Common Pediatric Skin and Soft Tissue Conditions

Dr.Md.Shahidul Islam

Assistant Professor,Dermatology

CBMCB

Erythema Toxicum Neonatorum

Impressive 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.

MiliariaPrickly heat, sweat rash

Many red macules with central papules, vesicles or pustules are present.

These may be on the trunk, diaper area, head or neck.

Subcutaneous Fat NecrosisSelf 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

Infantile Atopic DermatitisCause is unknownRed, itchy papules and plaques that ooze and crustSites of Predilection

Face in the youngExtensor surfaces of the arms and legs 8-10 mo.Antecubital and popliteal fossa , neck, face in older

Differential Diagnosis- Atopic Dermatitis

Seborrheic dermatitis

Contact dermatitis

Nummular eczema

Psoriasis

Scabies

Eczema- TreatmentAvoidance or elimination of predisposing factors

Hydration and lubrication of dry skin

Anti-pruritic agents

Topical steroids

Seborrheic DermatitisCommon, generally self-limitingIts cause remains ill-understoodThere is a genetic predisposition Most frequent between the ages of 1 to 6 mo.Greasy, salmon-colored scaling eruption Hair-bearing and intertriginous areasThe rash causes no discomfort or itching

Seborrheic Dermatitis-Treatment

Anti-seborrheic shampoo

Topical steroids

Pityriasis RoseaMild inflammatory exanthem of unknown cause, maybe viralBenign, self limited disorderOccasionally there are prodromal symptoms including malaise, headache, sore throat, fatigue, and arthralgia.Herald patch- pink in color and scaly-mimicking tinea corporis

Diaper Rash

Candidal DermatitisStarts off in the deep flexures which show widespread erythema on the buttocks-beefy red color

There are also raised edge, sharp marginization and white scale at the border of lesions, with pinpoint pustulo-vesicular satellite lesions

Seborrheic DermatitisSalmon-colored greasy lesions with yellowish scale and predilection for intertriginous areas

Involvement of the scalp, face, neck, and post auricular and flexural areas

Irritant DermatitisRash confined to the convex surfaces of the buttocks,perineal area, lower abdomen, and proximal thighs, sparing the intertriginous creases Excessive heat, moisture, and sweat retentionHarsh soaps, detergents, and topical medications

Viral Exanthems

Smallpox- VariolaFatality 40 %

First invades upper respiratory tract

From lymph nodes it spreads via hematogenous spread

Chills, fever, headache, delirium, SZ

Face to upper arms and trunk, and finally to lower legs

Chickenpox-VaricellaHerpes virus varicellae

Incubation period 10-21 days

Fever, malaise, cough, irritability, pruritus

Papulesvesicles crusting

Spreads centripetally

VaricellaComplications:

Bacterial superinfection

CNS involvement

Pneumonia

Hepatitis, arthritis

Reye’s syndrome

VZIG

Varicella – TreatmentOral acyclovir- indications

Healthy nonpregnant teenagers and adultsChildren > 1 yr with chronic cutaneous or pulmonary conditionsPatients on chronic salicylate therapyPatients receiving short or intermittent courses of aerosolized corticosteroids

Dose: 80 mg/kg/day in four divided doses for 5 days

Varicella – Post exposure VZIG (1 vial/5 kg IM) :

Pts on high dose steroidsImmunocompromised without a history of CPPregnant womenNewborns exposed 5 days prior to birth and 2 days after deliveryNeonates born to nonimmune mothersHospitalized premature infants < 28 weeks’ gestation

MeaslesRubeola- 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 – Post ExposureImmunoglobulin therapy- indications

All susceptible contacts

Infants 5 mo. To 1 year of age

Immunocompromised

Pregnant women

<5 mo. If mother without immunity

Live measles virus vaccine- contraindicationImmunocompromised- excluding HIV

Pregnancy

Allergy to eggs, or neomycin

RubellaGerman Measles

Epidemic nature

Winter-spring

Prodrome

Face neck trunk

Lymphadenopathy

Serologic testing

Hand-Foot-Mouth DiseaseEnteroviruses

coxsackieviruses A and B

echoviruses

Vesicular lesions, may be petechial

Associated with aseptic meningitis, myocarditis

Erythema InfectiosumFifth 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

Complication

Exanthem SubitumRoseola Infantum

Children 6-19 months

Abrupt onset of high fever

Febrile seizures

Rash develops after fever dissipates

Mainly on trunk

Infectious MononucleosisAcute, 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

Bacterial Exanthems

ImpetigoSuperficial infection of the dermis

Two types:Impetigo contagiosa

Bullous impetigo

EtiologyGroup A ß hemolytic streptococcus

Coagulase positive S. aureus

Treatment : Keflex, erythromycin, Bactroban

Scarlet FeverToxin 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

Complications

Treatment

Staphylococcal Scalded-Skin Syndrome

Generally in less than 5 years of age

Induced by exotoxin produced by staphylococci

Fever, papular erythematous rash starting around mouth- not involving oral mucosa

Positive Nikolsky’s sign

Diagnosis: Tzanck test, bacterial culture

Treatment

Complications

Meningococcemia

Usually sudden onset of fever, chills, myalgia, and arthralgiaRash is macular, nonpruritic, erythematous lesionsPetechial rash develops in 75% of casesNeisseria meningitidesFever, rash, hypotension, shock, DICTreatment: PCN G

Differential Diagnosis

Gonococcemia

HSP

Typhoid fever

Rickettsial disease

Erythema multiforme

Purpura fulminans

Rocky Mountain Spotted Fever

Most common rickettsial infection in USAbrupt fever, headache, and myalgiaRash from extremities towards trunkMaculespetechiaeTreatment

TetracyclineDoxycyclineChloramphenicol

CellulitisMost common organisms:

S. aureus

S. pyogenes

H. influenza type B (HIB)

Most common sites?

CBC, x-ray?

Cellulitis- TreatmentIV antibiotics in:

ImmunocompromisedIll appearingSuspected bacteremia<6 mo. Of ageWBC> 15KHigh feverRapidly progressing

Periorbital- Orbital CellulitisS. aureus, S. pneumoniae, and HIB

CBC, blood culture, CT

LP?

IV antibiotics

Admit

Fungal Infections

Henoch-Schnlein PurpuraNo 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

Kawasaki SyndromeUnknown etiologyPeak incidence 18-24 monthsClinical findings:

Fever for at least five daysConjunctivitisPolymorphous rashOral cavity changesCervical adenopathy