1. Pediatric Dermatology Board Review

2. Common Transient Neonatal Skin Conditions

Erythema toxicum (neonatorum)

• First 3 to 5 days of life

• Central, small welt or pustule on a broader erythematous base

• Scraping of erythema toxicum reveals eosinophils

• Resolves spontaneously

3. Common Transient Neonatal Skin Conditions

Miliaria (prickly heat)

• First few weeks of life

• Caused by keratin plugging of eccrine (sweat) glands in the skin

• eruption of microvesicular lesions on the face, neck, scalp, or diaper area

• Tx: dressing infant lightly & avoiding excessive humidity

4. Common Transient Neonatal Skin Conditions

Milia

• White or yellow micropapules that develop when the pilosebaceous unit is obstructed by keratin/sebaceous material

• Clustered on nose, cheeks, chin, forehead

• Resolve w/o tx within several months

5. Eczematous Rashes

Seborrheic dermatitis

• Neonatal form

• First several months of life

• Cradle cap and then extend to other areas of skin where sebaceous glands are dense

• • Forehead, eyebrows, behind the ears, sides of nose, middle of chest, umbilical, intertrigignous, and perineal areas in infant

• Lack of pruritus

• Well circumscibed plaques with a greasy, yellow-orange overlying scale

6. Eczematous Rashes

Resolve by 8-12mo of age

Recur in childhood & adolescence (hormones)

TX: antiseborrheic shampoo

• Persistant scalp seborrhea- 2% ketoconazole shampoo

• Residual scalp lesions- 1% hydrocortisone topical steroid cream

*If rash is persistant or severe or is accompanied by anemia, adenopathy, or HSM- r/ohistiocytosis

7. Eczematous Rashes

Atopic Dermatitis

• eczema

• • erythema

• • microvesicles (often confluent)

• • weeping and crusting

• • thickening (lichenification) of the involved skin secondary to chronic scratching

• inherited predisposition of the skin

8. Eczematous Rashes

Incidence

• 2-3%

• winter and in temperate or cold climates (air is dry)

Develops in conjunction with 2 other diagnoses of the atopic triad

• asthma, allergic rhinitis (in the patient or family members)

9. Eczematous Rashes

Pattern

• Infants- face

• Toddlers- extensive surfaces of the arms and legs

• Older children and teens- antecubital and popliteal areas, neck, and face

10. Eczematous Rashes

Treatment

• Interrupt the itch-scratch cycle

• • oral antihistamine or colloidal oatmeal baths

• • unscented topical moisturizers ( after tepid bath with mild soap)

• • Inflamed lesions -topical steroid cream or ointment

• • • ointments are more potent(not on face, intertriginious areas)

• • • Tacrolimus and pimecrolimus (topical immunomodulators)

• Secondary infection (Staph aureus)

• • oral antibiotics or topical mupirocin

11. Eczematous Rashes

Contact dermatitis

• typical pattern

• • patches, linear arrays, and unusual distributions

• Poison Ivy, oak or sumac

• • Rhusdermatitis

• • • erythema develops on skin when contact with oil of plant leaves or stemrapidly becomes microvesicularprogress to larger blisters..open and weep

• pruritic

12. Eczematous Rashes

Treatment

• Oral antihistamine

• Topical steroids (moderate potency)

• If rash is extensive or involves genitalia or the skin around the eyes

• • Oral steroids 1-2mg/kg/day X1 week and then wean during the second week to prevent rebound rash

13. Eczematous Rashes

Acrodermatitis enteropathica

• AR disorder

• zinc deficiency

• similar presentation to nutritional zinc deficiency

• usually presents in genetically susceptible infants that have been breast-fed and are now weaning

• • ? Zinc-binding ligand in breast milk that enhances zinc absorption up to the time of weaning

14. Eczematous Rashes

Presentation

• rash- moist, erythematous, papular, forming plaques on the skin around orifices and on the acral areas (hand and feet)

• foul-smelling, frothy diarrhea, alopecia, irritability or apathy, generalized failure to thrive

Labs: low levels of zinc, alkaline phosphatase (zinc-dependent enzyme)

15. Eczematous Rashes

Treatment

• 5mg of zinc sulfate/kg/day

• dramatic reversal of symptoms

16. Papulosquamous Rashes(raised and covered with fine scales)

Pityriasis rosea

• most likely seen in teens and older children

• cause unknown

• • ?viral

17. Papulosquamous Rashes

• initial lesion

• • herald patch

• • • 2-4cm scaly round or oval plaque w/raised border

• 5-7days later

• • typical exanthem follows Xmas tree

• • • 2-10mm ovoid, slightly raised plaques with central scaling in addition to smaller individual papules

• rash lasts 6-10 weeks

• TX: Resolves w/o treatment

• ***secondary syphillis mimics this..however syphillis involves palms and soles**

18. Papulosquamous Rashes

Psoriasis

• 1-2% adults

• 35%