- 1. Pediatric Dermatology Board Review
2. Common Transient Neonatal Skin Conditions
- Erythema toxicum (neonatorum)
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- First 3 to 5 days of life
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- Central, small welt or pustule on a broader erythematous
base
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- Scraping of erythema toxicum reveals eosinophils
3. Common Transient Neonatal Skin Conditions
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- Caused by keratin plugging of eccrine (sweat) glands in the
skin
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- eruption of microvesicular lesions on the face, neck, scalp, or
diaper area
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- Tx: dressing infant lightly & avoiding excessive
humidity
4. Common Transient Neonatal Skin Conditions
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- White or yellow micropapules that develop when the
pilosebaceous unit is obstructed by keratin/sebaceous material
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- Clustered on nose, cheeks, chin, forehead
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- Resolve w/o tx within several months
5. Eczematous Rashes
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- First several months of life
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- Cradle cap and then extend to other areas of skin where
sebaceous glands are dense
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- Forehead, eyebrows, behind the ears, sides of nose, middle of
chest, umbilical, intertrigignous, and perineal areas in
infant
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- Well circumscibed plaques with a greasy, yellow-orange
overlying scale
6. Eczematous Rashes
- Recur in childhood & adolescence (hormones)
- TX: antiseborrheic shampoo
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- Persistant scalp seborrhea- 2% ketoconazole shampoo
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- 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
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- microvesicles (often confluent)
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- thickening (lichenification) of the involved skin secondary to
chronic scratching
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- inherited predisposition of the skin
8. Eczematous Rashes
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- winter and in temperate or cold climates (air is dry)
- Develops in conjunction with 2 other diagnoses of the atopic
triad
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- asthma, allergic rhinitis (in the patient or family
members)
9. Eczematous Rashes
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- Toddlers- extensive surfaces of the arms and legs
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- Older children and teens- antecubital and popliteal areas,
neck, and face
10. Eczematous Rashes
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- Interrupt the itch-scratch cycle
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- oral antihistamine or colloidal oatmeal baths
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- unscented topical moisturizers ( after tepid bath with mild
soap)
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- Inflamed lesions -topical steroid cream or ointment
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- ointments are more potent(not on face, intertriginious
areas)
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- Tacrolimus and pimecrolimus (topical immunomodulators)
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- Secondary infection (Staph aureus)
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- oral antibiotics or topical mupirocin
11. Eczematous Rashes
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- patches, linear arrays, and unusual distributions
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- erythema develops on skin when contact with oil of plant leaves
or stemrapidly becomes microvesicularprogress to larger
blisters..open and weep
12. Eczematous Rashes
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- Topical steroids (moderate potency)
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- If rash is extensive or involves genitalia or the skin around
the eyes
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- Oral steroids 1-2mg/kg/day X1 week and then wean during the
second week to prevent rebound rash
13. Eczematous Rashes
- Acrodermatitis enteropathica
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- similar presentation to nutritional zinc deficiency
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- usually presents in genetically susceptible infants that have
been breast-fed and are now weaning
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- ? Zinc-binding ligand in breast milk that enhances zinc
absorption up to the time of weaning
14. Eczematous Rashes
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- rash- moist, erythematous, papular, forming plaques on the skin
around orifices and on the acral areas (hand and feet)
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- 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
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- 5mg of zinc sulfate/kg/day
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- dramatic reversal of symptoms
16. Papulosquamous Rashes(raised and covered with fine
scales)
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- most likely seen in teens and older children
17. Papulosquamous Rashes
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- 2-4cm scaly round or oval plaque w/raised border
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- typical exanthem follows Xmas tree
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- 2-10mm ovoid, slightly raised plaques with central scaling in
addition to smaller individual papules
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- TX: Resolves w/o treatment
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- ***secondary syphillis mimics this..however syphillis involves
palms and soles**
18. Papulosquamous Rashes