pediatric dermatology
DESCRIPTION
TRANSCRIPT
- 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
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- Resolves spontaneously
3. Common Transient Neonatal Skin Conditions
- Miliaria (prickly heat)
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- First few weeks of life
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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
- Milia
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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
- Seborrheic dermatitis
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- Neonatal form
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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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- Lack of pruritus
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- Well circumscibed plaques with a greasy, yellow-orange overlying scale
6. Eczematous Rashes
- Resolve by 8-12mo of age
- 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
- Atopic Dermatitis
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- eczema
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- erythema
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- microvesicles (often confluent)
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- weeping and crusting
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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
- Incidence
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- 2-3%
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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
- Pattern
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- Infants- face
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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
- Treatment
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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
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11. Eczematous Rashes
- Contact dermatitis
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- typical pattern
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- patches, linear arrays, and unusual distributions
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- Poison Ivy, oak or sumac
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- Rhusdermatitis
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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
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- pruritic
12. Eczematous Rashes
- Treatment
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- Oral antihistamine
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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
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13. Eczematous Rashes
- Acrodermatitis enteropathica
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- AR disorder
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- zinc deficiency
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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
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14. Eczematous Rashes
- Presentation
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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
- Treatment
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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)
- Pityriasis rosea
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- most likely seen in teens and older children
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- cause unknown
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- ?viral
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17. Papulosquamous Rashes
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- initial lesion
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- herald patch
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- 2-4cm scaly round or oval plaque w/raised border
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- 5-7days later
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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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- rash lasts 6-10 weeks
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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
- Psoriasis
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- 1-2% adults
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- 35%