emergencies in pediatric dermatology ayelet shani adir, m.d. pediatric dermatologist haemek medical...
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Emergencies in Emergencies in Pediatric DermatologyPediatric Dermatology
Ayelet Shani Adir, M.DAyelet Shani Adir, M.D..
Pediatric DermatologistPediatric Dermatologist
Haemek Medical CenterHaemek Medical Center
• Widespread skin involvement (massive trans-epidermal loss)
• Skin findings as clues for diagnosis
Dermatology in Emergency Medicine
Case 1
• 15 months old healthy infant
• Fever, malaise and skin tenderness for the past 3 days
SSSSSSSSStaphylococcal Scalded Skin SyndromeStaphylococcal 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
SSSS: Clinical Findings• Generalized erythema with flexural
accentuation
• Skin tenderness
• Flaccid bulla in skin folds
• Positive Nikolsky’s sign
• Desquamation
SSSS: Therapy
• Maintain fluid status
• Intravenous anti-staphylococcal antibiotics
• Prevent secondary infection
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
Physical Examination
• Febrile, 390 C
• Generalized maculo-papular rash on skin, erosions on oral mucosa and eyes
• Large tense bulla on skin
Toxic Epidermal Necrolysis
Nikolsky’s Sign
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
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
SJS-TEN Therapy• Prompt discontinuation of suspected drug
• PICU
• Wound care: nonstick dressings, debridement
• Ophthalmologic intervention
• Hydration, electrolyte balance, nutritional support, pain control
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
Hypersensitivity SyndromeDrug Rash with Eosinophila and Systemic
Symptoms (DRESS Syndrome)
• Severe multi-organ reaction
• Fever, rash, Lymphadenopathy and
hepatitis
• Anticonvulsants, sulfa antibiotics
• 1:10000 exposures
Dress Syndrome• Immediate withdrawal of suspected
drug
• Close monitoring of liver and kidney functions
• Corticosteroids 1-2 mg/kg
• IVIG
Skin Findings as Clues for Diagnosis
• Systemic infections
• Kawasaki’s
Disease
• Child Abuse
purpuric, necrotic lesions
of Meningococcemia
Condyloma acuminata
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