Atopic Dermatitis
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Transcript Atopic Dermatitis
Pediatric Dermatology
Dr. Jerald E. Hurdle
Kennebec Medical Consultants
Learning Objectives
To review common congenital &
acquired skin lesions,
To recognize rashes that present in
childhood, and
To manage the kids and their parents.
Vascular Lesions
Commonly seen in pediatric population
Need to distinguish hemangioma from
vascular malformation
Hemangioma
Normally not present at
birth
Grows rapidly in first few
months
Then involute
Rx: nothing, steroids, laser
& surgery
Hemangioma
Gradual Involution
Vascular Malformation
Present at birth
Abnormal size &
number of vascular
structures
Salmon patch or stork
bite
Vascular Malformation
Port Wine Stains
Much less common
Hypertrophy with time
If V1/V2 rule out Sturge
Weber Syndrome
Rx: laser
Pigmented Lesions
Congenital vs. Acquired
Congenital nevomelanocytic
nevus (syn. congenital hairy
nevus)
Small, medium or large
50% hairy
Have verrucous surface
Small: No increased risk of
melanoma
Giant Congenital Nevi
>5% BSA in infants
8.5% MM risk in 1st
15 years
Rx: surgical excision,
tissue expanders, flaps
& grafts
Case 1
9/12 old baby
3/7 of fever
Febrile fit
Fever defervesces with
this rash
Diagnosis?
Case 1: Roseola
HHV6
2/3 of patients get
erythematous papules
mucosa of soft palate
(Nagayama spots)
Case 2
3 yr old girl
Slightly irritable for a
few days
Presents with this
rash!
Diagnosis?
Case 2: Fifth Disease or Erythema
Infectiosum
Classical Slapped cheeks
appearance
Caused by Parvovirus B19
Aplastic Anemia
Arthritis
Hydrops Fetalis
Case 2: Fifth Disease or Erythema
Infectiosum
Classical Slapped cheeks
appearance
Caused by Parvovirus B19
Aplastic Anemia
Arthritis
Hydrops Fetalis
Case 3:
10 year old boy
Sore throat , myalgia
for 3 days before
presentation with this
rash
Rash feels like
sandpaper
Case 3:
10 year old boy
Sore throat , myalgia
for 3 days before
presentation with this
rash
Rash feels like
sandpaper
Case 3: Scarlet Fever
Group A Strep
Erythrogenic toxin
Culture potential bacterial
reservoirs (throat
commonest)
Rx: penicillin
Watch out for poststreptococcal
glomerulonephritis
Case 4
7 yr old girl
Ring like lesions on
the back of her hands
for 3 months
PCP tried antifungals
Diagnosis?
Case 4
Case 4: Granuloma Annulare (GA)
Localized GA
Self limiting
Tends to spontaneously
resolve
Can try potent topical
steroids
Link with DM
(controversial)
Case 5
2 yr old boy presents
with 2/7 of this nonitchy rash
Affects his hands &
feet
Had diarrhea 1/52 ago
Case 5: Gianotti-Crosti Syndrome
Originally described in conjunction with
Hep B in 1955
Other associations: EBV, RSV, Coxsackie,
echo, Parainfluenzae, CMV etc etc.
Case 6
4/12 baby girl
Febrile & irritable for
2/7
Developed rash on
face yesterday
Now red all over
Father noticed some
blistering
Case 6: Staphylococcal scalded
skin syndrome (SSSS)
Occurs in kids <6 yrs
Staph producing exotoxin
disrupts barrier at granular
layer
Rx: admit patients with
generalized disease for
IVABs & minimize
trauma to skin with
emollients
Atopic Dermatitis: Causes
Genetics (filaggrin gene)
Staph acting as super
antigen
Extremes of climate
Food as allergen
controversial
Aeroallergens & house
dust mite
Atopic dermatitis
Itch & scratch
Sleep deprivation for the whole family
Worsening weeping eczema think Staph
Sudden painful eczema think herpes
Atopic Dermatitis
Atopic dermatitis
Atopic dermatitis
Secondarily Infected Eczema with Staph
Atopic dermatitis
Secondarily Infected Eczema with Herpes:
Eczema herpeticum
Treatment
Educate parents about what is known about AD
Encourage emollients (point to diaper area to
show that moist environment helpful)
500g per week or more
Treatment: Steroids
Tackle Steroid phobia
head on!
Atrophy rarely seen when
appropriate steroid is used
for appropriate time
No increased risk of
cancer
Use potent steroid to
induce quick remission &
get family on your side
Treatment: Steroids
Finger Tip Units (FTU)
Squeeze ointment DIP
crease = 1 FTU
Covers 2 hands of skin
2FTUs = 1g
(http://www.patient.co.uk/
showdoc/27000762/)
Treatment: calcineurin inhibitors
Pimecrolimus cream
limited efficacy
Tacrolimus ointment
0.1 & 0.03%
No atrophy
Treatment: Antihistamines
No role for nonsedating
Use benadryl, atarax
will make patient more
drowsy
Treatment: Antibiotics
Take cultures, lesion &
nares
Culture other members of
family if recurrent
Treat for likely Staph
Review patient when
cultures are back
Treatment: Eczema herpeticum
Acyclovir p.o.
Analgesia
May need Staph
coverage as well
Pitryriasis Alba (PA)
1/3 of kids in USA
may have PA
Occurs in all races
♂>♀
More problematic in
darker skin
Pitryriasis Alba (PA)
Associated with
Atopic Dermatitis
3 stages
Papular erythematous
Papular hypochromic
Smooth hypochromic
Pitryriasis Alba (PA): Rx
Gentle Skin care
1% Hydrocortisone
Cream
Sunscreen
Reassurance
Learning Objectives
To review common congenital &
acquired skin lesions,
To recognize rashes that present in
childhood, and
To manage the kids and their parents.