Download Atopic Dermatitis

Pediatric Dermatology
Dr. Jerald E. Hurdle
Kennebec Medical Consultants
Learning Objectives
 To review common congenital &
acquired skin lesions,
 To recognize rashes that present in
childhood, and
 To manage the kids and their parents.
Vascular Lesions
 Commonly seen in pediatric population
 Need to distinguish hemangioma from
vascular malformation
Hemangioma
 Normally not present at
birth
 Grows rapidly in first few
months
 Then involute
 Rx: nothing, steroids, laser
& surgery
Hemangioma
 Gradual Involution
Vascular Malformation
 Present at birth
 Abnormal size &
number of vascular
structures
 Salmon patch or stork
bite
Vascular Malformation
Port Wine Stains
 Much less common
 Hypertrophy with time
 If V1/V2 rule out Sturge
Weber Syndrome
 Rx: laser
Pigmented Lesions
 Congenital vs. Acquired
 Congenital nevomelanocytic
nevus (syn. congenital hairy
nevus)
 Small, medium or large
 50% hairy
 Have verrucous surface
 Small: No increased risk of
melanoma
Giant Congenital Nevi
 >5% BSA in infants
 8.5% MM risk in 1st
15 years
 Rx: surgical excision,
tissue expanders, flaps
& grafts
Case 1




9/12 old baby
3/7 of fever
Febrile fit
Fever defervesces with
this rash
Diagnosis?
Case 1: Roseola
 HHV6
 2/3 of patients get
erythematous papules
mucosa of soft palate
(Nagayama spots)
Case 2
 3 yr old girl
 Slightly irritable for a
few days
 Presents with this
rash!
Diagnosis?
Case 2: Fifth Disease or Erythema
Infectiosum
 Classical Slapped cheeks
appearance
 Caused by Parvovirus B19
 Aplastic Anemia
 Arthritis
 Hydrops Fetalis
Case 2: Fifth Disease or Erythema
Infectiosum
 Classical Slapped cheeks
appearance
 Caused by Parvovirus B19
 Aplastic Anemia
 Arthritis
 Hydrops Fetalis
Case 3:
 10 year old boy
 Sore throat , myalgia
for 3 days before
presentation with this
rash
 Rash feels like
sandpaper
Case 3:
 10 year old boy
 Sore throat , myalgia
for 3 days before
presentation with this
rash
 Rash feels like
sandpaper
Case 3: Scarlet Fever
 Group A Strep
 Erythrogenic toxin
 Culture potential bacterial
reservoirs (throat
commonest)
 Rx: penicillin
 Watch out for poststreptococcal
glomerulonephritis
Case 4
 7 yr old girl
 Ring like lesions on
the back of her hands
for 3 months
 PCP tried antifungals
Diagnosis?
Case 4
Case 4: Granuloma Annulare (GA)
 Localized GA
 Self limiting
 Tends to spontaneously
resolve
 Can try potent topical
steroids
 Link with DM
(controversial)
Case 5
 2 yr old boy presents
with 2/7 of this nonitchy rash
 Affects his hands &
feet
 Had diarrhea 1/52 ago
Case 5: Gianotti-Crosti Syndrome
 Originally described in conjunction with
Hep B in 1955
 Other associations: EBV, RSV, Coxsackie,
echo, Parainfluenzae, CMV etc etc.
Case 6
 4/12 baby girl
 Febrile & irritable for
2/7
 Developed rash on
face yesterday
 Now red all over
 Father noticed some
blistering
Case 6: Staphylococcal scalded
skin syndrome (SSSS)
 Occurs in kids <6 yrs
 Staph producing exotoxin
disrupts barrier at granular
layer
 Rx: admit patients with
generalized disease for
IVABs & minimize
trauma to skin with
emollients
Atopic Dermatitis: Causes
 Genetics (filaggrin gene)
 Staph acting as super
antigen
 Extremes of climate
 Food as allergen
controversial
 Aeroallergens & house
dust mite
Atopic dermatitis
 Itch & scratch
 Sleep deprivation for the whole family
 Worsening weeping eczema think Staph
 Sudden painful eczema think herpes
Atopic Dermatitis
Atopic dermatitis
Atopic dermatitis
Secondarily Infected Eczema with Staph
Atopic dermatitis
Secondarily Infected Eczema with Herpes:
Eczema herpeticum
Treatment
 Educate parents about what is known about AD
 Encourage emollients (point to diaper area to
show that moist environment helpful)
 500g per week or more
Treatment: Steroids
 Tackle Steroid phobia
head on!
 Atrophy rarely seen when
appropriate steroid is used
for appropriate time
 No increased risk of
cancer
 Use potent steroid to
induce quick remission &
get family on your side
Treatment: Steroids
Finger Tip Units (FTU)
 Squeeze ointment DIP
crease = 1 FTU
 Covers 2 hands of skin
 2FTUs = 1g
 (http://www.patient.co.uk/
showdoc/27000762/)
Treatment: calcineurin inhibitors
 Pimecrolimus cream
limited efficacy
 Tacrolimus ointment
0.1 & 0.03%
 No atrophy
Treatment: Antihistamines
 No role for nonsedating
 Use benadryl, atarax
will make patient more
drowsy
Treatment: Antibiotics
 Take cultures, lesion &
nares
 Culture other members of
family if recurrent
 Treat for likely Staph
 Review patient when
cultures are back
Treatment: Eczema herpeticum
 Acyclovir p.o.
 Analgesia
 May need Staph
coverage as well
Pitryriasis Alba (PA)
 1/3 of kids in USA
may have PA
 Occurs in all races
 ♂>♀
 More problematic in
darker skin
Pitryriasis Alba (PA)
 Associated with
Atopic Dermatitis
3 stages
 Papular erythematous
 Papular hypochromic
 Smooth hypochromic
Pitryriasis Alba (PA): Rx
 Gentle Skin care
 1% Hydrocortisone
Cream
 Sunscreen
 Reassurance
Learning Objectives
 To review common congenital &
acquired skin lesions,
 To recognize rashes that present in
childhood, and
 To manage the kids and their parents.