Common Pediatric Skin and Soft Tissue Conditions

1. Common Pediatric Skin and Soft Tissue Conditions Sirous Partovi, M.D.

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.

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.

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

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

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

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

19. Seborrheic Dermatitis-Treatment • Anti-seborrheic shampoo • Topical steroids

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

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

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

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

32. Viral Exanthems

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

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 • Reye’s syndrome • VZIG

38. 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

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 < 28 weeks’ gestation

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 • <5 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

46. Hand-Foot-Mouth Disease • Enteroviruses • coxsackieviruses A and B • echoviruses • Vesicular lesions, may be petechial • Associated with aseptic meningitis, myocarditis

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

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