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Emergencies in Pediatric Dermatology

Emergencies in Pediatric Dermatology. Ayelet Shani Adir, M.D. Pediatric Dermatologist Haemek Medical Center. Dermatology in Emergency Medicine. Widespread skin involvement (massive trans-epidermal loss) Skin findings as clues for diagnosis. Case 1. 15 months old healthy infant

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Emergencies in Pediatric Dermatology

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  1. Emergencies in Pediatric Dermatology Ayelet Shani Adir, M.D. Pediatric Dermatologist Haemek Medical Center

  2. Dermatology in Emergency Medicine • Widespread skin involvement (massive trans-epidermal loss) • Skin findings as clues for diagnosis

  3. Case 1 • 15 months old healthy infant • Fever, malaise and skin tenderness for the past 3 days

  4. SSSSStaphylococcal Scalded Skin Syndrome • Occurs mainly in infants and young children (<5 years) • Malaise, fever, generalized macular erythema with tenderness of skin • Exfoliation with exudation and crusting around mouth, eyes and nose • Diagnosis- Tzanck smear and bacterial cultures

  5. SSSS: Clinical Findings • Generalized erythema with flexural accentuation • Skin tenderness • Flaccid bulla in skin folds • Positive Nikolsky’s sign • Desquamation

  6. SSSS: Therapy • Maintain fluid status • Intravenous anti-staphylococcal antibiotics • Prevent secondary infection

  7. Case 2 • 11 year old healthy girl • Generalized skin eruption with bullae • Two weeks before: UTI treated with Resprim for 8 days, later switched to Zinnat

  8. Physical Examination • Febrile, 390 C • Generalized maculo-papular rash on skin, erosions on oral mucosa and eyes • Large tense bulla on skin

  9. Toxic Epidermal Necrolysis Nikolsky’s Sign

  10. SJS and TEN • Incidence: 0.4-1.2 cases per million per year • SJS: detachment of <10% BSA with widespread targetoid lesions • SJS-TEN overlap: 10-30% detachment • TEN: >30% detachment

  11. SJS and TEN • Prodromal period of 1-14 days with fever, cough, coryza, sore throat, myalgia • Extensive erosions of mucous mebranes: oropharynx, eyes, genitalia, rectum • Variable skin involvement

  12. SJS-TEN Therapy • Prompt discontinuation of suspected drug • PICU • Wound care: nonstick dressings, debridement • Ophthalmologic intervention • Hydration, electrolyte balance, nutritional support, pain control

  13. SJS-TEN Therapy • Use of systemic corticosteroids is controversial • High-dose IVIG (inhibit Fas-mediated apoptosis) 0.4-2 gr/kg/d for 2-5 days

  14. Hypersensitivity Syndrome Drug Rash with Eosinophila and Systemic Symptoms (DRESS Syndrome) • Severe multi-organ reaction • Fever, rash, Lymphadenopathy and hepatitis • Anticonvulsants, sulfa antibiotics • 1:10000 exposures

  15. Dress Syndrome • Immediate withdrawal of suspecteddrug • Close monitoring of liver and kidney functions • Corticosteroids 1-2 mg/kg • IVIG

  16. Skin Findings as Clues for Diagnosis purpuric, necrotic lesions ofMeningococcemia • Systemic infections • Kawasaki’s Disease • Child Abuse Condyloma acuminata

  17. תודה רבה

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