Pediatric Dermatology focuses on differentiating between benign skin disorders and life-threatening diseases in children.
This guide reflects essential concepts in the assessment and treatment of pediatric dermatological conditions.
Speaker: Sarah B. Wren, RN, MS, CPNP
No disclosures regarding potential conflicts of interest.
Evaluate skin lesions to assess for dangerous dermatologic disorders.
Differentiate skin disorders requiring immediate treatment from benign conditions.
Analyze pediatric skin diseases for evidence-based treatment plans.
Use accurate terminology for diagnosing and treating dermatological disorders.
Assess treatment modalities, particularly considering ethnically diverse populations.
Importance of evaluating skin of color due to underrepresentation in medical education.
Major differences in presentation:
Erythema
Eczema and dry skin dermatitis
Recognition of petechiae and purpura
Hypo- and hyperpigmentation
Lesions appear as punched-out and spread rapidly, often on the head and neck.
Concomitant infection can complicate presentation; febrile illness may be observed.
Hospital admission should be considered.
Caused by a new strain (Coxsackie A6) characterized by high fever and extensive vesiculobullous rash.
More severe than typical hand, foot, and mouth disease (HFMD).
Infants with eczema may be at risk for severe disease with Atypical Coxsackie.
Lesions often appear in areas affected by atopic dermatitis.
Appear similar to eczema herpeticum, requiring careful differential diagnosis.
Caused by the Varicella Zoster Virus; characterized by pruritic erythematous macules, papules, vesicles, and crusts.
Extremely contagious via airborne transmission.
Caused by Neisseria meningitidis.
Initial symptoms include a URI, sore throat, malaise, with a rash as the common manifestation.
Rapid rash progression can lead to purpura, with a mortality rate of 10-15% despite treatment.
Lesions typically present within the first weeks of life and can present with nonspecific sepsis-like symptoms.
Requires immediate medical attention and management.
Usually benign but can be mistaken for anaphylaxis; often has a variable etiology.
Self-limiting, but differentiation is key with the involvement of multiple organ systems in anaphylaxis.
An immune-mediated condition characterized by target lesions, commonly triggered by infections, particularly viral.
Skin lesions have a characteristic appearance and are usually asymptomatic aside from pruritus.
Caused by exotoxins from staph bacteria, presenting with fever, skin tenderness, and rash.
Rapid spread leading to exfoliation must be monitored closely in young children or immunocompromised individuals.
Caused by toxins from Group A Streptococcus; recognizable and treatable condition.
Characterized by a red rash often resembling sandpaper, typically starting in the groin region.
Emergency condition, usually due to Group A Streptococcus, starting with vague muscle soreness but progressing rapidly.
Requires immediate medical intervention, including surgical debridement.
Chronic inflammatory condition characterized by pruritus and dry skin, often starting in infancy.
Changes in distribution with age; common associated comorbidities include asthma and food allergies.
A newer treatment targeting specific interleukin receptors in atopic dermatitis.
Administered via subcutaneous injection; eligible for children over 6 months. Side effects may include injection site reactions.
High prevalence condition primarily caused by HSV Type 1; significant recurrent episodes.
Treatment options include Valacyclovir, particularly effective if started at prodromal symptom onset.
Severe mucocutaneous reactions triggered by viral or bacterial infections, most commonly Mycoplasma pneumonia-related.
Diagnosis is critical, often necessitating consultation with dermatology and supportive care.
Lecture Voice recorded (late)
Scarlet fever is experiencing a resurgence worldwide.
Increased literature exploring the reasons behind the rise in cases.
In the past, cases of scarlet fever were rare, and health professionals would bring awareness to each case as significant.
Currently, health professionals encounter scarlet fever cases on a daily basis.
The COVID-19 pandemic has had widespread effects on health.
Children were not exposed to various infections during lockdowns and restrictions, affecting their immunity.
Increased prevalence of multiple respiratory viruses leading to lower immunity among children.
This situation contributes to a higher susceptibility to infections like scarlet fever.
A new strain known as MIUK has been identified in England.
This strain is associated with higher susceptibility to both scarlet fever and invasive group strep infections.
Patients infected with the MIUK strain may present with characteristic rashes.
Sudden onset of blister and significant pain, erythema around the ankle or calf.
Medical emergency, colloquially known as flesh-eating disease.
Mostly caused by Group A Streptococcus (GAS), an invasive bacterial infection.
Symptoms include:
Extreme tenderness, often disproportionate to appearance.
Rapid spread of redness and pain over hours.
Requires immediate antibiotics and surgical debridement; high morbidity and mortality.
Also known as eczema; a common chronic skin condition, especially in children.
Key features include:
Dry, itchy skin; papules and plaques; most prevalent skin disease in children.
50% of cases persist into adulthood.
Presentation varies by age group:
Infants: extensor surfaces (face, chest).
Children: flexor surfaces (elbow, knee).
Adolescents & adults: similar to children, possible hand and foot involvement.
Headlight sign: classic indicator where skin around eyes and nose is spared even when affected by atopic dermatitis.
Associated comorbidities include asthma, allergies, sleep issues, anxiety, and learning disabilities.
Treatment considerations:
Patients often on multiple medications including steroids.
Importance of knowledge of topical steroids - mild (2.5% hydrocortisone), moderate (mometasone), and high potency.
Educate patients to use more potent treatments initially to control severe dermatitis.
Emphasize emollient therapy using creams and ointments to maintain skin moisture.
Advise against short baths, advocate for bleach baths for antimicrobial and anti-inflammatory effects.
Discuss the necessity of timely treatment initiation to prevent chronic exacerbations.
Immune-mediated mucocutaneous disorder triggered post-viral infection, often mycoplasma pneumonia related.
Symptoms include severe mucositis mainly in the mouth; may involve other mucous membranes.
Usually self-limiting, good prognosis, may see some skin lesions.
Treatment is primarily supportive; become aware of potential for misdiagnosis with other serious conditions (e.g., Stevens Johnson syndrome).
Importance of detailed history and examination in febrile rash patients.
Pay attention to blisters, denuding skin as possible indicators of serious conditions.
In immunocompromised patients, rashes should always raise concern.
Case of a teenage girl with swollen, crusted lips due to an irritant (garlic).
Unique presentation of atypical dermatitis mistaken for burns (burns hurt these don’t) as showcasing the therapeutic role of patient education regarding traditional remedies.
Importance of recognizing the emotional impact of skin diseases on adolescents in social contexts.