Paediatric Dermatology

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Slides showing you presentation of skin disorders in children and their treatment. Designed as a quiz so score yourself and see how many you get right.

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Presentation Transcript

Paediatric Dermatology : 

Paediatric Dermatology Dr S Sen SpR Paediatrics North Western Deanery

Objectives : 

Objectives By the end of this session we should be able to: Recognize common rashes in infants and children and know how to treat them Manage common paediatric infestations (scabies, head lice) Treat eczema and know when to refer 11/2/2009 2 Case Presentation/Acorn ward/Dr S Sen

Case Presentation : 

Case Presentation SA 5 year old Asian boy GP referral Infected area over scalp No response to Oral Flucloxacillin Worse after haircut 11/2/2009 Case Presentation/Acorn ward/Dr S Sen 3

Slide 4: 

11/2/2009 Case Presentation/Acorn ward/Dr S Sen 4

Diagnosis & Treatment : 

Diagnosis & Treatment Swab-Trichophyton tonsurans Kerion-Tinea capitis Treatment Griseofulvin 300mg once daily for 6 weeks Ketoconazole 2% shampoo twice daily Miconazole 2%cream twice daily Follow up 6/52 11/2/2009 Case Presentation/Acorn ward/Dr S Sen 5

Tinea capitis : 

Tinea capitis Tinea capitis is a disease caused by superficial fungal infection of the skin of the scalp, eyebrows, and eyelashes, with a propensity for attacking hair shafts and follicles Tinea capitis is caused by fungi of species of genera  Trichophyton  and Microsporum 11/2/2009 Case Presentation/Acorn ward/Dr S Sen 6

Treatment : 

Treatment Systemic administration of Griseofulvin provided the first effective oral therapy for Tinea capitis. Topical treatment alone usually is ineffective and is not recommended for the management of Tinea capitis. Newer antifungal medications, such as ketoconazole, itraconazole, terbinafine, and fluconazole, have been reported as effective alternative therapeutic agents for Tinea capitis Selenium sulfide shampoo may reduce the risk of spreading the infection early in the course of therapy by reducing the number of viable spores that are shed. 11/2/2009 Case Presentation/Acorn ward/Dr S Sen 7

Slide 8: 

Quiz 2 teams Shout when you know the rash Extra bonus points available Prize for winners! 11/2/2009 8 Case Presentation/Acorn ward/Dr S Sen

What's this rash? : 

What's this rash? 11/2/2009 9 Case Presentation/Acorn ward/Dr S Sen

Milia : 

Milia Epidermal inclusion cysts Pearly, yellow, 1-3mm diameter papules Face, chin, forehead 50% newborns Usually resolve in first month without treatment, but may persist for several months 11/2/2009 10 Case Presentation/Acorn ward/Dr S Sen

What are these? : 

What are these? 11/2/2009 11 Case Presentation/Acorn ward/Dr S Sen

Haemangioma : 

Haemangioma Most common benign tumours of infancy Begin as barely visible telangiectasia or red macules and grow into 0.5-4cm bright red partially compressible tumours 60% occur on head and neck area Virtually all gone by age 5yrs 11/2/2009 12 Case Presentation/Acorn ward/Dr S Sen

What's this? : 

What's this? 11/2/2009 13 Case Presentation/Acorn ward/Dr S Sen

Capillary malformations : 

Capillary malformations 2 common types Salmon patch (naevus simplex) Common (40% newborns) Small flat patches pink or red, poorly defined borders Nape of neck (stork mark), forehead (angel kiss), eyelids and sacrum Worse with crying Not associated with extracutaneous findings 11/2/2009 14 Case Presentation/Acorn ward/Dr S Sen

Capillary malformations : 

Capillary malformations Port wine stain Less common Large flat patch of purple or dark red skin with well defined borders Persist in childhood then darkens and thickens Extracutaneous defects 11/2/2009 15 Case Presentation/Acorn ward/Dr S Sen

What's that rash? : 

What's that rash? 11/2/2009 16 Case Presentation/Acorn ward/Dr S Sen

Nappy rash : 

Nappy rash Caused by combination of factors, irritation to the skin by urine and faeces & occlusion Intertriginous areas usually spared Secondary staph infection = thin-walled pustules on erythematous base If persistent and creases involved think seborrhoeic dermatitis, psoriasis, and candidiasis 11/2/2009 17 Case Presentation/Acorn ward/Dr S Sen

Nappy Rash - prevention and treatment : 

Nappy Rash - prevention and treatment Nappy off! Change nappy frequently Wash bottom at each change, can use aqueous cream Use emollient (aqueous cream) and barrier (zinc oxide) Low potency topical steroid (hydrocortisone) Candida - antifungal eg nystatin, can add low potency steroid for few days Sebhorrhoeic dermatitis - Emollients and steroid help, can add ketoconazole 11/2/2009 18 Case Presentation/Acorn ward/Dr S Sen

What's that rash? : 

What's that rash? 11/2/2009 19 Case Presentation/Acorn ward/Dr S Sen

Cradle cap : 

Cradle cap Greasy, yellow scaly patches over the scalp Seborrhoeic dermatitis of newborn possibly due to overactive sebaceous glands in the skin of newborn babies Possible relationship with skin yeasts (malassezia) Not itchy Treatment with mild baby shampoos. Wash regularly and brush softly to remove scales Baby oil can help soften scales (not olive oil!) Resolves by 6-12mths If fails to improve can try medicated shampoo with Ketoconazole or low potency steroids 11/2/2009 20 Case Presentation/Acorn ward/Dr S Sen

What's that rash? : 

What's that rash? 11/2/2009 21 Case Presentation/Acorn ward/Dr S Sen

What is the incubation period?Is the person infectious before the rash? : 

What is the incubation period?Is the person infectious before the rash? 11/2/2009 22 Case Presentation/Acorn ward/Dr S Sen

Chicken pox : 

Chicken pox Begins as itchy red papules progressing to vesicles on bright red base (dew drops on a rose petal) on the stomach, back and face, and then spreading to other parts of the body Central umbilication of blisters follows rapidly, crusting and desquamation within 10 days Fever, sore throat, anorexia, malaise may precede rash by several days Incubation 7-21 days symptomatic treatment only in immunocompetent Cool compress, Calamine lotion, antihistaminics 11/2/2009 23 Case Presentation/Acorn ward/Dr S Sen

What's that rash? : 

What's that rash? 11/2/2009 24 Case Presentation/Acorn ward/Dr S Sen

Meningococcus : 

Meningococcus What every parent worries about Rash is seldom early sign Classically non-blanching haemorrhagic rash In early stages rash may be blanching and macular or maculopapular (sometimes confused with flea bites) Important to search whole body for small petechiae Give IM Ben Pen and refer 11/2/2009 25 Case Presentation/Acorn ward/Dr S Sen

What that rash? : 

What that rash? 11/2/2009 26 Case Presentation/Acorn ward/Dr S Sen

Impetigo : 

Impetigo Superficial bacterial skin infection Strep pyogenes or staph aureus Round/oval lesions, begin as small pustular areas and rapidly extend Lesions rupture, oozy surface with honey-covered crust Advice about avoiding spread Localized lesion- topical antibiotic eg Fucidin cream Widespread infection - oral Flucloxacillin or Erythromycin 11/2/2009 27 Case Presentation/Acorn ward/Dr S Sen

What's that rash? : 

What's that rash? 11/2/2009 28 Case Presentation/Acorn ward/Dr S Sen

Molluscum contagiosum : 

Molluscum contagiosum Viral skin infection Pox virus aka ‘dimple wart’ Clusters of small round flesh-coloured umbilicated papules Often on face, trunk, axillae (warm moist places) Harmless but can persist for months, occasionally a couple of years No treatment necessary Can refer for cryotherapy/curettage 11/2/2009 29 Case Presentation/Acorn ward/Dr S Sen

What's this rash? What are the spots inside the mouth called? : 

What's this rash? What are the spots inside the mouth called? 11/2/2009 30 Case Presentation/Acorn ward/Dr S Sen

Measles : 

Measles Prodrome; fever, malaise, dry cough, coryza, conjunctivitis, photophobia Koplik spots on buccal mucosa Rash 3-4th day of illness Starts on face as blanching red macules and papules, non itchy Spreads down trunk and extremities Rash coincides with high fever Lesions become confluent, older lesions develop rusty hue Contagious 4 days before rash and 4 days after 11/2/2009 31 Case Presentation/Acorn ward/Dr S Sen

Where else on the body will you find lesions?Which virus causes this picture? : 

Where else on the body will you find lesions?Which virus causes this picture? 11/2/2009 32 Case Presentation/Acorn ward/Dr S Sen

Slide 33: 

11/2/2009 33 Case Presentation/Acorn ward/Dr S Sen

Hand foot & mouth : 

Hand foot & mouth Self-limiting condition affecting children under the age of ten Caused by coxsackie viruses, usually A16 but others may be implicated. 3-day incubation period. No specific treatment for the condition. Lasts for 7 days and does not recur. 11/2/2009 34 Case Presentation/Acorn ward/Dr S Sen

What's that rash? : 

What's that rash? 11/2/2009 35 Case Presentation/Acorn ward/Dr S Sen

Eyrthema infectiosum : 

Eyrthema infectiosum Fifth disease, slapped cheek, Parvovirus B19 First sign is firm red cheeks, which feel burning hot Rash follows 1-4 days later with a lace pattern on the limbs and then the trunk Fades over 2-3wks Usually well, may have slight fever or headache Rare complications Arthritis in teenagers/adults, aplastic crisis 11/2/2009 36 Case Presentation/Acorn ward/Dr S Sen

What's that rash? : 

What's that rash? 11/2/2009 37 Case Presentation/Acorn ward/Dr S Sen

Herpes simplex : 

Herpes simplex Gingivostomatitis commonest manifestation of primary herpes infection in kids Clusters of red papules, evolve into vesicles and often pustules in 24-48hrs. Vesicles rupture and crust over. Heal in 10-14 days Cool compress, analgesia, consider aciclovir Monitor hydration when oral lesions Can be recurrent 11/2/2009 38 Case Presentation/Acorn ward/Dr S Sen

Head Lice : 

Head Lice Infest clean and dirty hair Adult lice are size of sesame seed, brownish grey, and wiggle their legs Only adult lice contagious Spread by head to head contact They don’t jump/fly Normally asymptomatic Can present with itchy scalp 11/2/2009 39 Case Presentation/Acorn ward/Dr S Sen

Head Lice- Treatment : 

Head Lice- Treatment Insecticides - malathion, phenothrin, permethrin, carbaryl 2 applications 7 days apart Shampoos not effective Wet-comb conditioned hair with fine tooth comb until lice removed and rpt at 3-4 day intervals for 2/52 Electric combs, tea tree - no evidence 11/2/2009 40 Case Presentation/Acorn ward/Dr S Sen

What that rash? : 

What that rash? 11/2/2009 41 Case Presentation/Acorn ward/Dr S Sen

Scabies : 

Scabies Sarcoptes scabiei mite Pruritic burrows pathognomic (irregular, tortuous, and slightly scaly) In infants, burrows are widespread with involvement of trunk, scalp, extremities, palms and soles Consider in infants with widespread dermamtosis that involves the palms and soles 11/2/2009 42 Case Presentation/Acorn ward/Dr S Sen

Scabies - treatment : 

Scabies - treatment Permethrin (malathion) Ivermectin in combination for ‘norwegian scabies’ All family members at same time Whole body treatment inc, scalp, neck, face, ears and under nails Repeat 1 week later 11/2/2009 43 Case Presentation/Acorn ward/Dr S Sen

Infantile eczema : 

Infantile eczema 11/2/2009 44 Case Presentation/Acorn ward/Dr S Sen

Eczema : 

Eczema Infants Infants less than one year old often have widely distributed eczema. The skin is often dry, scaly and red with small scratch marks made by sharp baby nails The cheeks of infants are often the first place to be affected by eczema. The napkin area is frequently spared due to the moisture retention of nappies (but they can still get nappy rash) 11/2/2009 45 Case Presentation/Acorn ward/Dr S Sen

Childhood eczema : 

Childhood eczema 11/2/2009 46 Case Presentation/Acorn ward/Dr S Sen

Eczema : 

Eczema Toddlers and pre-school As children begin to move around, the eczema becomes more localised and thickened. Toddlers scratch vigorously and the eczema may look very raw and uncomfortable Often affects the extensor aspects of joints, particularly the wrists, elbows, ankles and knees. It may also affect the genitals As the child becomes older the pattern frequently changes to involve the flexor surfaces of the same joints The affected skin often becomes lichenified 11/2/2009 47 Case Presentation/Acorn ward/Dr S Sen

Eczema : 

Eczema School children Older children tend to have the flexural pattern of eczema and it most often affects the elbow and knee creases. Other susceptible areas include the eyelids, earlobes, neck and scalp. Many children develop a 'nummular' pattern of atopic dermatitis. This refers to small coin-like areas of eczema scattered over the body. These round patches of eczema are dry, red and itchy and may be mistaken for ringworm Mostly improves during the school years 11/2/2009 48 Case Presentation/Acorn ward/Dr S Sen

Treatment of eczema : 

Treatment of eczema Advice - loose cotton clothes, avoid wool, keep cool, nails short, gloves in bed Emollients Antihistamines Topical steroids Topical immunosuppressant Bandages (zinc/ ichthammol/ Tar) Wet wrapping - weeping eczema Immunosuppressant Phototherapy 11/2/2009 49 Case Presentation/Acorn ward/Dr S Sen

Name the condition and 3 associations … or more : 

Name the condition and 3 associations … or more 11/2/2009 50 Case Presentation/Acorn ward/Dr S Sen

Acanthosis nigricans : 

Acanthosis nigricans Acanthosis nigricans may be associated with: advanced malignancy; particularly: gastric carcinoma lymphoma endocrine disorders; for example: acromegaly Cushing's syndrome diabetes insulin resistance obesity and: the polycystic ovarian syndrome non-insulin dependent diabetes no endocrine disorder 11/2/2009 51 Case Presentation/Acorn ward/Dr S Sen

What is this? : 

What is this? 11/2/2009 52 Case Presentation/Acorn ward/Dr S Sen

Collodian baby : 

Collodian baby This term is used to describe the appearance of the skin in a neonate who has, in the vast majority of cases, congenital ichthyosiform erythroderma The skin of the neonate is a yellow, tight, shiny film that resembles dried collodion or sausage skin The membrane dries and peels during the first days of life, and is generally completely shed within a few weeks In about 10% of cases, collodion babies subsequently have normal skin 11/2/2009 53 Case Presentation/Acorn ward/Dr S Sen

Name the condition and its inheritance : 

Name the condition and its inheritance 11/2/2009 54 Case Presentation/Acorn ward/Dr S Sen

Peutz-Jegher Syndrome : 

Peutz-Jegher Syndrome Autosomal dominant condition multiple hamartogenous polyps of the gastrointestinal tract - most often in the small bowel but may occur affect any portion of the GI tract mucocutaneous pigmentation - mainly, of the lips, buccal mucosa, genitalia, hands & feet Patients often present with small bowel intussusception <10yr of age The polyps have a very low malignant potential. About 10-20% of patients develop GI carcinoma but this is thought to arise from coexistent adenomas. 11/2/2009 55 Case Presentation/Acorn ward/Dr S Sen

Slide 56: 

What does this symbol mean? What was applied to the skin to make the rash? Which component causes the majority of the reactions? 11/2/2009 56 Case Presentation/Acorn ward/Dr S Sen

Henna Tattoo : 

Henna Tattoo Henna dye is obtained from the dried leaves of this plant - the dried leaves are powdered and mixed with oil or water, and used to prepare hair and body dyes The henna used in Africa is generally black the henna used in India is reddish brown Para-phenylenediamine (PPD) is also sometimes added to obtain a dark, blackish henna PPD causes the majority of cases of contact dermatitis reported in subjects with tattoos 11/2/2009 57 Case Presentation/Acorn ward/Dr S Sen

Spot diagnosis : 

Spot diagnosis 11/2/2009 58 Case Presentation/Acorn ward/Dr S Sen

Paint! : 

Paint! 11/2/2009 59 Case Presentation/Acorn ward/Dr S Sen

What rare condition is this? : 

What rare condition is this? 11/2/2009 60 Case Presentation/Acorn ward/Dr S Sen

Artifactual Injury : 

Artifactual Injury Injuries self inflicted Pencil rubber found in bed! 11/2/2009 61 Case Presentation/Acorn ward/Dr S Sen

Slide 62: 

Name this eponymous condition Name one virus it is associated with 11/2/2009 62 Case Presentation/Acorn ward/Dr S Sen

Gianotti-Crosti rash : 

Gianotti-Crosti rash patient acutely develops hundreds of red macules and papules on the face, extremites and buttocks with sparing of the trunk malaise and lymphadenopathy accompany the eruption the lesions become purpuric and then slowly fade over the next two to three weeks the rash appears to be the result of an underlying viral infection. It may occur in association with: Coxsackie's, varicella, hepatitis B, and Epstein-Barr viruses. 11/2/2009 63 Case Presentation/Acorn ward/Dr S Sen

Slide 64: 

Where would you expect this woman to live? What has caused these lesions 11/2/2009 64 Case Presentation/Acorn ward/Dr S Sen

Cupping : 

Cupping South East Asia Or now-a-days… Hollywood 11/2/2009 65 Case Presentation/Acorn ward/Dr S Sen

How is this acquired and what is the organism? : 

How is this acquired and what is the organism? 11/2/2009 66 Case Presentation/Acorn ward/Dr S Sen

Neonatal Herpes simplex : 

Neonatal Herpes simplex In true foetal infection: microcephaly intracranial calcification Retinopathy Clinical features of neonatal infection occur in the first month of life and include: lethargy hepatosplenomegaly bleeding neurological symptoms vesicular rash The infection may be localised to the skin, mouth or eyes though disseminated disease may occur with CNS and visceral involvement. 11/2/2009 67 Case Presentation/Acorn ward/Dr S Sen

Name this lesion? What is this lesion predisposed to do? : 

Name this lesion? What is this lesion predisposed to do? 11/2/2009 68 Case Presentation/Acorn ward/Dr S Sen

Giant Hairy Naevus : 

Giant Hairy Naevus 5-10% become malignant Half of which arise before the age of 5yrs Mortality 45% 11/2/2009 69 Case Presentation/Acorn ward/Dr S Sen

What transmitted the infection?What is the infection?What is the rash?Where in the UK can you get this? : 

What transmitted the infection?What is the infection?What is the rash?Where in the UK can you get this? What is the association with Bambi? 11/2/2009 70 Case Presentation/Acorn ward/Dr S Sen

Lyme disease : 

Lyme disease Tic borne Erythema migrans Can be caught in New Forest, Scotland, etc Sheep or deer ticks in UK 11/2/2009 71 Case Presentation/Acorn ward/Dr S Sen

The two most likely differentials, using this distribution what is most likely and thereforewhat key investigations are required? : 

The two most likely differentials, using this distribution what is most likely and thereforewhat key investigations are required? 11/2/2009 72 Case Presentation/Acorn ward/Dr S Sen

Henoch-Schonlein Purpura : 

Henoch-Schonlein Purpura Differential: Menningoccocal septicaemia Investigations: Urine dipstick Blood pressure FBC & U&E’s 11/2/2009 73 Case Presentation/Acorn ward/Dr S Sen

What is this condition? : 

What is this condition? 11/2/2009 74 Case Presentation/Acorn ward/Dr S Sen

Aplasia Cutis : 

Aplasia Cutis Naevoid abnormality which may present as absent areas of epidermis - ulceration - on the scalp. It is sometimes associated with skull defects and brain abnormalities. These lesions are often mistakenly thought to have been caused by birth trauma, and generally heal with a resultant atrophic scar - a bald patch. This condition may also be associated: carbimazole use during pregnancy with Patau's syndrome (RARE). 11/2/2009 75 Case Presentation/Acorn ward/Dr S Sen

What is the underlying skin condition?What treatment is required? : 

What is the underlying skin condition?What treatment is required? 11/2/2009 76 Case Presentation/Acorn ward/Dr S Sen

Eczema herpeticum : 

Eczema herpeticum Aciclovir 11/2/2009 77 Case Presentation/Acorn ward/Dr S Sen

Name the condition, what food should she avoid?What advice would you give? : 

Name the condition, what food should she avoid?What advice would you give? 11/2/2009 78 Case Presentation/Acorn ward/Dr S Sen

Acne Vulgaris : 

Acne Vulgaris Contrary to popular belief diet does not affect acne Do not pick lesions as they scar 11/2/2009 79 Case Presentation/Acorn ward/Dr S Sen

What is the association? : 

What is the association? 11/2/2009 80 Case Presentation/Acorn ward/Dr S Sen

Von Recklinghausen's disease, or Neurofibromatosis type I : 

Von Recklinghausen's disease, or Neurofibromatosis type I Friedrich Daniel von Recklinghausen 11/2/2009 81 Case Presentation/Acorn ward/Dr S Sen

When lateral pressure is put on the skin with the thumb, the epidermis appears to slide over the underlying dermis- What is the sign?What is the underlying condition : 

When lateral pressure is put on the skin with the thumb, the epidermis appears to slide over the underlying dermis- What is the sign?What is the underlying condition 11/2/2009 82 Case Presentation/Acorn ward/Dr S Sen

Staph scalded skin syndrome : 

Staph scalded skin syndrome When lateral pressure is put on the skin with the thumb, the epidermis appears to slide over the underlying dermis  Nikolsky’s sign 11/2/2009 83 Case Presentation/Acorn ward/Dr S Sen

Name the two common dermatological symptoms? : 

Name the two common dermatological symptoms? 11/2/2009 84 Case Presentation/Acorn ward/Dr S Sen

Itchy and Scratchy (Simpsons) : 

Itchy and Scratchy (Simpsons) 11/2/2009 85 Case Presentation/Acorn ward/Dr S Sen

Is this baby normal? : 

Is this baby normal? 11/2/2009 86 Case Presentation/Acorn ward/Dr S Sen

This baby is normal : 

This baby is normal …shhhhh…he is sleeping…. 11/2/2009 87 Case Presentation/Acorn ward/Dr S Sen

Add up your scores – how did you do? : 

Add up your scores – how did you do? 11/2/2009 88 Case Presentation/Acorn ward/Dr S Sen