Dermatology- Peds

stratum corneum, Cellular stratum - granulosum, spinosum,barrier, uv protection

fibroblasts
elastin gives distensibility
collagen gives mechanical strength
reticulum fibers stability
sensory fibers – pain, touch, temp
autonomic motor nerves – innervate blood vessels, glands, arrectores pilorum muscles

fat
protective cushion
cutaneous vasculature
loose connective tissue
heat, insulation, shock absorption, reserve of calories

macules/patch
papules/plaque
pustules
wheal
nodule/tumor
vesicle/bulla
cyst

scale
licenification
scars
keloids
excoriation
fissure
erosion
ulcer

common, benign, self-limited, symptomatic
up to 50 %
pustules, like flea bites
occurs 1 to 10 days after birth
fades 5 to 7 days

Slate grey to blue black, often sacral area
fades by age 7
can be mistaken for abuse

“Neonatal acne”
multiple papules over nose and cheeks
response to maternal hormones
resolve by 4 to 6 mos

Yellow raised plaque on scalp may develop secondary neoplasm

Difficulty with thermoregulation
reddish/blue
ok with early infants, if continues then sign of hypothyroidism

Obstruction of eccrine gland
sweat retention
rupture & leave while scale

“prickly heat”
blockage of ducts
inflammation
more common
kids cannot thermoregulate

Usually not evident at birth
shows first months after birth
continues to grow
raised
soft and compressible

flat
noncompressible

“Salmon patch, stork bite, angel kiss”
found nape of neck, forehead, upper eyelids
fades 1st year

moles
sun exposure

Speckled appearance
white spots (pigmentation problem)
Michael Jackson

Tan macules and patches
Check number
More than 5 with >1 cm D suggests neurofibromatosis (Von Recklinghausen disease)

Common inherited
Red well demarcated plaques with silvery scale
Single or guttate (scattered)

Mild dry scaling to prominent large plate-like scales
Inherited, noted within 1st yr

Benign, self limited
Herald patch then fir tree rash
Reaches peak then fades over 4-6 wks
UV light hastens disappearance of eruption

Chronic allergic skin inflammation
Signs and symptoms
Chronic allergic inflammatory disease
Severe pruritus, weeping, crusting, lichenification
Family history
Manifests 3 months, 3 years, puberty
Nummular eczema
May have
Dennie-Morgan folds, allergic shiners, hyperliniear palms and soles
Also icthyosis vulgaris, keratosis pilaris, pityriasis alba, cataracts, juvenile plantar dermatosis
Common
Infantile seen 1 to 6 mos, lasts 2 to 3 yrs
Red itch papules oozing &crusting, cheeks, forehead, extremities
Childhood begins 4 to 10 yrs, lasts to 12
Differential Diagnosis AD
Seborrheic dermatitis
Contact or irritant dermatitis
Ichthyosis vulgaris
Psoriasis
Tinea Corporis
Scabies
Immune, metabolic, genetic, proliferative disorders
Complications AD
Staphylococcal infections (impetigo)
HSV
Human papillomavirus
Molluscum contagiosum
Short stature

chronic skin inflammation seen in infancy near sebaceous glands
Signs and symptoms
Common in infants and adolescents
Nonpruritic oily yellow scaling plaques that block sweat and sebaceous glands (cradle cap)
Also may be nasolabial folds, axillary and inguinal folds, neck, diaper area

skin inflammation d/t irritant contact
Signs and symptoms
Irritant dermatitis - diaper, other irritants
Allergic contact dermatitis - rhus, shoe dermatitis
Lesions associated with contact sites
Erythema can progress papules, weeping lesions

Urushiol oil is potent
Oil is in all plant parts
Does not affect animals but pet can carry to child
Full reaction in 2 days
Itching stops in 10-14 days.

Factors
Wet - greater friction & higher permeability
Elevated pH - 4.5 to 5.5, urease
Fecal enzymes - proteases & lipases
Microorganisms
Candida albicans
Staphylococcus aureus
H&P
Ask diapers, illnesses, medication, FH
Distribution patterns
Differential Dx - AD, SD, psoriasis
Labs
Skin scraping
Culture

Occurrence predominately during puberty, more severe in males
Location on face, chest, back and shoulders
Open comedones (blackheads or closed comedomes (whiteheads)
Inflamed papules or pustules
Nodules or cysts may be present
Occurrence predominately during puberty, more severe in males
Location on face, chest, back and shoulders
Open comedones (blackheads or closed comedomes (whiteheads)
Inflamed papules or pustules
Nodules or cysts may be present
ETIOLOGY
Hormones - androgens
Follicular obstruction - keratinized cells
accumulation of sebaceous and ketatinous debris
Bacteria - proliferation of Propinonibacrerium acnes
KEY HISTORY
Medications tried?
Products to treat acne?
History of medical problems?
Other medications?
Cosmetics or hair greases?
Recreational or occupational activities?
Females - menstruating? hirsuitism or oligomenorrhea? OCs?

Treatment
Cleansing
Anti-bacterials
Oral isotretinoin
Teratogen, numerous side effects

Separation of epidermis & dermis
Caused by staph toxin

Tinea - superficial skin infection caused by fungal dermatophytes
Tinea capitis
Broken hairs with circular alopecia
Tinea Corporis (ringworm)
Circular lesions central clearing & scaly annular border
Tinea pedis
Tinea cruris
Tinea veriscolor

Corporis – ringworm
Cruris – jock itch
Pedis – athlete’s foot
Veriscolor
Superficial, occurs on the trunk
Frequent in adolescents
Warm humid weather

This is an infection caused by the yeast like fungus Candida albicans or occasionally other species of Candida.

Highly pruritic dermatosis with papules, pustules, vesicles, hives, crusts
Spread by close personal contact
Female mite burrows into stratum corneum, eggs hatch and immune system reacts
DX
Look digital web space, extensor surface of elbow, flexor aspect of wrists
Ask about other family members and treat
Clean all bedding, clothing, towels, etc.

Bacterial – superficial layers
Nonbullous – skin trauma
Bullous S. aureus toxin production
Etiology – S. Aureus primarily

Follows disruption of skin surface
Facial, perivaginal or perianal or joint

Superficial bacterial inflammation of hair follicle
Deeper infection with base of follicle and deep dermis is feruncle

HPV (60 types) with local trauma
Round discrete skin colored with rough surface - common in nail biters
Disappear spontaneously over 2 years
Functional impairment and self-consciousness
treat - cryotherapy, duct tape, salycylic acid plasters

HSV1 - facial
Common contagious infection of skin and mucous membranes
transmitted by infections body fluids
painful fluid-filled vesicles which ulcerate, dry and crust within 7-14 days
HSV2 can be transmitted to infant during birth - Do C-section
Herpes simplex - neonatal HSV 1 & 2
HSV1 - gingivostomatitis HSV2-genital
HSV6&7 - roseola, seizures, mono, meningoencephalitis, hepatitis

Secondary bacterial infection
Reye’s syndrome
Neurological complications
Varicella pneumonia
Hematologic complications
Hepatitis
Zoster

Babies born with rubella can be deaf, blind, and have mental retardation
Thickening of the lens causes blindness

Fifth disease
Bright red erythematous patches over both cheeks, raised, not tender

Exanthem subitum
Fever then rash with discrete rose-pink macules or maculopapules