Common pediatric skin rash
-
Upload
sahar-kamal -
Category
Health & Medicine
-
view
471 -
download
4
Transcript of Common pediatric skin rash
Common dermatology terms
Macule: circumscribed change in skin color without elevation or
depression.
Papule: solid elevated lesion usually <0.5 cm in diameter.
Plaque: raised lesion >0.5cm in diameter
Wheal (hive): rounded or flat-topped elevated lesion formed by local
dermal edema.
Purpura: non-blanching erythema or violaceous color due to
extravasation of blood.
Nodule: palpable solid lesion of varying size
Vesicle: circumscribed elevated lesion which contains free fluid and is
<0.5 cm in diameter
Bulla (blister): same as vesicle but with diameter >0.5 cm.
Cyst: sac containing liquid or semisolid material usually in the dermis.
Pustule: circumscribed elevated lesion which contains pus
Abscess: collection of pus in the dermis or subcutis.
Primary skin lesions
Erythema Toxicum Neonatorum
Huge 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. .
Erythema Toxicum Neonatorum
Prickly heat, sweat rash.
Many red macules with central papules, vesicl
es or pustules are present.
These may be on the trunk, diaper area, head
or neck.
Miliaria
Miliaria
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.
Subcutaneous Fat Necrosis
Subcutaneous Fat Necrosis
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
Infantile Atopic Dermatitis
Infantile Atopic Dermatitis
Infantile Atopic Dermatitis
Avoidance or elimination of predisposing
factors.
Hydration and lubrication of dry skin.
Anti-pruritic agents.
Topical steroids.
Eczema- Treatment
Common, generally self-limiting.
Its cause remains ill-understood.
There is a genetic predisposition.
Most frequent between the ages of 1:6 mo.
Greasy, salmon-colored scaling eruption.
Hair-bearing and intertriginous areas.
The rash causes no discomfort or itching.
Seborrheic Dermatitis
Seborrheic Dermatitis
Seborrheic Dermatitis
Anti-seborrheic shampoo
Topical steroids
Seborrheic Dermatitis-
Treatment
Starts off in the deep flexures which show wide
spread erythema on the buttocks-beefy red color.
There are also raised edge, sharp marginization
and white scale at the border of lesions, with pin
point pustulo-vesicular satellite lesions
Candidal 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
Seborrheic 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
Irritant Dermatitis
Variola viruses ,Fatality 40 %.
First invades upper respiratory tract.
From lymph nodes it spreads via hematogenousspread.
Chills, fever, headache, delirium, SZ.
Face to upper arms and trunk, and finally to lower legs
Smallpox- Variola
Herpes virus varicellae
Incubation period 10-21 days
Fever, malaise, cough, irritability, pruritus
Papules vesicles crusting
Spreads centripetally
Chickenpox-Varicella
Complications:
Bacterial superinfection
CNS involvement
Pneumonia
Hepatitis, arthritis
Reye’s syndrome
VZIG
Varicella
Oral acyclovir- indications:
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
Varicella
Treatment
VZIG (1 vial/5 kg IM) :
Pts on high dose steroids
Immunocompromised
Pregnant women
Newborns exposed 5 days prior to birth and 2 days
after delivery
Neonates born to nonimmune mothers
Varicella
Post exposure
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.
Measles
Immunoglobulin therapy- indications
All susceptible contacts
Infants 5 mo. To 1 year of age
Immunocompromised
Pregnant women
Live measles virus vaccine- contraindication
Immunocompromised
Pregnancy
Allergy to eggs
Measles
Post exposure
German Measles.
Epidemic nature.
Winter-spring.
Prodrome.
Face neck trunk.
Lymphadenopathy.
Serologic testing.
Rubella
Enteroviruses
coxsackieviruses A and B
echoviruses
Vesicular lesions, may be petechial.
Associated with aseptic meningitis, myocarditis
Hand-Foot-Mouth Disease
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
Erythema Infectiosum
Roseola Infantum(HHV-6B)
Children 6-19 months
Abrupt onset of high fever
Febrile seizures
Rash develops after fever dissipates
Mainly on trunk
Exanthem Subitum
Acute, self limited illness
Epstein-Barr virus
Oral transmission – incubation 30-50 days
Fever, fatigue, pharyngitis, LA, splenomegaly,
atypical lymphocytosis
Exanthem is seen in 10-15%
Erythematous, maculopapular, morbilliform,
scarlatiniform, urticarial, hemorrhagic, or even
nodular
Infectious Mononucleosis
Superficial infection of the dermis
Two types:
Impetigo contagiosa
Bullous impetigo
Etiology
Group A ß hemolytic streptococcus
Coagulase positive S. aureus
Treatment : B-lactam ABs, erythromycin
Impetigo
Toxin producing strain of group A -hemolytic
streptococcus
Strep pharyngitis with systemic complaints
Rash from neck to trunk to extremities
Sandpaper feel, erythema, warmth
White and red strawberry tongue
Petechiae in linear form
Treatment :penicillin or amoxicillin
Scarlet Fever
Usually sudden onset of fever,chills, myalgia,and
arthralgia
Rash is macular, nonpruritic, erythematous
lesions
Petechial rash develops in 75% of cases
Neisseria meningitides
Fever, rash, hypotension, shock, DIC
Treatment: PCN G
Meningococcemia
Most common rickettsial infection in US
Abrupt fever, headache, and myalgia
Rash from extremities towards trunk
Macules petechiae
Treatment
Tetracycline
Doxycycline
Chloramphenicol
Rocky Mountain Spotted Fever
No clear etiologic agent, often post viral
2-10 years of age
Palpable purpura over the buttocks and LE
Transient migratory arthritis
Renal and GI involvement
Henoch-Schnlein Purpura
Unknown etiology
Peak incidence 18-24 months
Clinical findings:
Fever for at least five days
Conjunctivitis
Polymorphous rash
Oral cavity changes
Cervical adenopathy
Kawasaki Syndrome