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Pediatric Dermatology

Pediatric Dermatology. Mary Tedesco-Schneck MSN, CPNP. Objectives. Discuss the basic physiology of skin Identify primary & secondary lesions Understand the standards of care for some common pediatric dermatological conditions Discuss prevention strategies. Physiology of Skin.

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Pediatric Dermatology

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  1. Pediatric Dermatology Mary Tedesco-Schneck MSN, CPNP

  2. Objectives • Discuss the basic physiology of skin • Identify primary & secondary lesions • Understand the standards of care for some common pediatric dermatological conditions • Discuss prevention strategies

  3. Physiology of Skin

  4. Epidermal appendages • Hair/Hair Follicle: Facilitates evaporative H2O; warmth /protection • Nails: Protect distal phalanges • Sebaceous glands: Produces sebum (complex blend of lipids) stimulated by androgenic hormones; decreases H2O loss; largest glands are found in the face, scalp, upper back, and chest

  5. Epidermal appendages • Eccrine glands: Sweat glands help regulate body temperature through evaporative H2O loss; remove urea, ammonia from the tissue; contain IG. • Apocrine glands: Sweat glands extend deeper into the dermis than eccrine glands; found in face, scalp, axillary, and anogenital regions.

  6. Definition Primary Lesions Secondary Lesions • De novo • Earliest lesions to appear • Changes either from an external factor or the natural evolution of the lesion

  7. Primary Lesions Less than 1 cm Greater than 1 cm • Macule • Papule • Vesicle • Pustule • Nodule • Patch • Tumor • Bulla • Abscess • Plaque

  8. Table 1. Common Primary Lesions4 Modified from Toronto Notes 2010 Retrieved from: http://learnpediatrics.com/

  9. Macule: Flat & < 1 cm

  10. Papule: Raised & < 1 cm

  11. Vesicle: Fluid filled & < 1 cm

  12. Pustule: Purulent fluid & < 1 cm

  13. Nodule: Raised solid & < 1 cm • Distinct borders • Neurofibroma • Greatest mass is below the skin surface

  14. Patch: Flat & > 1 cm • Café au lait • Tinea versicolor

  15. Plaque: Raised & > 1 cm • Solid raised flat-topped lesion. • May show epidermal changes.

  16. Tumor: Solid & > 1 cm • Raised and solid • Greatest masses below the skin surface.

  17. Bulla: Fluid filled & > 1 cm

  18. Abscess: Purulent d/c & > 1 cm Circumscribed, elevated lesion

  19. Secondary Lesions • Crusts • Erosions • Scale • Atrophy • Excoriations • Fissures • Ulcers

  20. Crusts Dried exudate composed of serum, blood, or pus

  21. Erosion vs. Excoriation • Erosion: loss of the surface of the epithelial i.e. un-roofing of a vesicle or bulla • Excoriation: an erosion with loss of the epidermis in an angular configuration related to picking

  22. Erosion Excoriation

  23. Fissures Linear breaks in the skin often down to the dermis; often result from excessive xerosis

  24. Ulcers Full thickness loss of epidermis extending into the dermis (e.g. aphthous ulcer)

  25. Scale (ichthyosis) Desiccated plates of keratin (fibrous structural protein of the epidermis) results from: • Increased shedding • Proliferation

  26. Scar Fibrotic skin changes as a result of tissue injury

  27. Atrophy • Epidermal: wasting away of the epidermis (e.g. wrinkling, increased underlying vascular prominence) • Dermal: reflects loss of fat or subcutaneous tissue (e.g. see this with intra-lesional steroid injection)

  28. Morphology • Mobile versus immobile • Hard versus soft • Fluctuant • Sclerosed • Compressible • Diffuse verus well-demarcated

  29. Color of Lesion • Red: vasodilation or hyperemia • Blanching: vasodilation • Non-blanching: vascular damage with extravasations of blood in dermis (petechiae, purpura) • White: de-pigmentation or hypo-pigmentation • Yellow: lipid accumulation or bile • Brown/Black/Blue/Grey: related to ↑melanin or blood/blood byproducts

  30. Configuration of the lesions • Annular • Nummular

  31. Distribution • Generalized • Grouped • Linear

  32. Distribution • Acral • Extensor • Flexor

  33. Distribution • Symmetrical

  34. Blaschko lines vs Dermatome

  35. Additional Terminology • Lichenification: thickening of the epidermis with exaggerated skin markings; caused by chronic scratching • Xerosis: dry • Polymorphous: More than one primary lesion

  36. Additional Terminology • Umbilicated: central depression • Verrucous: warty • Pedunculated: stalk • Flat-topped

  37. Skin Color • Melanin producing cells in the stratum basale epidermis • Melanin absorbs and scatters solar radiation.

  38. Melanogenesis: The process by which melanocytes produced melanin. • Light-skinned people: lower levels of melanogenesis. • Melanogenesis: stimulated by exposure to UV-B radiation. • Melanin produced by melanogenesis is dark and absorbs and blocks UV-B radiation from going deeper into the skin layers. • Other factors stimulate melanogenesis such as hormones, medications.

  39. Evolution of Skin Type We have different skin colors related to how close we are to the equator because dark skin is protective of UV light.

  40. Type I

  41. Type II

  42. Type III

  43. Type IV

  44. Type V

  45. Type VI

  46. Common Dermatological Disorders • Atopic Dermatitis • Psoriasis • Acne • Hemangioma • Nevi

  47. Atopic Dermatitis

  48. Characteristics • Transepidermal H2O loss (skin barrier dysfunction) • Intense itchy • Cutaneous inflammation

  49. Precedes other atopic diseases ATOPIC MARCH • Asthma • Food allergies • Allergic rhinitis

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