Transcript Paediatric Dermatology

Paediatric Skin
Katie Hocking
Paedsoc.com
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Newborn
Vernix caseosa
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Waxy or cheese-like white
substance found coating the
skin of newborn babies.
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Vernix starts developing on the
baby in the womb around 18
weeks into pregnancy.
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Secreted by the sebaceous
glands of the fetus in utero
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Shed towards the end of
gestation to coincide with
maturation of the transepithelial barrier
Chalky White
Stuff
Millia
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Keratinous cysts
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Benign
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Self resolving
Tiny white
spots
Mongolian
Blue Spot
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DOCUMENT!!! Maybe
mistaken for NAI
Dark blue
pigmentation
Melanocytic
Naevi (Moles)
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Congenital pigmented naevi
>9cm diameter
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4-6% lifetime risk of subsequent
malignant melanoma
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Attempt to remove surgically
Extensive
Pigmented areas
White hair
Albinism
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Defect in biosynthesis and
distribution of melanin.
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Lack pigment in iris // retina //
eyelids // eyebrows
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Failure of fixation reflex
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Pendular nystagmus
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Photophobia
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Fitting of tinted contacts in
childhood can allow normal
reflex development.
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Skin burns easy  increased
risks of skin CA
Erythema toxicum
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Features
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Red blotches with central
white vesicle
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Each spot lasts about 24
hours, moves from place to
place
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Spots are sterile and baby is
well
Management
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Reassurance
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Only do swab if suspect sepsis
Red blotches
with central
white vesicle
Collodion Baby
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Born encased in tight and shiny
film or dried collodion (sausage
skin)
Tight &
Shiny Film
Inherited ichthyoses (90%)
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Skin is dry and scaly
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AR inheritance
Membrane becomes fissured
and separates within a couple
weeks
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Leaving icthyotic (90%) or
normal skin (10%)
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Is due to abnormal
desquamation
Emollients to manage
Peels to
Leave Scales
Rashes of Infancy
Nappy Rashes
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Irritant dermatitis
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Effect of urine
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Infrequent nappy change
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Faeces  urea splitting 
increased pH
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Convex surfaces of buttocks,
perineal region and lower abdo
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Flexures spared
Erythematous
& some scaling
Nappy Rashes
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Candida Infection
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Flexures effected
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Satellite pustules
Satellite
lesions
Infantile Seborrhoeic
Dermatitis
Scaly Yellow Skin
o First 2M of life
o Starts on the scalp then
spreads
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Face, flexures & napkin
area
o Scaly eruption forming an
adherent yellow layer
“cradle cap”
o Not itchy
o Increased risk of developing
atopic eczema
Face, Flexures &
Napkin areas
Mostly Facial,
patchy elsewhere
Atopic Eczema
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Onset usually between 2-12M
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Associated with asthma (33%) //
hayfever
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ITCHY
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Prolonged scratching can cause
lichenification
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Distribution
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Secondary infection
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Infants: face and scalp
Older: Skin flexures and
frictional areas
Staph Aureus
Herpes Simplex
Rxo
Emollients
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Topical steroids
Avoid exacerbating factors
Flexures,
Wrists and
Ankles
Eczema
herpeticum
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Herpetic superinfection of
eczema
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Can be life threatening
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Miserable, unwell and febrile
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Treat with acyclovir, antibiotics
PMHx- Eczema
Infections &
Infestations
Annular Skin
Lesions
Ringworm
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Dermatophyte fungi hyphae
invade dead keratinous
structures
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Annular skin lesions
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Severe pustular ringworm
patch = Kerion
Scalp ringworm is usually from
cats and dogs
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Horny layer of
skin//nails//hair
Patchy alopecia
Treat with topical or systemic
antifungals
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Treat any animal sources
Tinea Capitis
Scabies
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Infestation by Sarcoptes Scabiei
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8 legged mite
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Burrows pathognomonic
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Severe itchiness
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Worse in warmth & at night
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Attempt to remove surgically
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Infants and young:
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Older Children:
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Palms // soles // trunk
Between fingers & toes
Axillae//flexor
wrists//nipples//penis//
buttocks
Spread by close contact
Tracks and Burrows
Pediculosis
Capitis
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Head lice infestation
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Itchy scalp
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Identify live lice or nits (empty
egg cases)
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Remove with fine toothed comb
and special shampoos
INFESTATION
Molluscum
Contagiosum
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Caused by Poxvirus
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Pearly paules +/- central
umbilication
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Usually multiple
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Usually disappear
spontaneously within a year
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Once the scabs on the bullous
have fallen off, scarring is
minimal.
Central
Umbilication
Mumps
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Fever, malaise and parotitis
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Spread by droplet to resp tract
then gains access to parotid
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Only one side initially but
usually becomes bilateral
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Abdo pain + raised amylase =
pancreatic involvement
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Complciations
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Viral meningitis and
encephalitis
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Orchitis ♂
Parotitis
Measles (1)
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Paramyxovirus,
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Incubation period of about 10
days
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Maculopapular rash
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Spreads downwards from behind
ears to the whole of the body
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Begins as discrete rash but
becomes blotchy and confluent
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Contagious
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Cough
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Coryza
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Conjunctivitis
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‘C’oplick spots
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White spots on buccal mucosa
Complications
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Maculopapular Rash
Encephalitis // SSPE
White spots on
Buccal mucosa
Strawberry tongue
Scarlet fever (2)
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Sore throat and high
temperature (fever) are first
symptoms.
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A bright red rash follows. Starts
as small red spots, on the neck
and upper chest then spreads to
rest of body. Skin feels like
sandpaper.
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The tongue may become pale
but coated with red spots
(strawberry tongue). After a
few days the whole tongue may
look red.
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Due to group A strep
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Treatment - antibiotics
Sandpaper skin
Rubella (3)
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Usually a mild condition that
gets better without treatment
in seven to 10 days.
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Droplet spread
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Prodrome malaise, cough, sore
throat, fever, headache, eye
pain
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Rash behind ears, neck, face,
trunk, limbs
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Rash lighter and less confluent
than measles
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Lymphadenopathy, esp.
occipital
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Complications rare
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Risk to fetus
Pinkish-red rash that first
appears on the face and
later spreads elsewhere on
the body
Scalded Skin
Syndrome (4)
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Caused by Exfoliative Staph
Toxin
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Separation of epidermal skin
layers
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Separate on gentle pressure
to leave denuded skin
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Children present with fever and
malaise
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Dry and heal without scarring
but requires Anbx to resolve
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Main issue is with secondary
infection
Skin appears scaled
He doesn’t have
path
Slapped Cheek (5)
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Parvovirus B19
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Symptoms begin 6 days
following exposure
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Lasts ~1 week
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Patients are contagious before
symptomatic, but not after
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Lace-like rash on upper
extremities and trunk
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Red cheeks, with white pallor
around the mouth
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Parvovirus B19-- aplastic
crisis
Look at those red
cheeks….
Roseola (6)
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Cause: HHV6/7
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Features
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Affects those aged 6-36
months
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3-5 day fever, no obv. Source
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Sub-occipital nodes
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Rose-pink macular rash
appears once fever settles
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Starts on trunk, may spread to
face and extremities
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Lasts up to 2 days
Management
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Treat symptomatically,
reassure
High Fever
No Obvious Source
Mouth
Hand foot &
mouth
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Coxsackie A16 virus
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Droplet spread
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Infectious till lesions have
healed
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May have fever and sore throat
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Treatment is supportive
Hand
Feet
Impetigo
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Caused by Staph or Group A
Strep
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Localised lesions
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Face//neck//hands
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Begin as erythematous
macules which become
vesicular
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Rupture to leave fluid exudate
 Confluent honey-coloured
crusted lesions
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Highly contagious
Confluent honeycoloured crusted
lesions
Periorbital
Cellulitis
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Caused by Staph or Group A
Strep
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Or haemophilus influenza if
unvaccinated
Fever with erythema,
tenderness and oedema of the
eyelid
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Usually unilateral
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Treat promptly with IV Anbx to
avoid posterior spread to orbit
or brain (meningitis/abscess)
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Orbital cellulitis:
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Proptosis
Reduced visual acuity
Painful ocular movement
Warm and swollen
Chickenpox
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Varicella zoster
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Incubation 14 – 21 days
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Infectious 1-2 days before rash
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Vesicular rash
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Fever
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Complications – infection of
lesions, pneumonia, sepsis,
necrotising fasciitis,
encephalitis
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Treatment – none, can use
acyclovir in at risk patients to
reduce severity of disease.
Very common
vesicular rash
Meningitis
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The glass test
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Symptoms
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Photophobia
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Neck stiffness
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Headache
In infants:
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Bulging frontanelle
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Irritability
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High pitched cry
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Poor feed
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hypotona
Non-blanching rash
Systemic Disease
HenochSchonlein
Purpura
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Vasculitic condition
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Typically purpura of lower
limbs, extensor surfaces; can
affect upper limbs
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Can affect whole body most
commonly skin, kidneys and GIT
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Monitor urine and BP
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Treatment largely supportive
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Steroids for resistant cases
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Commonly follows URTI
Can also affect
kidneys
Purpura of lower
limbs
Kawasaki
Disease
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Classically, five days of fever
plus four of five diagnostic
criteria must be met to
establish the diagnosis. The
criteria are:
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Inflammation and irritation of
the lips, mouth and/or tongue
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Rash on the trunk
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Erythema, oedema and/or
desquamation of the
extremities
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Bilateral dry conjunctivitis
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Cervical lymphadenopathy
>1.5 cm
Peeling hands
Kawasaki
Disease
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Care on Paeds-Cardiac unit
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Rx with aspirin and IV-Ig
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Reduces fever and cardiac
sequel
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+/-Steroids if severe
Follow-up echocardiography
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Aneurysm?
PCI/CABG maybe required in
future
Neurocutaneous Signs
Ataxia
Telangiectasia
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Disorder of DNA Repair
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Gene ATM
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AR
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Mild delay in motor movement
and oculomotor dyspraxia
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Cutaneous Signs:
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Telangiectasia of the
conjunctiva (4yr+)
Symptoms:
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Dystonia and cerebellar
dysfunction
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Weakened immune system
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Increased risk of CA
Prominent
Blood Vessels
Hx of Delayed
gross motor
development
Spina Bifida
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Failure of neural plate to fuse
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First 28d of gestation
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Lack of folic acid
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Myelomeningocele
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May be ass. with:
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Lower limb paralysis
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M imbalance
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Sensory loss
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Bowel/Bladder dysfunction
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Hydrocephalus from Chiari
malformation
Meningeal
Membrane Sac
NF1
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Mutation of NF1
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AD
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Can be ass. with MEN syndromes
Axillary Freckling
2+ of the following criteria:
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6+ café au lait spots
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Optic gliomas
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Axillary freckling
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>1 neurofibroma along any
peripheral nerve
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One lisch nodule (hamartoma of
the iris)
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Sphenoid dysplasiaeye
protrusion
Pigmented Spots
Hamartoma
Tuberous
Sclerosis
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AD (30%) Spontaneous (70%)
Depigmented areas
Cutaneous Features:
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Depigmented ‘ash-leaf’ patches
(fluoresce under UV)
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Rough patches over lumbar spine
(Shagreen patches)
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Adenoma Sebaceum
(angiofibromata) in butterfly
distribition
Rough Patches
Other Features:
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Epilepsy
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Severe learning difficulties
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PCK
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Rhabdomyomata of the heart
Butterfly
Distribution
Sturge-Weber
Syndrome
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Haemangiomatous facial lesion
port wine stain
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Within distribution of CN [5]
Usually CN[5a]
Associated with similar intracranial lesion -cerebral and
vascular malformations
Skull Xray
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Calcification of gyri in ‘railroad track’
Presentation:
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Epilepsy
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Learning disability
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Hemipelegia
‘Port-Wine’ Stain
THANK YOU!!!
Any questions?