PAEDIATRIC DERMATOLOGY. OBJECTIVES Common paediatric dermatologic conditions Common paediatric...
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Transcript of PAEDIATRIC DERMATOLOGY. OBJECTIVES Common paediatric dermatologic conditions Common paediatric...
PAEDIATRIC PAEDIATRIC DERMATOLOGYDERMATOLOGY
OBJECTIVESOBJECTIVES
Common paediatric dermatologic Common paediatric dermatologic conditionsconditions
Dermatologic presentation of Dermatologic presentation of systemic diseasesystemic disease
Conditions which may require Conditions which may require urgent/emergent managementurgent/emergent management
ASSESSMENT OF SKIN ASSESSMENT OF SKIN PROBLEMSPROBLEMS
HistoryHistory
DESCRIBE WHAT YOU SEE!DESCRIBE WHAT YOU SEE!
ASSESSMENT OF SKIN ASSESSMENT OF SKIN PROBLEMSPROBLEMS
HistoryHistoryOnset, progression, changeOnset, progression, change
blister, bleed, drainblister, bleed, drainDistributionDistributionDurationDurationAggravating/relieving factorsAggravating/relieving factorsItch, pain, triggersItch, pain, triggersTreatmentTreatmentAssociated S & S e.g. feverAssociated S & S e.g. fever
ASSESSMENT OF SKIN ASSESSMENT OF SKIN PROBLEMSPROBLEMS
Past Medical HistoryPast Medical HistoryAsthma, atopyAsthma, atopyIllnessesIllnesses
AllergiesAllergiesFood, drugs, seasonal, environmentalFood, drugs, seasonal, environmental
ASSESSMENT OF SKIN ASSESSMENT OF SKIN PROBLEMSPROBLEMS
Family HistoryFamily HistorySkin diseaseSkin diseaseSystemicSystemic
SocialSocialOthers affected at home, school or Others affected at home, school or
daycaredaycareCrowding, povertyCrowding, poverty
5 ITCHES5 ITCHES
1.1. DermatitisDermatitis
2.2. VaricellaVaricella
3.3. UrticariaUrticaria
4.4. ScabiesScabies
5.5. Insect bitesInsect bites
DERMATITISDERMATITIS
Itching, redness, swelling, oozing, Itching, redness, swelling, oozing, scabbing, scaling, lichenification, scabbing, scaling, lichenification,
++blistersblisters
DERMATITISDERMATITIS
Atopic (eczema)Atopic (eczema)Diaper dermatitisDiaper dermatitisSeborrheic dermatitis (cradle cap)Seborrheic dermatitis (cradle cap)
ATOPIC DERMATITIS ATOPIC DERMATITIS (ECZEMA)(ECZEMA)
Site:Site:Infant - face, scalp, extensor surfacesInfant - face, scalp, extensor surfacesChild - flexor surfacesChild - flexor surfaces
FH atopy (asthma, hayfever, FH atopy (asthma, hayfever, anaphylaxis, allergies)anaphylaxis, allergies)
Inheritance:Inheritance:1 parent >60%1 parent >60%2 parents >80%2 parents >80%
ATOPIC DERMATITIS ATOPIC DERMATITIS (ECZEMA) (ECZEMA)
ATOPIC DERMATITIS ATOPIC DERMATITIS (ECZEMA)(ECZEMA)
Complications:Complications:Secondary bacterial infectionsSecondary bacterial infectionsEczema herpeticum (herpes infecting Eczema herpeticum (herpes infecting
the lesionsthe lesions))
Prognosis:Prognosis:50% clear by age 1350% clear by age 13
MANAGEMENT OF MANAGEMENT OF DERMATOLOGICAL DERMATOLOGICAL
PROBLEMSPROBLEMS
If it’s dry – wet itIf it’s dry – wet it
If it’s wet – dry itIf it’s wet – dry it
And if you don’t know what to do And if you don’t know what to do give steroids!!give steroids!!
ATOPIC DERMATITIS ATOPIC DERMATITIS (ECZEMA)(ECZEMA)
ManagementManagementBathingBathingBath oil (e.g. Aveeno, Keri)Bath oil (e.g. Aveeno, Keri)Pat dryPat dryOintments when wetOintments when wet
ATOPIC DERMATITIS ATOPIC DERMATITIS (ECZEMA)(ECZEMA)
ManagementManagementTopical corticosteroidsTopical corticosteroidsVaselineVaselineAntihistaminesAntihistaminesWarn about course!Warn about course!
TOPICAL STEROIDSTOPICAL STEROIDS
Weak = 1% hydrocortisoneWeak = 1% hydrocortisoneModerate = 0.05% betamethasoneModerate = 0.05% betamethasone
3 times a day and reduce…3 times a day and reduce…
BEST ANTI-ITCHBEST ANTI-ITCH
Hydroxyzine 0.5 mg/kg QIDHydroxyzine 0.5 mg/kg QID(max 400 mg/day)(max 400 mg/day)
DESCRIBE WHAT YOU SEE!DESCRIBE WHAT YOU SEE!
DIAPER DERMATITISDIAPER DERMATITIS
DIAPER DERMATITISDIAPER DERMATITIS
Contact iirritationContact iirritation
DIAPER DERMATITISDIAPER DERMATITIS
ManagementManagementKeep area dry – expose to airKeep area dry – expose to airProtect Protect
DESCRIBE WHAT YOU SEE!DESCRIBE WHAT YOU SEE!
CANDIDIASISCANDIDIASIS
CANDIDIASISCANDIDIASIS
FoldsFoldsManagement:Management:
Nystatin – 4 times a day/every diaper Nystatin – 4 times a day/every diaper changechange
Consider oral tooConsider oral tooNystatin – 1 mL PO 4-6 times a day Nystatin – 1 mL PO 4-6 times a day afterafter
foodfood7-10 days7-10 days
DESCRIBE WHAT YOU SEE!DESCRIBE WHAT YOU SEE!
SCALP SEBORRHEIC DERMATITIS (CRADLE
CAP)
SEBORRHEIC DERMATITIS SEBORRHEIC DERMATITIS (CRADLE CAP)(CRADLE CAP)
Occurs in any babyOccurs in any babySebaceous glands pump out greasy Sebaceous glands pump out greasy
substance that keeps the old skin substance that keeps the old skin cells attached as it driescells attached as it dries
GreasyGreasyYellowYellow
SEBORRHEIC DERMATITIS SEBORRHEIC DERMATITIS (CRADLE CAP)(CRADLE CAP)
Onset most commonly in first 3 Onset most commonly in first 3 monthsmonths
gone by 8 to 12 months gone by 8 to 12 months Teens often have a similar scalp Teens often have a similar scalp
condition = dandruff!!condition = dandruff!!
SEBORRHEIC DERMATITIS SEBORRHEIC DERMATITIS (CRADLE CAP) (CRADLE CAP)
Management:Management:Oil to soften/loosen scalesOil to soften/loosen scalesSoft brush or dry terry cloth to brush Soft brush or dry terry cloth to brush
awayawayConsider mild topical Consider mild topical steroidsteroid, if , if
red/inflamedred/inflamed
Rarer now because cleanerRarer now because cleaner
SCABIESSCABIES
Management:Management:Permethrin 5% dermal cream – single Permethrin 5% dermal cream – single
applicationapplicationNeck down for 12 hours adultsNeck down for 12 hours adultsInclude head and scalp in prepubertalInclude head and scalp in prepubertal
Hot launder clothes from last 3 days or Hot launder clothes from last 3 days or Seal for 48 hoursSeal for 48 hoursSafety under 3 months not establishedSafety under 3 months not establishedHydroxyzineHydroxyzineIVERMECTINIVERMECTIN
HEAD LICEHEAD LICE
Nix (shampoo) cream rinse Nix (shampoo) cream rinse Nits = dead Nits = dead School after treatmentSchool after treatment
http://www.cps.ca/ENGLISH/http://www.cps.ca/ENGLISH/statements/ID/id08-06.htmstatements/ID/id08-06.htm
BIRTH MARKSBIRTH MARKS
Mongolian SpotsMongolian SpotsCafé-au-lait spotsCafé-au-lait spots- Transient macular stains (Salmon Transient macular stains (Salmon
patches)patches)- Port wine stainsPort wine stains
MONGOLIAN SPOTSMONGOLIAN SPOTS
Blue/grey maculaBlue/grey maculaAppear at or shortly after birthAppear at or shortly after birthBase of spine, buttocks and backBase of spine, buttocks and backNot associated with any conditions or Not associated with any conditions or
illnessesillnessesGradually disappearGradually disappear
MONGOLIAN SPOTSMONGOLIAN SPOTS
CAFÉ-AU-LAIT SPOTSCAFÉ-AU-LAIT SPOTS
CAFÉ-AU-LAIT SPOTSCAFÉ-AU-LAIT SPOTS
Well-circumscribed, homogenously Well-circumscribed, homogenously pigmented, light brown maculespigmented, light brown macules
1.5 - 15 cm in diameter1.5 - 15 cm in diameterFrequently present at birth, are Frequently present at birth, are
almost always present by 1 year of almost always present by 1 year of ageage
May increase in number during early May increase in number during early childhoodchildhood
CAFÉ-AU-LAIT SPOTSCAFÉ-AU-LAIT SPOTS
Approximately 2% of all newborn Approximately 2% of all newborn infantsinfants
Up to 25% of the normal adultsUp to 25% of the normal adultsMore common in darker-pigmented More common in darker-pigmented
racesraces ≥≥66 with diameter > 0.5 cm before with diameter > 0.5 cm before
puberty, and 1.5 cm after puberty puberty, and 1.5 cm after puberty suggests neurofibromatosissuggests neurofibromatosis
SALMON PATCHSALMON PATCH
SALMON PATCHSALMON PATCH
Transient, macularTransient, macularPresent in up to 70% of newbornsPresent in up to 70% of newbornsEyelids, nape of neck, glabellaEyelids, nape of neck, glabellaMost fade by 1 year of ageMost fade by 1 year of ageThose in nape of neck persist in 25% Those in nape of neck persist in 25%
of adultsof adults
PORT WINE STAINPORT WINE STAIN
PORT-WINE STAINPORT-WINE STAIN
Malformation of superficial capillaries Malformation of superficial capillaries of skinof skin
Pinkish/red maculesPinkish/red maculesWell defined edges in infancyWell defined edges in infancyFacial most commonFacial most common
PORT-WINE STAINPORT-WINE STAIN
Present at birthPresent at birthPermanentPermanentVariable sizeVariable sizeDo not proliferate but enlarge as Do not proliferate but enlarge as
child growschild growsLesions darken to purple and may Lesions darken to purple and may
develop a pebbly or slightly develop a pebbly or slightly thickened surface with timethickened surface with time
MANAGEMENTMANAGEMENT
Most are uncomplicatedMost are uncomplicatedLaser therapy may help fade the Laser therapy may help fade the
lesion, best done in infancylesion, best done in infancyAround eye innervated by branch 1 Around eye innervated by branch 1
of trigeminal nerve – need of trigeminal nerve – need ophthalmology assessment ophthalmology assessment /neuroimaging/neuroimaging
VASCULAR VASCULAR MALFORMATIONSMALFORMATIONS
HemangiomasHemangiomasCapillary (strawberry)Capillary (strawberry)CavernousCavernous
HEMANGIOMASHEMANGIOMASCAPILLARY CAPILLARY
(STRAWBERRY)(STRAWBERRY)
HEMANGIOMASHEMANGIOMAS
Begin as flat, pale white spots & later Begin as flat, pale white spots & later become larger & elevated, bright become larger & elevated, bright red, non compressiblered, non compressible
mm - several cmmm - several cmUsually solitaryUsually solitaryFemales 3:1Females 3:155% present at birth, rest develop 55% present at birth, rest develop
laterlater
CAVERNOUS CAVERNOUS HEMANGIOMASHEMANGIOMAS
CAVERNOUS CAVERNOUS HEMANGIOMASHEMANGIOMAS
HEMANGIOMASHEMANGIOMASCAPILLARY (CAVERNOUS)CAPILLARY (CAVERNOUS)
Lie deeper in in skin with a slightly Lie deeper in in skin with a slightly bluish discolorationbluish discoloration
Growth until 1 year of lifeGrowth until 1 year of life Involute over 3-10 yearsInvolute over 3-10 years
COMPLICATIONSCOMPLICATIONSPeri-orbitalPeri-orbital
risk to vision ( amblyopia)risk to vision ( amblyopia)EarEar
decreased auditory conduction, speech decreased auditory conduction, speech delaydelay
Multiple cutaneous/large facial may Multiple cutaneous/large facial may be associated with visceral be associated with visceral hemagiomashemagiomas
SubglotticSubglottichoarseness, stridor, respiratory failurehoarseness, stridor, respiratory failure
CosmeticCosmetic
CASECASE
5 week old with croup5 week old with croup6 day history of cough-initially 6 day history of cough-initially
harsh,looseharsh,loosenow high pitched seal-like coughnow high pitched seal-like coughno distress, Ono distress, O22 sat 99%, HR 130, RR sat 99%, HR 130, RR
3030erythema of left anterior tongue, left erythema of left anterior tongue, left
posterior palate with ? thrushposterior palate with ? thrush
……reassessment...reassessment...
1 hour post epi1 hour post epimoderate-severe respiratory distressmoderate-severe respiratory distressclassic “croupy” cough, RR40classic “croupy” cough, RR40severe intercostal indrawing, abd severe intercostal indrawing, abd
breathing, tracheal tugbreathing, tracheal tug improved with 2nd dose epiimproved with 2nd dose epi
““let’s bring her in…”let’s bring her in…”
admissionadmissionNPO/IV/epi/steroids/ ONPO/IV/epi/steroids/ O22 unable to discontinue steroidsunable to discontinue steroidsbreast feeding well limited to 10 breast feeding well limited to 10
minsminsno better by day 10no better by day 10
SIDE EFFECTS STEROIDSSIDE EFFECTS STEROIDS
CushingoidCushingoidhypernatremia/hypertension/wt gainhypernatremia/hypertension/wt gainhyperglycemiahyperglycemiaadrenal suppression/adrenal suppression/immunityimmunitybone densitybone densitycataractscataracts
MANAGEMENTMANAGEMENT
Natural history of haemangiomataNatural history of haemangiomata Oral systemic steroids were the Oral systemic steroids were the
mainstay of Rx if complications arisemainstay of Rx if complications arisePropranolol 2 mg/kg/dayPropranolol 2 mg/kg/day
INFECTIONSINFECTIONS
FungalFungalBacterialBacterial
TINEA CAPITISTINEA CAPITIS
TINEA CAPITISTINEA CAPITIS
Non-scarring alopecia with scalesNon-scarring alopecia with scalesRound, scaly patches of alopecia, Round, scaly patches of alopecia,
+/- broken hairs+/- broken hairs++ Boggy, elevated, dischargingBoggy, elevated, discharging
May be secondarily infected +/- May be secondarily infected +/- scarringscarring
TINEA CAPITISTINEA CAPITIS
Etiology: Fungal Etiology: Fungal Investigations: Investigations:
Wood’s light: green fluorescence only Wood’s light: green fluorescence only for microsporum infectionsfor microsporum infections
Culture of scales/hair shaftCulture of scales/hair shaftMicroscopic exam of KOH preparation Microscopic exam of KOH preparation
showing hyphaeshowing hyphae
TINEA CAPITISTINEA CAPITIS
Management:Management:Terbinafine (Lamisil) for 1 monthTerbinafine (Lamisil) for 1 month10-20 kg 62.5 mg daily10-20 kg 62.5 mg daily20-40 kg 125 mg daily20-40 kg 125 mg daily
TINEA CORPORIS TINEA CORPORIS (RINGWORM(RINGWORM))
TINEA CORPORIS TINEA CORPORIS (RINGWORM(RINGWORM))
Etiology: fungalEtiology: fungalPruritic (not severe), scaly, Pruritic (not severe), scaly,
round/oval plaque(s) with round/oval plaque(s) with erythematous margin(s) and erythematous margin(s) and central clearingcentral clearing
Peripheral enlargement of lesionsPeripheral enlargement of lesionsMostly trunk, limbs, faceMostly trunk, limbs, faceContact with infected animals/petsContact with infected animals/pets
TINEA CORPORIS TINEA CORPORIS (RINGWORM)(RINGWORM)
Management Management Clotrimazole (Canesten) creamClotrimazole (Canesten) cream
BACTERIAL INFECTIONSBACTERIAL INFECTIONS
ImpetigoImpetigoStaphylococcal scalded skin Staphylococcal scalded skin
syndrome (SSSS)syndrome (SSSS)CellulitisCellulitisFuruncle/boilFuruncle/boil
IMPETIGOIMPETIGO
IMPETIGOIMPETIGOPurulent, vesicular lesion Purulent, vesicular lesion golden golden
yellow crustyellow crustPre-school & young adultsPre-school & young adultsCrowded conditions, poor hygiene, Crowded conditions, poor hygiene,
minor traumaminor traumaDDx: infected eczema, HSV, DDx: infected eczema, HSV,
varicellavaricellaOrganisms: Staph. Aureus, GAS, Organisms: Staph. Aureus, GAS,
bothbothPotential complication: post-Potential complication: post-
streptococcal glomerulonephritisstreptococcal glomerulonephritis
IMPETIGOIMPETIGOOrganisms: Staph. aureus, GAS, Organisms: Staph. aureus, GAS,
bothbothPotential complication: post-Potential complication: post-
streptococcal glomerulonephritisstreptococcal glomerulonephritis
TREATMENT TREATMENT TopicalTopical
e.g. 2% mupirocin or fucidin tide.g. 2% mupirocin or fucidin tidSystemic 7-10 daysSystemic 7-10 days
e.g. cephalexin 50 mg/kg divided e.g. cephalexin 50 mg/kg divided tid/qidtid/qid
BULLOUS IMPETIGOBULLOUS IMPETIGOScattered, thin-walled bullae Scattered, thin-walled bullae
containing yellow/turbid fluidcontaining yellow/turbid fluidStaph. aureus Staph. aureus Complications:Complications:
Generalized skin peelingGeneralized skin peelingStaphylococcal Scalded Skin Staphylococcal Scalded Skin
SyndromeSyndrome
STAPHYLOCOCCAL STAPHYLOCOCCAL SCALDED SKIN SCALDED SKIN
SYNDROME (SSSS)SYNDROME (SSSS)
STAPHYLOCOCCAL STAPHYLOCOCCAL SCALDED SKIN SCALDED SKIN
SYNDROME (SSSSSYNDROME (SSSS))
CELLULITIS
CELLULITISCELLULITIS
Erythematous, flat, poorly-Erythematous, flat, poorly-demarcated lesions, not uniformly demarcated lesions, not uniformly raisedraised
TenderTenderWarmWarmGroup A Strep, Staph. aureusGroup A Strep, Staph. aureusDifferential diagnosis:Differential diagnosis:
necrotizing fasciitisnecrotizing fasciitis
CELLULITIS
TREATMENTTREATMENT
Cephalexin 50 – 100 mg/kg/d Cephalexin 50 – 100 mg/kg/d divided q6h POdivided q6h POSecond line = cloxacillin or Second line = cloxacillin or
clindamycinclindamycin
Cefazolin IV +/- clindamycin for Cefazolin IV +/- clindamycin for severesevere
FURUNCLES (BOILS)FURUNCLES (BOILS)Red, hot, tender, inflammatory Red, hot, tender, inflammatory
nodulesnodulesTense for 2-4 days, then fluctuantTense for 2-4 days, then fluctuantYellowish point ruptures with Yellowish point ruptures with
discharge of pusdischarge of pusCommonly around hair follicles at Commonly around hair follicles at
areas of friction & sweat areas of friction & sweat nose, neck, face, axillae, buttocksnose, neck, face, axillae, buttocks
MANAGEMENTMANAGEMENT Incision and DrainageIncision and Drainage
Relieves pressure & painRelieves pressure & painHot packsHot packs
Antibiotic PO:Antibiotic PO:e.g. cloxacilline.g. cloxacillin
Consider:Consider:Culture blood/pusCulture blood/pus
SYSTEMIC ILLNESSSYSTEMIC ILLNESS
Erythema multiformeErythema multiformeBullous erythema multiformeBullous erythema multiformeToxic epidermal necrolysis (Stevens Toxic epidermal necrolysis (Stevens
Johnson)Johnson)Henoch Schonlein purpuraHenoch Schonlein purpuraKawasaki diseaseKawasaki disease
ERYTHEMA MULTIFORMEERYTHEMA MULTIFORME
Target lesions (3 rings)Target lesions (3 rings)HERPES SIMPLEX VIRUSHERPES SIMPLEX VIRUSFixed (not transient e.g. giant urticaria)Fixed (not transient e.g. giant urticaria)
No painNo painNo pruritusNo pruritusNo scale/crustNo scale/crust
May include palms/solesMay include palms/solesMay include mucosaMay include mucosa
ERYTHEMA MULTIFORMEERYTHEMA MULTIFORME
Management:Management:Herpes isolationHerpes isolationOral acyclovirOral acyclovirTopical steroidsTopical steroids
BULLOUS ERYTHEMA BULLOUS ERYTHEMA MULTIFORMEMULTIFORME
Atypical targetsAtypical targetsCentral vesicleCentral vesicle
Vesicles without targetsVesicles without targetsDiscreteDiscrete lesions lesionsErosions & crustsErosions & crustsMucous membranes involvedMucous membranes involvedMYCOPLASMAMYCOPLASMA
BULLOUS ERYTHEMA BULLOUS ERYTHEMA MULTIFORMEMULTIFORME
Management:Management:AdmitAdmitMycoplasma isolationMycoplasma isolationAntibiotics for mycoplasmaAntibiotics for mycoplasmaOphthalmology, dermatology/wound Ophthalmology, dermatology/wound
oral careoral careSystemic steroids often neededSystemic steroids often needed
STEVENS JOHNSON STEVENS JOHNSON SYNDROMESYNDROME
TOXIC EPIDERMAL TOXIC EPIDERMAL NECROLYSISNECROLYSIS
(STEVENS JOHNSON)(STEVENS JOHNSON) Vesicles & bullaeVesicles & bullae May begin as dusky papuleMay begin as dusky papule Rapid progressionRapid progression Develops Develops confluenceconfluence Mucous membrane involvementMucous membrane involvement Systemic involvementSystemic involvement DRUG CAUSE USUALLYDRUG CAUSE USUALLY
AntiepilepticsAntiepileptics SulphursSulphurs Penicillins Penicillins
TOXIC EPIDERMAL TOXIC EPIDERMAL NECROLYSISNECROLYSIS
(STEVENS JOHNSON)(STEVENS JOHNSON)Management:Management:Life threatening Life threatening ICU/burns unit ICU/burns unitSupportive treatmentSupportive treatmentHistory for all infections/medicinesHistory for all infections/medicines IVIG (0.75-1 g/kg/d x 3 days)IVIG (0.75-1 g/kg/d x 3 days)CyclosporinCyclosporinSteroids are controversialSteroids are controversial
COURSECOURSE< 5% mortality overall< 5% mortality overallRegrowth of epidermis by 3 weeksRegrowth of epidermis by 3 weeks
COMPLICATIONSCOMPLICATIONS
•corneal scarring/blindness, corneal scarring/blindness, •phimosis, vaginal synechiae phimosis, vaginal synechiae (stenosis)(stenosis)• renal tubular necrosisrenal tubular necrosis•renal failurerenal failure•esophageal stricturesesophageal strictures•respiratory failurerespiratory failure•scarring/cosmetic deformityscarring/cosmetic deformity
HENOCH-SCHONLEIN HENOCH-SCHONLEIN PURPURAPURPURA
““Anaphylactoid purpura”Anaphylactoid purpura”Autioimmune vasculitisAutioimmune vasculitisSkin – petichiae, palpable, purpuraSkin – petichiae, palpable, purpura Joints – arthralgia/arthritisJoints – arthralgia/arthritisRenal – hematuria, Renal – hematuria, ↑↑BP, BP,
((glomerulonephritis)glomerulonephritis)GI – pain secondary to edema, GI – pain secondary to edema,
intussusceptionintussusception
KAWASAKI DISEASEKAWASAKI DISEASE
>80% less than age 4>80% less than age 4Seen in all racesSeen in all racesAsian>Black>WhiteAsian>Black>WhiteMost common cause of acquired Most common cause of acquired
heart disease in childrenheart disease in childrenTypical vs atypicalTypical vs atypical
DIAGNOSTIC CRITERIADIAGNOSTIC CRITERIAFEVER > 38.5FEVER > 38.5C > 5 days PLUS 4 of:C > 5 days PLUS 4 of:1.1. EYESEYES
Bilateral non-purulent conjunctivitisBilateral non-purulent conjunctivitis2.2. ‘‘CENTRAL’CENTRAL’
Oral mucosal changes – fissured red lips, strawberry Oral mucosal changes – fissured red lips, strawberry tonguetongue
3.3. NECKNECK Asymmetric cervical lymphadenopathy >1.5 cmAsymmetric cervical lymphadenopathy >1.5 cm
4.4. PERIPHERALPERIPHERAL Desquamation (edema, erythema)Desquamation (edema, erythema)
5.5. RASHRASH PolymorphicPolymorphic
Illness not explained by other (e.g. Strep/measles)Illness not explained by other (e.g. Strep/measles)
ASSOCIATED FEATURESASSOCIATED FEATURES
Irritability ***Irritability ***ArthritisArthritisAseptic meningitisAseptic meningitisHydrops of the gallbladderHydrops of the gallbladderHepatic dysfunctionHepatic dysfunctionDiarrheaDiarrheaPneumonitisPneumonitisUveitisUveitis
COMPLICATIONSCOMPLICATIONS
Coronary artery ectasia/dilatationCoronary artery ectasia/dilatation20% if untreated20% if untreated2% treated2% treated
Myocarditis/pericarditisMyocarditis/pericarditisArrhythmiasArrhythmias
TREATMENTTREATMENT
IVIG infusionIVIG infusionHigh dose then low dose aspirinHigh dose then low dose aspirinSupportiveSupportive
SUMMARYSUMMARY
Assessment of skin problemsAssessment of skin problems Itchy (2/5)Itchy (2/5) Birth MarksBirth Marks Vascular malformationsVascular malformations InfectionsInfections Systemic illnessesSystemic illnesses
REFERENCESREFERENCES
E.O. 021.08, 021:09 and 021:11E.O. 021.08, 021:09 and 021:11Nelson’s Essentials of PediatricsNelson’s Essentials of PediatricsColor Atlas/Synopsis of Clinical Color Atlas/Synopsis of Clinical
DermatologyDermatologyClass HandoutClass HandoutCanadian Paediatric Society Policy Canadian Paediatric Society Policy
StatementsStatementshttp://www.aboutkidshealth.cahttp://www.aboutkidshealth.ca