Pediatric Dermatology: Newborn to Infectious Rashes

benign, epidermal, papules, cheeks, Epstein, spontaneously

Milia: Background

-______ rash most common in newborns

-Tiny ________ cysts filled with keratinous material

-1-2 mm white _________ occurring mostly to face (nose, _______)

• Intraoral version are ________ pearls

-No treatment necessary

-____________ resolves over a few weeks

rubra, blockage, sweat, sweating, fever

Miliaria (Heat Rash): Background

-Types → crystallina, ______, profunda

-Pathophysiology → _________ of eccrine _____ glands, sometimes accompanied by inflammation

-Etiology → anything that causes ___________ like hot/humid environment, physical activity, _____, or occlusion of the skin

-Most beneficial treatment is to avoid sweating 

newborns, stratum corneum, vesicles, without, head, epidermis, leakage, inflammatory, erythematous, axilla 

Miliaria: Crystallina and Rubra

-Crystallina 

• Common in ___________ but can happen at any age 

• Blockage of duct within the _______ ________

• Small, thin walled _________ “dew drops” _________ inflammation

• Most common on the _____, neck, and upper trunk 

-Rubra

• Most common type 

• Blockage of duct within the ________ or dermis 

• _________ of sweat into surrounding tissue → _____________ response

• Small, ____________ papular, papulovesicular, or papulopustular lesions 

• Most common in skin folds of the neck, _______, or groin 

first few, Malassezia, inflammatory, absence, 4, cleansing, ketoconazole

Neonatal Cephalic Pustulosis

-Appears ______ ____ weeks of life (most commonly between 2-4 weeks)

-Inflammatory reaction to ____________ species 

-Characterized by ___________ papules and pustules, _________ of comedomes, and distribution limited to the face (especially cheeks) and scalp

-Spontaneously resolves within _ months 

-Treatment → Medications are not always recommended for treatment

• ________ with mild baby cleansers

• Avoid oils and lotions

• 2% ___________ twice daily 

• 1% hydrocortisone once daily (optional) 

3-4, males, sebaceous, androgenic, comedomes, scarring, 1, benzoyl peroxide, bactrim, tumor, puberty

Infantile Acne

-Presents around __-__ months

-Uncommon but presents more often in ______

-Results from hyperplasia of __________ glands, secondary to _________ stimulation

-Inflammatory papules, pustules, _________, and sometimes nodules (can lead to _________)

-Typically resolves spontaneously by _ year old

-Treatment

• Mild to Moderate → keratolytic agents (2.5% ______ _______), topical antibiotics (clinda or erythromycin), topical retinoids

• Severe → oral antibiotics (erythromycin or ________), could also try oral isotretinoin

-Severe, unremitting cases need to be evaluated for CAH, gonadal or adrenal _______, and precocious _________

higher, 72, erythematous, pustules, trunk, week

Erythema Toxicum Neonatorum

-Common newborn rash → most common in _______ birthweight or greater gestational age infants

-Appears within the first __ hours of life

-Multiple ____________ macules and papules → progress to _________ on an erythematous base, most commonly on the _____ and proximal extremities

-Spontaneously resolves within a ______, so no treatment is necessary

Asian, delayed, melanocytes, macule, ill, sacral-gluteal, shoulders, benign

Mongolian Spot (Congenital Dermal Melanocytosis)

-Most common in _______, AA, and Native American populations

-Results from ________ disappearance of dermal _____________

-Blue-gray, pigmented ________ or patch with ___-defined borders 

• Most common over ________-__________ region followed by the _________

-_______ and fades during the first couple years of life and most disappear between ages 6 and 10 

-Don’t confuse with bruising 

macules, benign, McCune-Albright, large, Neurofibromatosis, 6

Cafe au Lait Macule

-Usually present at birth or appear in early childhood, can be found anywhere on the body

-Flat, tan-brown _________ or patches (coffee with cream) that range from a few mm to > 15 cm. These can grow with the child

-Usually _______

-Can be associated with _________-__________ Syndrome, which has a _____, unilateral cafe au lait macule

-Can be associated with ______________ Type 1, which usually has > _ spots over 0.5 cm before puberty or 1.5 cm after puberty

dilation, capillaries, irregular, nape, 1

Salmon Patch (Nevus Simplex)

-Common vascular birthmark 

-Results from _______ of dermal __________

-Red, ________, macular patches that are commonly found on _____ of neck, eyelids, and glabella 

-Most facial lesions fade by _ y/o, but nuchal lesions may persist through life 

low, malformation, venules, blanchable, purple, face, complications, laser, capillary vessel

Port Wine Stain

-____ flow vascular ____________ of dermal capillaries and postcapillary _______

-Unilateral, ___________, pink-red, sharply demarcated macule/patch

• May darken to _______ and develop a pebbly or thickened surface

• Most common on ____

-Typically isolated but can occur as part of complex malformation syndromes

-If eye is involved, refer to ophthalmology and maybe neurology

-Treatment

• Cosmetic improvement and prevention of ____________ (thickening, nodularity, bleeding)

• Pulsed dye _______ therapy, which irreversibly damages _______ ______

females, white, telangiectasia, plaque, 6-8, 12-14, 3-10, ulceration, obstruction, beta blocker 

Infantile Hemangioma

-More common in _________; increased incidence in low birth weight or preterm infants 

-Present at birth or develop within the first few weeks of life 

-May initially appear as pale ______ macule with ____________ proliferating to a bright red, lobulated ________/nodule 

-Superficial → reach max size by __-__ months 

-Deep → may grow for ___-___ months 

-Most spontaneously resolve over __-___ years 

-Risks → __________, bleeding, amblyopia or pressure on globe if periorbital, may accompany other malformations 

• If subglottic, airway _________ can occur. Subglottic hemangiomas are also associated with Beard hemangiomas

-If treatment needed, you can try oral or topical _____ _________ or pulsed dye laser treatment 

benign, lymphatic, cysts, birth, translucent, cervicofacial, axilla, lateral, chromosomal, proximal, oral, resection

Lymphatic Malformations

-_______, slow flow vascular lesions composed of dilated __________ channels 

-Macrocystic (cystic hygroma)

• Collection of large, interconnected lymphatic ______

• Present at birth 

• Large, ___________, soft mass covered by normal skin

• Most commonly located in ____________, _____, or ______ chest wall 

• ½ are associated with __________ abnormalities 

-Microcystic (lymphangioma circumscriptum) 

• Cluster of clear, translucent or hemorrhagic vesicles 

• May present at birth or appear within the first few years of life 

• Most commonly located on ________ extremities, trunk, axilla, or ____ cavity 

-Treatment → surgical _________ (MC) or percutaneous chemoablation 

staph aureus, red, pustules, crusts, face, young, bullae, brownish, trunk, dermis

Impetigo: Background

-Most frequently seen in children ages 2-5 years old

-Commonly caused by _____ ________ or GAS

-Non-Bullous (MC)

• ____ papules → vesicles → _________ → enlarge then break down → forms thick yellow/honey colored ______

• Most commonly affects the _____ and extremities

-Bullous

• Seen mostly in ______ children

• Vesicles enlarge → form _____ with clear, yellow fluid → ruptures → leaves a ________ crust

• Usually affects the _____

-Ecthyma

• Ulcerative form, where the lesion extends into the ______

clinical, culture, Mupirocin, Cephalexin, bactrim, ecthyma, 24

Impetigo: Diagnosis and Treatment

-Diagnosis

• Almost always ________

• Gram stain and ________ (if unsure or concerned for MRSA or resistant pathogen) 

-Treatment 

• Topical therapy → _________ or retapamulin, indicated if limited skin involvement 

• Oral therapy → _________ (DOC for oral therapy), dicloxacillin, _______ or clindamycin if concern for MRSA. Indicated if extensive skin involvement or _______ subtype 

-Return to school or daycare __ hours after starting therapy 

feet, scalp, T. rubrum, direct, pruritic, scaling, clearing, raised, KOH, hyphae, antifungal, fluconazole, nystatin

Tinea Corporis

-Found anywhere on the body except ____, groin, face, ______, or nails

-Most common organism is __.______. Could also be T. mentagrophytes or M. canis

-Infected by _____ skin contact w/infected person or animal, contact with fomites, secondary spread

-Begins as _______, circular/oval, erythematous, _______ patch/plaque followed by central _________ with _______ border “ringworm”

-___ prep of skin scraping shows segmented _______

-Treatment

• Topical _________ agents of azoles, allylamines

• Oral antifungals of terbinafine, ___________, griseofulvin if extensive skin involvement or failure of topical treatment

• Do not use ________

scalp, pruritic, alopecia, black, hyphae, Griseofulvin, CBC, ketoconazole

Tinea Capitis

-Fungal infection of the _____ most common in prepubertal children

• Most commonly with trichophyton or microsporum species

• Contracted from infected person, animal, or contaminated object

-_______, scaly patches with ________

• May also be associated with visible _____ dots (broken hair) in areas of alopecia

-KOH prep may show fungal spores and/or _______. Could also do a fungal culture if diagnosis is uncertain

-Treatment

• Systemic antifungal agents → ____________ (DOC) x 6-12 weeks. Check LFTs and ___ if therapy > 8 weeks

• Selenium sulfide or __________ shampoo twice daily

moisture, diaper, maceration, frictional, irritants, urease, pH, enzymes, inflammation, pH, colonization, candida 

Diaper Dermatitis: Pathogenesis

-Increased ________ due to the occlusive ________ as well as stool and urine → leads to __________ of the skin → impairs skin barrier → more susceptible to _________ damage by diaper → leads to further impairment of skin barrier → increased affect of chemical ______ (stool/urine) and microorganisms 

-Fecal bacteria produce the enzyme _______ → interacts with urine → increases __  → activates other fecal _________ (protease/lipase) → leads to further irritation and ____________ of the skin 

-Elevated __→ alters skin microbiome → more susceptible to ___________ of skin and stool organisms (staph aureus, strep pyogenes, _______ albicans)

sparing, erythematous, asymptomatic, maceration, erosions, pain, glossy, painful, nodules, C. albicans, folds, diaper, red, papules, pustules

Diaper Dermatitis: Presentation

-Irritant diaper dermatitis → occurs in diaper area ______ skin folds 

-Mild → scattered ___________ papules, ___________

-Moderate → more extensive erythema with __________ or superficial skin _______, some ____ and discomfort 

-Severe → extensive erythema with a ______ appearance, _______ erosions, papules and _______

-Secondary infections (Candida, S. aureus, S. pyogenes) → _._______ most common. Typically involves skin ______ as well as _______ area. Described as beefy ___ plaques, satellite ________, and superficial _________

clinical, diaper changes, cleansing, corticosteroids, nystatin, mupirocin

Diaper Dermatitis: Diagnosis and Treatment

-Diagnosis → almost always clinical

-Treatment

• General measures → frequent ______ ______, air exposure, gentle _________, barrier preparations (petroleum, zinc oxide)

• Low potency topical ____________ (1% hydrocortisone) for more severe cases

• Topical antifungal (_____, clotrimazole, miconazole) if candida superinfection

• Topical antibiotics (_______) if bacterial superinfection

Poxvirus, palms/soles, trunk, popliteal, dome-shaped, umbilication, pruritus

Molluscum Contangiosum: Background and Presentation

-Etiology → _________ family

-Epidemiology → most common in childhood, but it can occur in adolescents and adults

-Symptoms → appear anywhere on the body (except _____/______), but the _____, axilla, antecubital/_______ fossa, crural folds are most common

• Firm, ____-______ papules with central ____________

• Polypoid with stalk like base

• ________

clinical, 2, 6-12, curettage, salicylic 

Molluscum Contagiosum: Diagnosis and Treatment

-Diagnosis → _________, maybe a biopsy with histologic exam 

-Treatment 

• Starts to resolve within _ months with complete clearing within _-__ months in immunocompetent patients 

• Cryotherapy

• _________

• Cantharidin (topical blistering agent)

• ________ acid (topical keratolytic agent)