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Mallory Prelims 27/1/05 1:16 Pm Page I Mallory Prelims 27/1/05 1:16 pm Page i Illustrated Manual of Pediatric Dermatology Mallory Prelims 27/1/05 1:16 pm Page ii Mallory Prelims 27/1/05 1:16 pm Page iii Illustrated Manual of Pediatric Dermatology Diagnosis and Management Susan Bayliss Mallory MD Professor of Internal Medicine/Division of Dermatology and Department of Pediatrics Washington University School of Medicine Director, Pediatric Dermatology St. Louis Children’s Hospital St. Louis, Missouri, USA Alanna Bree MD St. Louis University Director, Pediatric Dermatology Cardinal Glennon Children’s Hospital St. Louis, Missouri, USA Peggy Chern MD Department of Internal Medicine/Division of Dermatology and Department of Pediatrics Washington University School of Medicine St. Louis, Missouri, USA Mallory Prelims 27/1/05 1:16 pm Page iv © 2005 Taylor & Francis, an imprint of the Taylor & Francis Group First published in the United Kingdom in 2005 by Taylor & Francis, an imprint of the Taylor & Francis Group, 2 Park Square, Milton Park Abingdon, Oxon OX14 4RN, UK Tel: +44 (0) 20 7017 6000 Fax: +44 (0) 20 7017 6699 Website: www.tandf.co.uk All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. British Library Cataloguing in Publication Data Data available on application Library of Congress Cataloging-in-Publication Data Data available on application ISBN 1-85070-753-7 Distributed in North and South America by Taylor & Francis 2000 NW Corporate Blvd Boca Raton, FL 33431, USA Within Continental USA Tel: 800 272 7737; Fax: 800 374 3401 Outside Continental USA Tel: 561 994 0555; Fax: 561 361 6018 E-mail: [email protected] Distributed in the rest of the world by Thomson Publishing Services Cheriton House North Way Andover, Hampshire SP10 5BE, UK Tel: +44 (0) 1264 332424 E-mail: [email protected] Composition by Parthenon Publishing Printed and bound by T.G. Hostench S.A., Spain Mallory Prelims 27/1/05 1:16 pm Page v CONTENTS Preface vii Dedication ix Chapter 1. Principles of Clinical Diagnosis 1 2. Neonatal Dermatology 9 3. Papular and Papulosquamous Disorders 33 4. Eczematous Dermatoses 49 5. Acne and Acneiform Disorders 71 6. Bullous Disorders 81 7. Bacterial and Spirochetal Diseases 95 8. Viral and Rickettsial Diseases 119 9. Fungal Diseases 149 10. Infestations and Environmental Hazards 163 11. Hypersensitivity Disorders/Unclassified Disorders 177 12. Photodermatoses and Physical Injury and Abuse 199 13. Drug Eruptions 217 14. Pigmentary Disorders 229 15. Collagen Vascular Diseases 257 16. Vascular and Lymphatic Diseases 275 17. Tumors, Cysts, and Growths 297 18. Hair Disorders 335 19. Nail Disorders 359 20. Genodermatoses and Syndromes 369 21. Therapy 391 Index 411 Mallory Prelims 27/1/05 1:16 pm Page vi Mallory Prelims 27/1/05 1:16 pm Page vii PREFACE Pediatric dermatology is an exciting area of medicine. Teaching at a pediatric tertiary care hospital, we find When children are young, they cannot give a history. In that pediatric and family practice residents ask us fact, pediatrics is said to be much like veterinary frequently which book they might purchase for their medicine! The practitioner must use sharp observational library. Mainly, they are interested in a book that has skills to assess a problem. For example, rather than asking good photographs so that they can visually recognize skin a 1 year old if they scratch or if a rash itches, merely diseases combined with a practical, concise text. observing the child scratching in the office or seeing Our purpose in writing this book was to produce a excoriations on the skin will lead a physician to the manual of high-quality photographs which can easily aid correct conclusion. Thus, looking for clues further the pediatric house officer and primary care physician in sharpens one’s visual skills. the diagnosis of pediatric skin diseases. In addition, we This book is a synopsis of basic pediatric have tried to provide a pertinent, easy to read outline dermatology. The approaches that we use are practical with easily applied suggestions on treatment. Realistic ones which we have found to be simple basic approaches criteria for referring patients are also outlined and a few to problems that pediatricians and dermatologists see in pertinent references are given. their practices. This book is aimed at the common We hope that you enjoy this text and that it can be of problems seen in medical offices with some added benefit to all who read it. information about unique conditions in pediatric dermatology. Susan Bayliss Mallory MD Alanna Bree MD Peggy Chern MD Mallory Prelims 27/1/05 1:16 pm Page viii Mallory Prelims 6/4/05 3:02 pm Page ix DEDICATION We would like to dedicate this book to our children and For Peggy Chern, to my parents, Henry and Myra patients who have been a great source of learning not Chern, and to Matt Shaw for their support and only about pediatrics but also about pediatric encouragement. dermatology. Others who have been a major source of help and For Susan Bayliss Mallory, my children, Elizabeth and inspiration have been: General Elbert DeCoursey MD, Meredith, have been a source of joy and encouragement Esther DeCoursey, Jere Guin MD, Arthur Eisen MD and as well as keeping me grounded. My parents, Milward Lynn Cornelius MD. William Bayliss MD and Jeanette Roedell Bayliss were always encouraging me to study and learn. God has been Special thanks to the following physicians who helped an ever-loving omniscient presence in my life and has review the manuscript: Chan-Ho Lai, Pam Weinfeld, been my source of inspiration. Jason Fung, Tony Hsu, Angela Spray, D. Russell Johnson, Alison Klenk, Margaret Mann and Yadira For Alanna Bree, to all of my many teachers, especially Hurley. my first teachers – my parents, Al and Shirley Flath. Most importantly, to my husband, Doug, and children Sam and Kendyl for their unconditional love and constant support. Mallory Prelims 27/1/05 1:16 pm Page x Mallory Chapter 01 27/1/05 1:18 pm Page 1 1 PRINCIPLES OF CLINICAL DIAGNOSIS GENERAL 1. This includes the patient’s age, race, sex, details of previous treatments and duration of the • Diagnosis of cutaneous disorders in infants and problem children requires careful inspection of skin, hair and nails 2. Focus attention on the particular morphology • Skin disorders of infants are different from skin 3. Physicians should be sensitive to the anxieties disorders in adults that parents might have and address these 1. For example, erythema toxicum neonatorum is issues appropriately only seen in newborns a. While taking a family history, note whether 2. Skin of a young child tends to form blisters a family member has a similar but more more easily (e.g. insect bites or mastocytomas) severe disorder that may cause concern (e.g. • Determining morphology of skin lesions, their psoriasis). Talking about these issues will let color and distribution will help generate a the parent know that you understand their differential diagnosis concerns 4. Developmental aspects, previous illnesses and previous surgery are important points in the HISTORY history • Take a thorough history of events surrounding the 5. Newborn history should include the prenatal skin disorder (Table 1.1) period, pregnancy and delivery Table 1.1 Interviewing and treating pediatric dermatology patients 1. Children are different from adults. Learn the differences. 2. Approach patients cautiously. Sit across the room and talk to the parents before examining the child. This gives them time to ‘size you up’. 3. Speak directly to the child as if he/she understands what you are saying. Make eye contact with the child. 4. Keep the parent in the room for procedures as much as possible unless it interferes with the procedure or the parent wishes to step out of the room. 5. Conservative management is best. Try to use the lowest effective dose of medication for the shortest time. 6. Avoid new therapies which do not have a proven track record in pediatrics until adequate clinical trials are performed. 7. Do not use treatments which may decrease growth or mental development. 8. Anticipatory guidance and emotional support are helpful especially in chronic disorders (e.g. alopecia areata, atopic dermatitis). Adapted from Honig PJ. Potential clinical management risks in pediatric dermatology. Risk Management in Dermatology, Part II. AM Medica Communications LTS: New York, 1988: 6 Mallory Chapter 01 27/1/05 1:18 pm Page 2 2 Illustrated Manual of Pediatric Dermatology a. Maternal history may quickly lead to a 1. Additional lighting with high-intensity diagnosis in some cases (e.g. maternal HIV examination lights or systemic lupus erythematosus) 2. Side-lighting may demonstrate subtle elevations 6. Evaluation of young children requires a modified or depressions approach, depending upon the age of the child • A magnifying glass may enlarge tiny variations of a. Establish a positive relationship with not the skin only the parent but also the child • Examination of the genitalia should not be b. Gain eye contact with the child at his own overlooked; have an assistant or parent in the level.
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