James Lamberg, MS-III

PediatricSkin Conditions

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Terminology

Macule < 1cm => Patch > 1cmPapule < 1cm => Plaque > 1cmNodule small/deep => Tumor bigPetechiae < 3mm => Purpura > 3mmVesicle < 1cm => Bullae > 1cmPustule = pusWheel = comes and goesEnanthem = MM + Exanthema

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Viral Exanthem

• Erythematous, Blanches, No Pruritus, Seen Post-Infection

• Hx: Cold, URI• Rx: Supportive

Red SpotsWhite Halo

Adenovirus: Rash + Pharyngitis+ Non-Purulent Conjunctivitis

4 / 50

Rubella (German Measles)

• Discrete Pink/Red Fine Maculopapular, Starts on Face, Spreads Caudad

• Hx: 1-5d Fever, Malaise, Adenopathy, Sore Throat, Sick Contacts

• Rx: Supportive. Immunize.

Forchheimer Spots Scattered Rash

5 / 50

Rubeola (Measles)

• Tiny Bluish/White Dots, Red Halos, Blotchy, Erythematous, Blanching, Maculopapular

• Hx: Fever, Malaise, Dry Cough, Coryza, Conjunctivitis/Photophobia

• Rx: Supportive. Immunize.

Koplik SpotsBuccal Mucosa

1-2d aftersymptoms start

6 / 50

Varicella (Chickenpox)

• Appear Rapidly In Crops, Tiny Erythematous Papules => Vesicles With Red Halos, Pruritic

• Hx: Fever, URI Symptoms, Malaise• Rx: Supportive. Antihistamines. Avoid

Aspirin (Reye), IVAcyclovir If Immuno-Compromised. Immunize.

Different “Stages”

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Hand-Foot-Mouth (Coxsackie)

• Shallow Yellow Ulcers,Red Halos,

• Hx: Fever, Malaise,Sore Mouth, Anorexia.

• Rx: Supportive. Can Cause AsepticMeningitis, Myoperi-

carditis.

Palate Ulcers

Ulcers Near Gums

Erythematous MaculesHands & Feet

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Erythema Infectiosum (Fifth)

• Warm, Erythematous, Nontender, Circum-scribed Patches On Cheeks (“Slapped”). Lacy Rash On Extensor Surfaces.

• Hx: PrimarilyRash. Can HaveFever, Myalgias,Headache.

• Rx: Supportive.

Parvovirus B19

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Roseola Infantum

• Discrete Rose/Pink Macules ≈3d Post Fever• Hx: 6-36 Months, Rapid Temp Elevation,

Anorexia, Irritability.• Rx: Supportive.

HSV-6

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Infective Mononucleosis

• Diffuse Maculopapular,4+ Tonsils, PalatalPetechiae.

• Hx: Fatigue, Malaise,Headache, Sweats, Chills,Eyelid Edema, Pharyngitis.

• Rx: Supportive.Protect Airway, Steroids.Avoid Sports (Spleen).

11 / 50

Kawasaki Disease

• Diffuse Maculopapular Erythematous Rash.• Hx: Fever (5d), Conjunctivitis, Dry Lips,

Strawberry Tongue, Rash.• Rx: IVIG, Aspirin? Steroids?

PeriungualDesquamation(2w Later)

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Strep Scarlet Fever

• Flushed Face, PerioralPallor. Diffuse, Blanching,Erythematous, SandpaperRash. Strawberry Tongue.

• Hx: Abrupt Fever, Chills,Malaise, Sore Throat

• Rx: Antibiotics?

ErythrogenicToxin

1st… …2nd

Follow-Up:GlomerlulonephritisRheumatic Fever

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Staph Scalded Skin

• Epidermal Separation.• Hx: Impetigo. Infected

Umbilicus/Circumcision.• Rx: Treat Staph.

Exchange TransfusionIn Premies/Severe SSSS.

PositiveNikolsky

Sign

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Meningococcemia

• Purpuric/Petechial Rash, Scrape + Gram.• Hx: Age 6-12mo, Dorm. Fever, Lethargy, URI

Symptoms, Headache, Chills.• Rx: Antibiotics. Steroids If

Adrenal Insufficiency. Vaccinate.

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Henoch-Schönlein Purpura

• Palpable Purpura On Buttocks,Upper Thighs, Feet/Ankles.

• Hx: Fever, Malaise, Arthritis,Abdominal Pain, Hematochezia.

• Rx: Supportive. Replace Blood& Fluid Loss.

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Lyme Disease

• Erythematous Rash With Central Clearing.• Hx: Hiking/Woods. Flu-Like Symptoms.

Arthritis. Bell Palsy.• Rx: Antibiotics.

Ixodes Tick

Erythema Migrans

Watch For:AV Block

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Rocky Mountain Spotted Fever

• Starts Distal Hands/Soles. Petechial Or Erythematous Blanching Maculopapular.

• Hx: Hiking/Woods. Fever. Chills, Headache, Conjunctivitis, Cough, Myalgias.

• Rx: Antibiotics.2-6d Later

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Impetigo

• Strep: Papule => Vesicle, Red Halo.• Staph: Vesicle => Honey Colored Crusts.• Hx: Skin Lesion: Insect Bite, Injury,

Dermatitis. Usually Staph.• Rx: Topical

Antibiotics If Local,Oral Antibiotics IfExtensive.

Both Staph & Strep Can Cause Honey-Colored Crusts

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Acne Vulgaris

• Comedones, Papules, Pustules In Sebaceous Gland Distribution.

• Hx: Mild Pain, Tenderness.• Rx: Topical

Retinoids If Mild.Oral Retinoids& AntibioticsIf Severe.

20 / 50

Abscess

• Localized, Pus-Filled, Erythematous.• Hx: Skin Lesion: Insect Bite, Injury,

Dermatitis. Usually Staph.• Rx: Incision & Drainage +

Antibiotics (Staph).Consider MRSA.

Draining =>

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Erysipelas & Cellulitis

• Painful Raised Purple/Red Plaque.• Hx: Skin Lesion: Insect Bite, Injury,

Dermatitis. Group A Beta-Hemolytic Strep. Fever, Chills, Headache, Nausea.

• Rx: Antibiotics.Saline WetDressings IfNecrotic.

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Necrotizing Fasciitis

• Cellulitis + Black Tissue Necrosis.Hx: Deep Traumatic/Surgical Wounds, Diabetes. Fever, Edema, Wound Induration.

• Rx: Surgical Debridement.Antibiotics,BroadSpectrum.

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Congenital Rubella

• Thrombotic Petechiae + Jaundice = Blueberry Muffin.

• Hx: Maternal Rubella (TORCH). CMV Too.• Rx: Contact Precautions x 1yr.

Supportive.Vaccinate.

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Mongolian Spot

• Flat Slate-Gray/Bluish-Black Poorly Circumscribed Macules.

• Hx: 90% African American, 80% Asian, 10% Caucasian

• Rx: None.Fades ByAge 7.

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Bruises (In Child Abuse)

• Bruises At Different Stages Of Healing On Flexor Surfaces.

• Hx: Story Does Not MatchInjury Or Child Activity Level.

• Rx: Mandatory Reporting.Treat Injuries.

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Erythema Toxicum Neonatorum

• Yellow Papules/Pustules,Erythematous Rings,Appears On Trunk,“fleabite” dermatosis.

• Hx: Occurs In Up To 50%.• Rx: None. Fades

Within 5-7 Days.

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Neonatal Pustular Melanosis

• 1-2mm Vesiculopustules => Pigmented Macules With A Scale.

• Hx: Presents At Birth, Changes In 24-28h.• Rx: None. Fades

In 3wk – 3mo.

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Cutis Marmorata

• Netlike Red/Blue Mottling.• Hx: Normal Response To

Chilling.• Rx: None. Resolves

By 6 Months.

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Scald Burns (In Child Abuse)

• Blistering Burns On Hands/Feet/Buttocks.• Hx: Story Does Not Match

Injury Or Child Activity Level.• Rx: Mandatory Reporting.

Treat Injuries

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Milia

• Tiny White/Yellow Firm Papules.• Hx: Arise Spontaneously, Usually Face.• Rx: None. Resolves In Months To Years.

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Hemangiomas

• Bright Red Elevated “Strawberry” Plaque.• Hx: Grow For 6 Months, Slowly Resolve.• Rx: Watchful Waiting. Intervene If Interfering

With A Vital Function.

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Port-Wine Stain

• Purple/Red Lesion, Usually Covering Face.• Hx: Venous Malformation.• Rx: R/O Klippel-Weber (hemihypertrophy).

R/O Struge-Weber (seizures, mental retardation, glaucoma,hemiplegia).

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Salmon Patch (Stork Bite)

• Light Red Splotchy Area, May Redden With Crying Or Exertion.

• Hx: Capillary Malformation, Neck, Glabella, Forehead.

• Rx: None. FadeIn First Year.

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Acanthosis Nigricans

• Hyperpigmentation + Hyperkeratosis.• Hx: Benign (Common,

Obesity Related),Endocrine (InsulinResistance Related).

• Rx: R/O Diabetes

Malignancy-RelatedAcanthosis Does NotOccur In Childhood.

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Psoriasis

• Pruritic Red Silvery/White Scaly Rash.• Hx: Pain, Pruritis, Family History, No Fever.• Rx: Topical Steroids, UV/Solar Light Therapy.

<= Auspitz Sign

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Atopic Dermatitis (Eczema)

• Pruritic Red Papules/Plaques, Ooze/Crust.• Hx: Asthma, Allergy, Family History.• Rx: Topical Steroids.

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Seborrheic Dermatitis

• Red Scaling Hair-Bearing Areas, Flaking.• Hx: More In Winter. Non-Pruritic.• Rx: Topical Steroids.

Dandruff Shampoo.

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Pityriasis Rosea

• Oval Scaly Rings Running Parallel With Skin Lines, “Christmas Tree” Pattern, Starts With Herald Patch

• Hx: Malaise, Headache,Constitutional Symptoms.

• Rx: Supportive.

Herald Patch

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Contact Dermatitis

• Well-Demarcated Erythema, Crusting +/- Blistering.

• Hx: Allergic Contact,Poison Ivy (Shown), Nickel.

• Rx: Topical Steroids.Cool Compress, OatmealBath, Oral Antihistamines.

40 / 50

Urticaria (Hive)

• Edematous Erythematous Raised Plaques.• Hx: Allergen, Medications,

Foods, Chemicals.• Rx: Supportive.

Antihistamines.

Dermatographia =>(common)

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Tinea Corporis & Capitis

• Vesicular Red Border With Central Clearing.• Hx: Pruritic. Pets.• Rx: Topical Antifungal.

Oral Antifungal ForTinea Capitis.

WoodLamp

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Tinea Versicolor

• Small Oval Scaly Patches, Raindrop Pattern On Upper Chest, Back, Proximal Arms.

• Hx: Warm Climates,Pregnancy.

• Rx: SeleniumSulfide Or AzoleAntifungals.

43 / 50

Candidal Diaper Dermatitis

• Bright Red, Sharp Borders, Pinpoint Satellite Papules/Pustules

• Hx: Recent Antibiotic Use. Recent Diarrhea.• Rx: Topical

Antifungals.PetroleumJelly + ImprovedDiaper ChangingPractices.

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Erythema Multiforme

• Symmetric Dusky Red Target Macules On Palms, Soles, Extensor Surfaces.

• Hx: Medications, Viruses, Bacteria, Foods.Prodrome: Fever, Cough, Discomfort.

• Rx: StopCausative Agent.

Can Be Associated With Kawasaki

Disease

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Drug Eruption

• Erythematous Macules/Papules, Fine/Blotchy, Like-Measles/Viral Exanthems.

• Hx: Erupt On Face/Trunk5-14d After Medication.

• Rx: Stop Causative Agent.Supportive, Antihistamines,Topical Steroids.

46 / 50

Hymenoptera Stings

• Pain Erythema Edema < 2h Of Sting.• Hx: Bee, Wasp, Hornet, Yellow Jacket Sting.• Rx: Supportive. Manage Airway,

If AnaphylaxisAdministerEpinephrine

47 / 50

Scabies

• Pruritic Papules, Vesicles, Pustules, Linear Burrows On Finger/Toe Webs, Axilla, Flexor Surfaces, Nipples.

• Hx: 4-6wk Post-Exposure. Worse At Night.• Rx: Topical Permethrin. Household Cleaning.

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Lice

• Urticarial Papules (Bites), White Eggs (Nits)• Hx: Pruritis. Sharing Hats, Brushes.• Rx: Address School-Wide To Prevent

Re-Infestation.Metal Nit Comb.Nit-RemovalChemicals.Pediculicides.

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Warts

• Hyperkeratonic Papule With Rough Irregular Surface On Fingers/Hands/Feet.

• Hx: Local Trauma, Barefoot, Nail Biting.• Rx: Removal If Symptomatic.

50 / 50

Molluscum Contagiosum

• Sharply Circumscribed Single/Multiple Dome-Shaped Papules With Waxy Surfaces, Usually With Umbilicated Centers.

• Hx: Spread By Scratching.• Rx: Removal

If Symptomatic.Resolve In2-3 Years.

Poxvirus