Peds - Dermatology

Seborrheic dermatitis

Cradle cap 2-10 weeks after birth

thick greasy yellow erythematous scaling crusting lesion

Seborrheic dermatitis tx

Antiseborrheic shampoo, baby oil

*resolves in 1st year

Irritant diaper dermatitis

Erythematous patches & plaques +/- scaling, poorly defined borders in diaper/perianal region, spares skin folds

Irritant diaper dermatitis tx

Frequent changes

Allow skin to dry

Protective creams/ointments, powders

+/- weak topical steroids

Staphylococcal diaper dermatitis

Thin walled pustules on erythematous base

*gram stain -> neutrophils, clusters of gram + cocci

Staphylococcal diaper dermatitis tx

Bacitracin, mupirocin

Candidal diaper dermatitis

Bright red, marcerated sore erythematous papules and pustules that coalesce -> plaques w erosions involves skin folds

Candidal diaper dermatitis dx

KOH prep --> pseudohyphae and yeast

Candidal diaper dermatitis tx

Topical antifungal creams or ointments

Dermoid cysts

Inclusion cysts in subcutaneous fat, lined w keratinizing stratified squamous epithelium containing skin appendages

Dermoid cyst management

R/o intraspinal or intracranial prior to removing (CT/MRI)

If intracranial connection -> neurosurgery

Impetigo

Single erythematous papule -> many honey-colored lesions w crust

Bullous impetigo

Thin walled, red margins

Impetigo causes

staphylococcal and streptococcal bacteria

*incubation 7-10 days

Impetigo tx

Mupirocin

Oral Pen or Erythromycin if Group A Strep

Oral SMX/TMP or Clindamycin if Staph

*no school or daycare until treated > 24 hr

Erysipelas

Swollen, red, hot, tender area w sharply defined erythematous plaque + slightly raised border

Erysipelas cause

Group A Strep

*sx 2-5 days following skin break

Erysipelas tx

Parenteral ABX -> oral ABX

Molluscum Contagiosum

Viral infection -> discrete 2-5 mm umbilicated, pearly-white papules

*incubation 14 d - 6 months, skin-skin contact

Where does molluscum contagiosum usually occur on the body?

Axillae, anticubital/crural folds

Molluscum contagiosum tx

self-limited

liquid nitrogen, cantharone, curettage

Pityriasis Rosea

Single, large scaly 2-5 cm oval patch (Herald patch) -> crops of small, oval/scaly patches on trunk in Christmas tree pattern

+/- mild pruritis, malaise, pharyngitis

Atopic dermatitis

Xerosis, pruritis, erythematous papules or plaques w scale, secondary excoriation

Atopic dermatitis phases

1 = non-atopic in early infancy before sensitization

2 = IgE mediated sensitization

3 = scratching -> damage to skin cells, IgE AB produced

Infants atopic dermatitis distribution

Face & extensors

Childhood atopic dermatitis distribution

Flexors, wrists, ankles, hands

Teens atopic dermatitis distribution

Flexors, neck, hands, face, fingers, toes, upper back, arms

Atopic dermatitis tx

Moisturizer, corticosteroids, antihistamines, topical calcineurin inhibitors, UV light therapy

Superficial hemangiomas

Rapid vascular overgrowth -> superficial, well-demarcated bright red nodule or plaque. Soft, compressible, raised

Superficial hemangiomas tx

Steroids or laser if life threatening

Propranolol, vincristine, alpha interferon

Deep hemangioma

Bluish hue, indistinct borders, doughy on palpation, partially compressible. May lead to HF if large enough

Port-wine stain

Purplish-red macule, vascular malformation on head and neck present at birth

Port-wine stain w seizures, developmental delay, glaucoma

Sturge-Weber (ophthalmic branch of CNV)

Port-wine stain tx

Pulsed dye laser

Congenital melanocytic nevi

Oval or lancet shaped brown patches or plaques

-Usually larger, darker, thicker and hairier than acquired nevi

Congenital melanocytic nevi management

Follow annually, increased risk for melanoma in

med (1.5-20 cm), large (20-40 cm), giant (40-60 cm) lesions

*may need to excise at/before puberty