the water. This should create a solution of diluted bleach (about 0.005%), which is just a little stronger than chlorinated swimming pool water. • 4. Soak in the chlorinated water for about 10 minutes. • 5. Thoroughly rinse the skin clear with lukewarm, fresh water at the end of the bleach bath. • 6. As soon as you're finished rinsing off, pat dry. Do not rub dry as this is the same as scratching! • 7. Immediately apply any prescribed medication and/or emollients. • 8. Repeat bleach baths 2 to 3 times a week or as prescribed by the physician. • The following restrictions may apply: • Do not use undiluted bleach directly on the skin. Even diluted bleach baths can potentially cause dryness and/or irritation. • Do not use bleach baths if there are many breaks or open areas in the skin (for fear of intense stinging and burning) • Do not use bleach baths in patients with a known contact allergy to chlorine

12. Itching Rashes • Assess for: ITCHING • Idiopathic/psychogenic • Thyroid • Cancer • Herpes • Neuropathy/nephro • Gestational • Diabetes • Xerosis or dry skin

13. Rhus dermatitis

14. Rhus dermatitis • Findings vary • Pruritus • Edematous • Linear • Vesicles • TX with topical steroids or PO- PRN

15. Contact Dermatitis

16. Contact Dermatitis • ID of cause is essential • TX 2 weeks with topical steroid • http://www.medscape.com/viewarticle/586561?src=mp&spon=24&uac=101832MV

17. Eczema

18. Eczema • Eczematous inflammation • Erythema • Edema • Vesiculation • Pruritus • Supportive care • Steroids • Immune Modulators • Elidel/Protopic – 2 years or older BLACK BOX since 2007 • March 2010- Agency scientists said 46 cancer cases and 71 infection cases have been reported in patients aged 16 and younger from 2004 to 2008 with Novartis' Elidel and Astellas' Protopic. • Both drugs -- also known as pimecrolimus and tacrolimus respectively -- already carry strong warnings about cancer and infection, but officials should consider expanding them to include the new post-marketing reports, they wrote. • The documents were released ahead of an FDA advisory meeting Monday to weigh potential safety concerns with a variety of drugs used in younger patients.

19. Urticaria

20. Urticaria • Transient • Edematous • Red plaques- acute or chronic • No tests • Supportive care • Benadryl • Zyrtec etc. • Po steroids PRN

21. Erythema Multiforme

22. Erythema Multiforme • Lesions look like targets • Bullae develop in severe forms • Caused by medication or infections • Watch close • May TX with op steroids • Severe cases hospitalized

23. Mastocytoma

24. Mastocytoma • Solitary plaque • Red brown • Slightly raised • Stroking lesions induces intense erythema and a wheal (Darier sign) • Usually clears by puberty • FYI: mastocytosis is a systemic disease

25. Cafe au lait spots

26. Cafe au lait spots • Light colored to brown • Macules • Birth- months • Size and number increase with age • 6 or more over 5 mm is associated with neurofibromatosis

27. Neurofibromatosis

28. Neurofibromatosis • Cafe au lait > 6 • Axillary or inguinal freckling • Nodules • Refer to opthomology • Hearing evaluation • Wilms tumor • Renal artery stenosis • Refer to neurofibromatosis clinic

29. Stevens Johnson's

30. Stevens Johnson's • Sudden onset • Caused by herpes simplex, mycoplasma, and drugs (50% drugs) • Lesions variable • Dusky purple target lesions • Flu-like symptoms • Supportive treatment usually in the hospital

31. Halo Nevus

32. Halo Nevus • White depigmented halos surround nevi • Nevi may disappear • Oval or round • Around any type of nevi • Occurs primarily during adolescence

33. Sebaceous Nevus

34. Sebaceous Nevus • Distinctive congenital lesion • Usually present at birth • Usually a single lesion • Linear to oval/ Plaque 1-3 cm • 3 stages- corresponds with maturation • Excision just before puberty is recommended • FYI-A triad of sebaceous nevus, epilepsy and metal retardation is rare.

35. Miliaria

36. Miliaria • Small • Superficial • Keratin cyst with no visible opening • No treatment

37. Tinea Capitis

38. Tinea Capitis • Diffuse or patchy fine white adherent scales • Hair loss • Resembles dandruff • KOH test • TX- long term with Po med -1st line is still griseofulvin for 12 weeks -use along with a sulfide shampoo reduces spreading by reducing viable spores -new treatments now being studied Newer antifungal medications, such as ketoconazole, itraconazole, terbinafine, and fluconazole, have been reported as effective alternative therapeutic agents for tinea capitis. Of these agents, itraconazole and terbinafine are used most commonly.

39. Kerion

40. Kerion • One or more inflamed boggy tender areas of alopecia with pustules • Represents an exaggerated host response • May have fever and adenopathy • Caused by tinea capitis • TX based on clinical appearance • Steroids rarely helpful

41. Tinea Corporis

42. Tinea Corporis • Flat scaly spot with central clearing • Raised boarder • Usually mild with children • TX- topically Spectazole

43. Tinea Versicolor

44. Tinea Versicolor • Common • Usually asymptomatic • Small circular white macules on upper trunk • TX- Selsun blue

45. Tinea Pedis

46. Tinea Pedis • May present with classic ring worm pattern • Mostly found between toes • Sole can be covered with silvery scales • TX- with children • Topical • OTC

47. Blepharitis

48. Blepharitis • Scale of the lids at lash line • Treat with baby shampoo • FYI- chronic blepharitis may indicate cancer of the tissue at the lash line- refer!

49. Hemangioma

50. Hemangioma • Red to purple dermal nodular lesion • Appear as a pale patch in 1st month of life • Enlarges for first year • Soft or moderately firm • Does not blanch • Disappears by age 5 • Location is important • Eye lid, lip, spine