TCP Week 4 - Pediatric Dermatology

What five elements should be used to describe a dermatologic eruption?

Primary lesion or change; secondary lesion or change; color; configuration; distribution.

Which primary skin lesions were reviewed in the presentation?

Macule or patch; papule or plaque; nodule; tumor; vesicle or bulla; pustule; wheal.

What is scale?

Dry peeling or flaking skin.

What is lichenification?

Thickening of the epidermis with exaggeration of the normal skin lines.

What is an erosion?

A slightly depressed area of skin in which part or all of the epidermis has been lost.

What is a crust?

Dried plasma or exudate on the skin.

What is a fissure?

A linear cleavage of the skin that extends into the dermis.

What is a scar?

Fibrous tissue replacing normal skin after damage is repaired.

What is cutaneous atrophy?

Thinning or absence of the epidermis or subcutaneous fat.

What is an excoriation?

A skin abrasion caused by scratching.

Which color changes were reviewed in the presentation?

Hyperpigmentation; hypopigmentation; erythema; pallor; blanching; cyanosis; purpura; jaundice.

What does annular configuration mean?

Ring-shaped.

What does linear configuration mean?

Arranged in straight lines.

What does grouped configuration mean?

A cluster of lesions.

What does discrete configuration mean?

Independent lesions that remain separate.

What does confluent or coalescing mean?

Individual lesions merge into a larger lesion.

What does reticulate configuration mean?

Net-like.

What does serpiginous configuration mean?

Snake-like.

Which distribution terms were reviewed in the presentation?

Localized or generalized; symmetric or asymmetric; flexural or extensor; intertriginous; acral; dermatomal.

What does intertriginous distribution mean?

Involvement of skin folds.

What does acral distribution mean?

Involvement of the hands, feet, ears, or nose.

What does dermatomal distribution mean in the presentation's distribution vocabulary?

A rash distributed along a dermatome.

What is the typical epidemiology of acne neonatorum?

It may be present at birth but more often appears at 2-4 weeks of age and affects about 20% of newborns.

How does acne neonatorum present?

Inflammatory papules and pustules on the face.

How is acne neonatorum diagnosed?

Clinically.

How is acne neonatorum managed?

Reassurance; it resolves spontaneously by 6-12 months.

What are milia?

Keratin-filled epidermal cysts.

How common are milia in newborns?

They occur in about 50% of newborns.

How do milia present?

Tiny 1-2 mm white papules on the face.

What are oral milia called?

Epstein pearls or gingival cysts.

How common are gingival cysts in newborns?

Approximately 80% of newborns have gingival cysts.

How are milia diagnosed and treated?

Clinical diagnosis; lesions rupture spontaneously, so reassurance is appropriate.

What is the epidemiology of congenital dermal melanocytosis?

It occurs in more than 80% of newborns of Asian or African descent and in fewer than 10% of Caucasian infants.

How does congenital dermal melanocytosis present?

A gray-blue-black macule over the lumbosacral area; extrasacral lesions may also occur.

What important social or diagnostic issue is associated with congenital dermal melanocytosis?

It can be mistaken for evidence of abuse.

How is congenital dermal melanocytosis diagnosed and managed?

Clinical diagnosis; it usually fades spontaneously with age but may persist.

What is an infantile hemangioma?

A benign tumor of capillary endothelial cells.

When do infantile hemangiomas usually develop?

At 1-8 weeks of age.

What is the typical natural history of an infantile hemangioma?

It grows rapidly and then involutes slowly, usually leaving minimal persistent skin changes.

How common is spontaneous resolution of infantile hemangioma?

About 90% resolve by age 9.

Which sex is more commonly affected by infantile hemangioma?

Females.

What may precede an infantile hemangioma?

A bruise-like area, a pale macule with telangiectasia, or another vascular lesion.

How does a superficial infantile hemangioma appear?

As a bright erythematous macule, papule, or plaque.

How does a deep infantile hemangioma appear?

As a purple, blue, or skin-colored nodule.

How are infantile hemangiomas diagnosed?

Clinically.

What is the usual management of an uncomplicated infantile hemangioma?

Observation and reassurance because most resolve spontaneously.

Which infantile hemangioma features require rapid specialist follow-up?

Face or neck location; five or more hemangiomas; scalp involvement; intertriginous involvement.

What is first-line pharmacologic treatment for an infantile hemangioma that requires therapy?

Oral propranolol 2-3 mg/kg/day.

What is the epidemiology of erythema toxicum neonatorum?

It affects up to 50% of full-term newborns and usually begins at 24-48 hours of age.

How does erythema toxicum neonatorum present?

Multiple 1-4 mm erythematous macules and papules that rapidly progress to pustules on an erythematous base.

Where is erythema toxicum neonatorum distributed?

Face, trunk, and proximal extremities, with sparing of the palms and soles.

How is erythema toxicum neonatorum diagnosed and treated?

Clinical diagnosis; reassurance because it usually resolves by days 7-14 of life.

What is the typical epidemiology of infantile seborrheic dermatitis?

It is very common during the first 3 months of life.

What is the classic presentation of infantile seborrheic dermatitis?

Yellowish, greasy, adherent scales on the scalp called cradle cap.

Where else can infantile seborrheic dermatitis occur?

The face, diaper region, and flexural folds.

How is infantile seborrheic dermatitis diagnosed?

Clinically.

What is the natural history of infantile seborrheic dermatitis?

It typically resolves by 6 months of age.

How can cradle cap be treated for cosmetic reasons?

Regular shampooing; apply an emollient, gently brush the scalp, and shampoo to remove scales.

What is oral candidiasis or thrush?

A superficial fungal infection of the oral mucosa caused by overgrowth of Candida species.

How common is thrush in healthy neonates and infants?

Approximately 2-7%.

How does thrush appear on examination?

Loosely attached white or yellow-white plaques with an erythematous base.

Which oral sites may be involved in thrush?

Tongue, buccal mucosa, hard palate, soft palate, and oropharynx.

What feeding symptoms can accompany thrush?

Irritability, decreased oral intake, and feeding refusal.

What happens when thrush plaques are removed?

They are difficult to remove; the underlying surface may be raw, erythematous, and bleeding.

How is uncomplicated thrush diagnosed?

Clinically.

When should microscopic examination of a thrush scraping be considered?

When the infant is immunocompromised or unresponsive to treatment.

What is the nystatin regimen for infant thrush?

Nystatin suspension 100,000 units or 1 mL in each side of the mouth, for a total of 200,000 units or 2 mL, four times daily for 7-14 days.

How long should nystatin be continued after thrush symptoms resolve?

At least 48 hours after resolution of perioral symptoms.

What is impetigo?

A contagious skin infection that can occur at any age but is most common in young children.

What age group is most commonly affected by impetigo?

Children 2-5 years old.

What proportion of pediatric skin complaints is attributed to impetigo in the presentation?

Approximately 10%.

What is the most common pathogen causing impetigo?

Staphylococcus aureus.

Which additional organisms can cause impetigo?

Group A beta-hemolytic Streptococcus and MRSA.

What often precedes impetigo?

Trauma to the skin.

What is the classic presentation of nonbullous impetigo?

Honey-colored crusted lesions.

How does bullous impetigo evolve?

A vesicle rapidly progresses to a flaccid bulla, ruptures, and forms a crust.

Can bullous impetigo cause systemic symptoms?

Yes, but systemic symptoms are rare.

How is impetigo diagnosed?

Clinically.

What is the topical treatment regimen for impetigo?

Mupirocin 2% ointment three times daily for 5-7 days.

What hygiene measures are recommended for impetigo?

Frequent handwashing, avoid touching lesions, and maintain good hygiene.

What causes herpes labialis?

Herpes simplex virus.

How common is HSV seropositivity in adults in the United States?

Approximately 60-70%.

What percentage of children are HSV seropositive by age 5?

Approximately 20%.

What percentage are HSV seropositive at ages 6-13?

Approximately 33%.

How can primary HSV infection present?

It may be asymptomatic or cause herpetic gingivostomatitis.

How does primary herpetic gingivostomatitis present?

Painful vesicles on the lips, gingiva, oral palate, and tongue on a red base; lesions may coalesce and rupture into irregular ulcers.

What prodromal findings may occur with primary herpetic gingivostomatitis?

Fever, irritability, and cervical lymphadenopathy.

Where do recurrent herpes labialis lesions usually occur?

The vermilion border or hard palate.

How do recurrent herpes labialis lesions evolve?

Clustered papules on an erythematous base become vesicles, then rupture into ulcers, crust, and heal.

How quickly do recurrent herpes labialis lesions usually heal?

Within 3-4 days.

What prodrome may precede recurrent herpes labialis?

Tingling, burning, pain, or itching at the site.

How is herpes labialis diagnosed?

Clinically; viral culture may be used if needed.

What education is recommended for herpes labialis?

It spreads through contact; avoid triggers; use daily sunscreen; wash hands frequently.

When should antiviral medication for herpes labialis be started?

As soon as possible to improve symptoms and shorten illness duration.

What is the acyclovir regimen listed for pediatric herpes labialis?

Acyclovir 15 mg/kg, maximum 200 mg, orally five times daily for 7 days.

What causes molluscum contagiosum?

A poxvirus transmitted by contact with an infected person or fomite.

How common is molluscum contagiosum in young healthy children?

Approximately 5-8%.

How does molluscum contagiosum present?

A single lesion or small group of painless, flesh-colored, pearly, umbilicated papules measuring 1-10 mm.

How is molluscum contagiosum diagnosed?

Clinically.

What is the usual natural history of molluscum contagiosum?

Spontaneous resolution within 6-18 months.