Download Paediatric Skin

Paediatric Skin
Becky Ollerenshaw
(And Katie)
Newborn
Vernix caseosa
o
Waxy or cheese-like white
substance found coating the
skin of newborn babies.
o
Vernix starts developing on the
baby in the womb around 18
weeks into pregnancy.
o
Secreted by the sebaceous
glands of the fetus in utero
o
Shed towards the end of
gestation to coincide with
maturation of the transepithelial barrier
Chalky White
Stuff
Millia
o
Keratinous cysts
o
Benign
o
Self resolving
Tiny white
spots
Mongolian
Blue Spot
o
DOCUMENT!!! Maybe
mistaken for NAI
Dark blue
pigmentation
Melanocytic
Naevi (Moles)
o
Congenital pigmented naevi
>9cm diameter
o
4-6% lifetime risk of subsequent
malignant melanoma
o
Attempt to remove surgically
Extensive
Pigmented areas
White hair
Albinism
o
Defect in biosynthesis and
distribution of melanin.
o
Lack pigment in iris // retina //
eyelids // eyebrows
o
Failure of fixation reflex
o
Pendular nystagmus
o
Photophobia
o
Fitting of tinted contacts in
childhood can allow normal
reflex development.
o
Skin burns easy  increased
risks of skin CA
Erythema toxicum
o
o
Features
o
Red blotches with central
white vesicle
o
Each spot lasts about 24
hours, moves from place to
place
o
Spots are sterile and baby is
well
Management
o
Reassurance
o
Only do swab if suspect sepsis
Red blotches
with central
white vesicle
Collodion Baby
o
o
o
o
Born encased in tight and shiny
film or dried collodion (sausage
skin)
Tight &
Shiny Film
Inherited ichthyoses (90%)
o
Skin is dry and scaly
o
AR inheritance
Membrane becomes fissured
and separates within a couple
weeks
o
Leaving icthyotic (90%) or
normal skin (10%)
o
Is due to abnormal
desquamation
Emollients to manage
Peels to
Leave Scales
Rashes of Infancy
Nappy Rashes
o
Irritant dermatitis
o
Effect of urine
o
Infrequent nappy change
o
Faeces  urea splitting 
increased pH
o
Convex surfaces of buttocks,
perineal region and lower abdo
o
Flexures spared
Erythematous
& some scaling
Nappy Rashes
o
Candida Infection
o
Flexures effected
o
Satellite pustules
Satellite
lesions
Infantile Seborrhoeic
Dermatitis
Scaly Yellow Skin
o First 2M of life
o Starts on the scalp then
spreads
o
Face, flexures & napkin
area
o Scaly eruption forming an
adherent yellow layer
“cradle cap”
o Not itchy
o Increased risk of developing
atopic eczema
Face, Flexures &
Napkin areas
Mostly Facial,
patchy elsewhere
Atopic Eczema
o
Onset usually between 2-12M
o
Associated with asthma (33%) //
hayfever
o
ITCHY
o
Prolonged scratching can cause
lichenification
o
Distribution
o
o
o
Secondary infection
o
o
o
Infants: face and scalp
Older: Skin flexures and
frictional areas
Staph Aureus
Herpes Simplex
Rxo
Emollients
o
o
Topical steroids
Avoid exacerbating factors
Flexures,
Wrists and
Ankles
Eczema
herpeticum
o
Herpetic superinfection of
eczema
o
Can be life threatening
o
Miserable, unwell and febrile
o
Treat with acyclovir, antibiotics
PMHx- Eczema
Infections &
Infestations
Viral Warts
o
HPV
o
♀ vaccinated against
16+18
o
Children usually get it on toes
and fingers - verrucae
o
Sexually active teens can get
genital
Viral particles
Annular Skin
Lesions
Ringworm
o
Dermatophyte fungi hyphae
invade dead keratinous
structures
o
o
Annular skin lesions
o
o
Severe pustular ringworm
patch = Kerion
Scalp ringworm is usually from
cats and dogs
o
o
Horny layer of
skin//nails//hair
Patchy alopecia
Treat with topical or systemic
antifungals
o
Treat any animal sources
Tinea Capitis
Scabies
o
Infestation by Sarcoptes Scabiei
o
8 legged mite
o
Burrows pathognomonic
o
Severe itchiness
o
Worse in warmth & at night
o
Attempt to remove surgically
o
Infants and young:
o
o
Older Children:
o
o
o
Palms // soles // trunk
Between fingers & toes
Axillae//flexor
wrists//nipples//penis//
buttocks
Spread by close contact
Tracks and Burrows
Erythema migrans
(Lyme disease)
o
A circular rash at the site of the
infectious tick attachment. It
can appear within 3-36 days, but
typically in 7-10.
o
It starts as a red macule or
papule at the site of the tick bite
o
Other symptoms include
fatigue, myalgia, arthralgia,
headache, fever, stiff neck, and
regional lymphadenopathy.
o
Treatment – amoxicillin for 14
days
Radiating from bite
site…..
Pediculosis
Capitis
o
Head lice infestation
o
Itchy scalp
o
Identify live lice or nits (empty
egg cases)
o
Remove with fine toothed comb
and special shampoos
INFESTATION
Molluscum
Contagiosum
o
Caused by Poxvirus
o
Pearly paules +/- central
umbilication
o
Usually multiple
o
Usually disappear
spontaneously within a year
o
Once the scabs on the bullous
have fallen off, scarring is
minimal.
Central
Umbilication
Mumps
o
Fever, malaise and parotitis
o
Spread by droplet to resp tract
then gains access to parotid
o
Only one side initially but
usually becomes bilateral
o
Abdo pain + raised amylase =
pancreatic involvement
o
Complciations
o
Viral meningitis and
encephalitis
o
Orchitis ♂
Parotitis
Measles (1)
o
Paramyxovirus,
o
Incubation period of about 10
days
o
Maculopapular rash
o
Spreads downwards from behind
ears to the whole of the body
o
Begins as discrete rash but
becomes blotchy and confluent
o
Contagious
o
Cough
o
Coryza
o
Conjunctivitis
o
‘C’oplick spots
o
o
White spots on buccal mucosa
Complications
o
Maculopapular Rash
Encephalitis // SSPE
White spots on
Buccal mucosa
Strawberry tongue
Scarlet fever (2)
o
Sore throat and high
temperature (fever) are first
symptoms.
o
A bright red rash follows. Starts
as small red spots, on the neck
and upper chest then spreads to
rest of body. Skin feels like
sandpaper.
o
The tongue may become pale
but coated with red spots
(strawberry tongue). After a
few days the whole tongue may
look red.
o
Due to group A strep
o
Treatment - antibiotics
Sandpaper skin
Rubella (3)
o
Usually a mild condition that
gets better without treatment
in seven to 10 days.
o
Droplet spread
o
Prodrome malaise, cough, sore
throat, fever, headache, eye
pain
o
Rash behind ears, neck, face,
trunk, limbs
o
Rash lighter and less confluent
than measles
o
Lymphadenopathy, esp.
occipital
o
Complications rare
o
Risk to fetus
Pinkish-red rash that first
appears on the face and
later spreads elsewhere on
the body
Scaled Skin
Syndrome (4)
o
Caused by Exfoliative Staph
Toxin
o
Separation of epidermal skin
layers
o
Separate on gentle pressure
to leave denuded skin
o
Children present with fever and
malaise
o
Dry and heal without scarring
but requires Anbx to resolve
o
Main issue is with secondary
infection
Skin appears scaled
He doesn’t have
path
Slapped Cheek (5)
o
Parvovirus B19
o
Symptoms begin 6 days
following exposure
o
Lasts ~1 week
o
Patients are contagious before
symptomatic, but not after
o
Lace-like rash on upper
extremities and trunk
o
Red cheeks, with white pallor
around the mouth
o
Parvovirus B19-- aplastic
crisis
Look at those red
cheeks….
Roseola (6)
o
Cause: HHV6/7
o
Features
o
o
Affects those aged 6-36
months
o
3-5 day fever, no obv. Source
o
Sub-occipital nodes
o
Rose-pink macular rash
appears once fever settles
o
Starts on trunk, may spread to
face and extremities
o
Lasts up to 2 days
Management
o
Treat symptomatically,
reassure
High Fever
No Obvious Source
Mouth
Hand foot &
mouth
o
Coxsackie A16 virus
o
Droplet spread
o
Infectious till lesions have
healed
o
May have fever and sore throat
o
Treatment is supportive
Hand
Feet
Impetigo
o
Caused by Staph or Group A
Strep
o
Localised lesions
o
Face//neck//hands
o
Begin as erythematous
macules which become
vesicular
o
Rupture to leave fluid exudate
 Confluent honey-coloured
crusted lesions
o
Highly contagious
Confluent honeycoloured crusted
lesions
Periorbital
Cellulitis
o
Caused by Staph or Group A
Strep
o
o
Or haemophilus influenza if
unvaccinated
Fever with erythema,
tenderness and oedema of the
eyelid
o
Usually unilateral
o
Treat promptly with IV Anbx to
avoid posterior spread to orbit
or brain (meningitis/abscess)
o
Orbital cellulitis:
o
o
o
Proptosis
Reduced visual acuity
Painful ocular movement
Warm and swollen
Chickenpox
o
Varicella zoster
o
Incubation 14 – 21 days
o
Infectious 1-2 days before rash
o
Vesicular rash
o
Fever
o
Complications – infection of
lesions, pneumonia, sepsis,
necrotising fasciitis,
encephalitis
o
Treatment – none, can use
acyclovir in at risk patients to
reduce severity of disease.
Very common
vesicular rash
Meningitis
o
The glass test
o
Symptoms
o
o
Photophobia
o
Neck stiffness
o
Headache
In infants:
o
Bulging frontanelle
o
Irritability
o
High pitched cry
o
Poor feed
o
hypotona
Non-blanching rash
Systemic Disease
HenochSchonlein
Purpura
o
Vasculitic condition
o
Typically purpura of lower
limbs, extensor surfaces; can
affect upper limbs
o
Can affect whole body most
commonly skin, kidneys and GIT
o
Monitor urine and BP
o
Treatment largely supportive
o
Steroids for resistant cases
o
Commonly follows URTI
Can also affect
kidneys
Purpura of lower
limbs
Kawasaki
Disease
o
Classically, five days of fever
plus four of five diagnostic
criteria must be met to establish
the diagnosis. The criteria are:
o
Erythema of the lips or oral
cavity or cracking of the lips
o
Rash on the trunk
o
Swelling or erythema of the
hands or feet
o
Red eyes (conjunctival
injection)
o
Swollen lymph node in the neck
of at least 15 mm
Peeling hands
Kawasaki
Disease
Neurocutaneous Signs
Ataxia
Telangiectasia
o
Disorder of DNA Repair
o
Gene ATM
o
AR
o
Mild delay in motor movement
and oculomotor dyspraxia
o
Cutaneous Signs:
o
Telangiectasia of the
conjunctiva (4yr+)
Symptoms:
o
Dystonia and cerebellar
dysfunction
o
Weakened immune system
o
Increased risk of CA
Prominent
Blood Vessels
Spina Bifida
o
Failure of neural plate to fuse
o
First 28d of gestation
o
Lack of folic acid
o
Myelomeningocele
o
May be ass. with:
o
Lower limb paralysis
o
M imbalance
o
Sensory loss
o
Bowel/Bladder dysfunction
o
Hydrocephalus from Chiari
malformation
Meningeal
Membrane Sac
NF1
o
Mutation of NF1
o
AD
o
Can be ass. with MEN syndromes
Axillary Freckling
2+ of the following criteria:
o
6+ café au lait spots
o
Optic gliomas
o
Axillary freckling
o
>1 neurofibroma along any
peripheral nerve
o
One lisch nodule (hamartoma of
the iris)
o
Sphenoid dysplasiaeye
protrusion
Pigmented Spots
Hamartoma
Tuberous
Sclerosis
o
AD (30%) Spontaneous (70%)
Depigmented areas
Cutaneous Features:
o
Depigmented ‘ash-leaf’ patches
(fluoresce under UV)
o
Rough patches over lumbar spine
(Shagreen patches)
o
Adenoma Sebaceum
(angiofibromata) in butterfly
distribition
Rough Patches
Other Features:
o
Epilepsy
o
Severe learning difficulties
o
PCK
o
Rhabdomyomata of the heart
Butterfly
Distribution
Sturge-Weber
Syndrome
o
Haemangiomatous facial lesion
port wine stain
o
o
o
o
Within distribution of CN [5]
Usually CN[5a]
Associated with similar intracranial lesion -cerebral and
vascular malformations
Skull Xray
o
Calcification of gyri in ‘railroad track’
Presentation:
o
Epilepsy
o
Learning disability
o
Hemipelegia
‘Port-Wine’ Stain
THANK YOU!!!
Any questions?