Common Pediatrics Rashes I by changcheng2

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									Common Pediatrics Rashes
Primary skin lesions
             Primary skin lesions
• Macule
  A macule is an area of color change less than 1.5 cm diameter. The
  surface is smooth.

• Patch
  A patch refers to a large area of color change, with smooth surface.

• Papule
  Papules are small palpable lesions. The usual definition is that they
  are less than 0.5 cm diameter, although some authors allow up to
  1.5 cm. They are usually visibly raised above the skin surface, and
  may be solitary or multiple.
• Papules may be sessile, pedunculated, filiform, or verrucous.
              Primary skin lesions
• Plaque
  A plaque is a palpable flat lesion greater than 0.5 cm diameter. Most
  plaques are elevated, but a plaque can also be a thickened area
  without being visibly raised above the skin surface.

• Nodule
  A nodule is an enlargement of a papule in three dimensions (height,
  width, length).

• Vesicle
  Vesicles are small blisters less than 0.5cm diameter. They are fluid-
  filled papules, and may be single or multiple.

• Pustule
  A pustule is a purulent vesicle. It is filled with neutrophils, and may
  be white, or yellow. Not all pustules are infected.
              Primary skin lesions
• Bulla
  A bulla is a large fluid-filled blister. It may be a single compartment
  or multiloculated.

• Wheal
  A wheal is an edematous papule or plaque caused by swelling in the
  dermis. Whealing often indicates urticaria.

• Purpura
  Purpura is bleeding into the skin. This may be as petechiae (small
  red or brown spots), or as ecchymoses (bruises).

• Telangiectasia
  Telangiectasia is the name given to prominent cutaneous blood
  vessels.
          Secondary skin lesions
• Scaling
  Scaling is an increase in the dead cells on the surface of the skin
  (stratum corneum). The scale can be psoriatic-type (large white or
  silver flakes), pityriasis-type (branny powdery scale), or lichenoid
  (tightly adherent to skin surface).

• Lichenification
  Lichenification is caused by chronic rubbing which results in
  palpably thickened skin with increased skin markings and lichenoid
  scale. It occurs in chronic eczema eg. atopic dermatitis or lichen
  simplex.

• Exfoliation
  Exfoliation is the stratum corneum peeling off, usually occurring after
  acute inflammation.
          Secondary skin lesions
• Crusting
  Crust occurs when plasma exudes through an eroded epidermis. It
  is rough on the surface and is yellow or brown in color. Bloody crust
  appears red, purple or black.

• Excoriation
  An excoriation is a scratch mark. It may be a linear erosion or a
  picked scratch. Excoriations may occur in the absence of a primary
  dermatosis.

• Erosion
  An erosion is caused by loss of the surface of a skin lesion, it is a
  shallow moist or crusted lesion.
          Secondary skin lesions
• Fissure
  A fissure is a thin crack within epidermis or epithelium, and is due to
  excessive dryness.

• Ulcer
  An ulcer is full thickness loss of epidermis or epithelium. It may be
  covered with a dark-colured crust called an eschar.

• Erythroderma
  Erythroderma is a term used to indicate red skin over the entire
  body.
• A 10-year-old girl with atopic dermatitis
  reports itching that has recently become
  relentless, resulting in sleep loss. Her mother
  has been reluctant to treat the girl with
  topical corticosteroids, because she was told
  that they damage the skin, but she is
  exhausted and wants relief for her child.

•   1. What is atopic dermatitis?
•   2. What causes it?
•   3. What questions would you ask the parent?
•   4. How should the problem be managed?
Atopic dermatitis
    clustered lichenified
    follicular papules
Atopic dermatitis




    Scaly erythematous plaque
Atopic dermatitis
        uniform symmetric 2
        mm hypopigmented
        follicular papules
Atopic dermatitis




 symmetric lichenified scaly red plaques
Atopic dermatitis

      symmetric red scaly
      crusted excoriated
      plaques
Atopic dermatitis

   symmetric red scaly crusted
   excoriated plaques
Atopic dermatitis


acute red edematous annular
scaly and crusted plaques
                                      TOPICAL CORTICOSTEROID POTENCY

Generic name -> Trade name and strength
Class 1--superpotent
Betamethasone dipropionate = Diprolene gel/ointment, 0.05%; Diflorasone diacetate = Psorcon ointment, 0.05%
Clobetasol propionate = Temovate cream/ointment, 0.05%; Halobetasol propionate = Ultravate cream/ointment, 0.05%

Class 2--potent
Mometasone furoate = Elocon ointment, 0.1%; Amcinonide = Cyclocort ointment, 0.1%;
Betamethasone dipropionate = Diprosone ointment, 0.05%; Desoximetasone = Topicort cream/ointment, 0.25%; gel
0.05%; Fluocinonide = Lidex cream/ointment, 0.05%; Halcinonide = Halog cream, 0.1%

Class 3--upper mid-strength
Betamethasone dipropionate = Diprosone cream, 0.05% Betamethasone valerate = Valisone ointment, 0.1% Diflorasone
diacetate = Florone, Maxiflor creams, 0.05% Triamcinolone acetonide = Aristocort cream, 0.5%
Fluticasone propionate = Cutivate ointment, 0.05%

Class 4--mid-strength
Mometasone furoate = Elocon cream, 0.1%; Desoximetasone = Topicort LP cream, 0.05%;
Fluocinolone acetonide = Synalar-HP cream, 0.2%; Synalar ointment, 0.025%;
Flurandrenolide = Cordran ointment, 0.05%; Triamcinolone acetonide = Aristocort, Kenalog ointments, 0.1%

Class 5--lower mid-strength
Betamethasone dipropionate = Diprosone lotion, 0.05%; Betamethasone valerate = Valisone cream/lotion, 0.1%
Fluocinolone acetonide = Synalar cream, 0.025%; Flurandrenolide = Cordran cream, 0.05%;
Hydrocortisone butyrate = Locoid cream, 0.1%; Hydrocortisone valerate = Westcort cream, 0.2%; Prednicarbate =
Dermatop emollient cream, 0.1%; Triamcinolone acetonide = Kenalog cream/lotion, 0.1%; Fluticasone propionate =
Cutivate cream, 0.05%

Class 6--mild
Alclometasone dipropionate = Aclovate cream/ointment, 0.05%; Triamcinolone acetonide = Aristocort cream, 0.1%;
Desonide = DesOwen cream, 0.05%,Tridesilon cream, 0.05%
Fluocinolone acetonide = Synalar cream/solution, 0.01%; Betamethasone valerate= Valisone lotion, 0.1%

Class 7--least potent
Hydrocortisone (0.5, 1.0, 2.5%) = Cortaid, Cortizone 10 (OTC), 2.5% (Hytone) is Rx only
• A 3-month-old girl developed an
  asymptomatic scaly red eruption in the
  diaper area and the face. The lesions in the
  diaper area were well circumscribed and red-
  orange in color.

• 1. What is the rash?
• 2. What causes it?
• 3. How do you manage it?
Seborrheic dermatitis

   symmetric red scaly confluent plaques
Seborrheic dermatitis
      symmetric red scaly
      confluent plaques
Seborrheic dermatitis




  symmetric red greasy scaly patches
Seborrheic dermatitis
thick tenacious scale with crust
and underlying erythema
Seborrheic dermatitis
     confluent red papules
     extending from the creases
• A 6-month-old boy presents with a diaper
  rash consisting of confluent, bright red
  papules and plaques with scattered pustules,
  overlying scale, and satellite lesions at the
  periphery.

• 1. What is the rash?
• 2. What causes it?
• 3. How do you manage it?
Candidal Diaper dermatitis




confluent bright red papules and plaques
with scattered pustules, overlying scale,
and satellite lesions at the periphery
• A mother describes to you a diaper rash that
  cleared rapidly with frequent application of a
  barrier paste and air drying after diaper
  changes. She wants to know why this
  happens.

• 1. What is the cause of this rash?
• 2. How do you manage it?
Irritant/Contact diaper dermatitis
         symmetric uniform 2-3 mm red eroded papules
• A 2-month-old healthy boy developed a
  pustular eruption in the diaper area 2 days
  ago. A Gram stain showed neutrophils and
  Gram positive cocci.

• 1. What is the rash?
• 2. What causes it?
• 3. How do you treat it?
Staphylococcal pustulosis
      3-5 mm pustules, some ruptured
      and drying with a collarette of scale
• A 10-year-old boy developed asymptomatic
  relapsing and remitting hypopigmented
  minimally scaly patches on his facial cheeks.

• 1. What is the rash?
• 2. What causes it?
• 3. How do you manage it?
 Pityriasis alba




hypopigmented patch with fine scale
• A healthy adolescent developed a large scaly
  red patch on the back followed a week later
  by a widespread papulosquamous eruption.
  The lesions were primarily truncal and only
  minimally pruritic.

• 1. What is the rash?
• 2. What causes it?
• 3. How do you mange it and what is the
  expected outcome?
Pityriasis rosea




         symmetric oval 0.5-3.0 cm
         red patches with central
         trailing scale
Pityriasis rosea


                   multiple widespread
                   round to oval 1-3
                   cm almost confluent
                   plaques
• An 18-year-old boy was evaluated for facial
  acne. He had multiple open and closed
  comedones and a few red papules and
  pustules on his malar and temporal areas.

• 1. What causes acne vulgaris?
• 2. What are the different types?
• 3. How do you manage it?
       Acne vulgaris




open and closed comedones
Acne vulgaris




   symmetric grouped uniform 2 mm
   papules with a central dark scaly core
Acne vulgaris
      multiple symmetric deep
      tender nodules, violaceous
      cysts, pustules, and
      comedones. BEFORE Rx
      (isotretinoin)
Acne vulgaris




   symmetric grouped uniform 2 mm
   papules with a central dark scaly core.
   AFTER
• A 17-year-old boy complained of dry scaly
  sandpaper like papules on the extensor
  surfaces of his upper arms and thighs for as
  long as he could remember. His father had
  similar lesions.

• 1. What is the rash?
• 2. What causes it?
• 3. How do you manage it?
Keratosis pilaris




 symmetric sandpaper like follicular papules
  Keratosis pilaris


symmetric red sand paperlike follicular papules
• An 8-year-old boy demonstrated an annular
  scaly plaque on the neck extending into the
  scalp with broken hairs and a prominent
  right occipital lymph node.

• 1. What is the rash?
• 2. What causes it?
• 3. How do you treat it?
   Tinea capitis




annular scaly plaque with occipital
adenopathy
Tinea capitis
ID reaction / autoeczematization / Tinea capitis




            patches of scale and erythema over
            neck and trunk with pruritic pustules
Tinea capitis / kerion




         boggy occipital area
ID reaction
• A 10-year-old boy developed an expanding
  annular plaque on the anterior neck. A
  potassium hydroxide preparation showed
  branching hyphae.

• 1. What is the rash?
• 2. What causes it?
• 3. How do you treat it?
Tinea corporis




    concentric red scaly annular plaques
• A 16-year-old soccer player complained of
  intense itching and burning in the groin for
  one week. He attributed the rash to playing
  matches in the rain for the preceding two
  weeks.

• 1. What is the rash?
• 2. What causes it?
• 3. How do you treat it?
               Tinea cruris




Erythematous,
hyperpigmented
scaly plaques
centered on the
inguinal creases and
extending down the
medial thighs
• A 20-year-old man had an extensive itchy
  rash involving the soles, undersurfaces of
  the toes, and web spaces of both feet.

• 1. What is the rash?
• 2. What causes it?
• 3. How do you treat it?
• An 8-year-old girl was evaluated for multiple
  hypopigmented macules on her face. A
  potassium hydroxide preparation made from
  a scraping of fine scale from the macules
  showed pseudohyphae and spores.

• 1. What is the rash?
• 2. What causes it?
• 3. How do you treat it?
Pityriasis versicolor



                    Well-demarcated
                    hypopigmented
                    macules with
                    minimal scale
Pityriasis versicolor
                Pityriasis versicolor




Red macules
                                         Brown macules




White macules                           Hyphae and spores
• An otherwise-healthy 6-year-old boy
  presents for evaluation of multiple papules
  on his arms, legs, and trunk. He has
  developed over 50 of these lesions, which
  are asymptomatic, over the last 4-5 months.

• 1. What is the most likely etiology?
• 2. What causes it?
• 3. How do you treat it?
Molluscum contagiosum




    pearly 3-4mm papules, some with a central dell
Molluscum contagiosum




      5 mm pearly papule with central white scale
• A 9-year-old healthy boy developed
  persistent warts on his hands that spread to
  his upper lip and hard palate.

• 1. What are the different types of warts?
• 2. What is the etiology?
• 3. What are his treatment options?
                        Warts




multiple 1-3 mm rough topped papules
              Warts




1 cm eroded rough brown
papule with central crust
and hemorrhage
• A 19-year-old notes diffuse, intense itching.
  He reports that his girlfriend has the same
  itching. Examination of the skin reveals
  interdigital lesions, with small papules,
  vesicles, and excoriations on the hands, and
  indurated nodules on the genitalia.

• 1. What is the rash?
• 2. What causes it?
• 3. How do you treat it and what is the expected
  outcome?
 Scabies




generalized, symmetric, linear
red papules and pustules
                Scabies




generalized, symmetric, linear red papules and pustules
Scabies
multiple, symmetric red excoriated
papules, vesicles, and pustules
Scabies
  multiple, elongated, excoriated
  red edematous papules
Scabies




      Scabies mite under scope
• A 7-year-old girl is sent home after the
  school nurse detects head lice. She will not
  be permitted to return to school until the
  absence of infestation is documented.

• 1. What is the technical term for head lice?
• 2. How does it develop?
• 3. What treatment strategy is most likely to allow
  her to return to school with a minimal risk of
  infecting her classmates, i.e. How do you treat
  it?
Pediculosis capitis




 excoriated crusts and live crawlers
 Pediculosis capitis




nits on hair shafts and fecal
material on the skin above
the ear
Pediculosis capitis




         adult female head louse
Pediculosis capitis




           viable head louse egg

								
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