DOCSLIB.ORG

Pediatric Dermatology: Not Child’S Play

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pediatric Dermatology: Not Child’S Play Warning! Cute Kids Ahead! Pediatric Dermatology: Not Child’s Play Mary Ann Maurer, DO WVU School of Medicine, Charleston Campus CAMC Family Medicine Residency Are you itching to learn?! Pre-Test: What is… Common Pediatric Derm Issues • Newborn – Milia – Dermal melanocytosis – Hemangioma – Erythema toxicum neonatorum • Infants – Diaper dermatitis – Cradle cap – Viral exanthem • Roseola • Parvovirus B-19 • Measles • Varicella Just a • Children – Contact dermatitis roadmap, – Drug eruptions • Hives • Erythema multiforme don’t • SJS • TEN panic – Warts – Traction alopecia – Mycoplasma pneumonia associated mucositis • Adolescents – Acne – Tinea versicolor – Tinea corporis – Keratosis pilaris • Newborn – Milia – Dermal melanocytosis – Hemangioma – Erythema Toxicum Neonatorum Milia • Tiny white bumps • Typically on face • Small follicular plugs • Often seen 3-5 days after birth • Spontaneously resolve / self-limited http://www.dermnetnz.org/site-age- Don’t specific/neonate.html pick! Milia Dermal Melanocytosis http://newborns. stanford.edu/Ph • Benign otoGallery/Slate • Seen in pts with darker Grey1.html skin – Asian – Hispanic – Black http://www.skinsig ht.com/infant/blue – Native American - GraySpotMongolia • aka Mongolian Spot nSpot.htm • Often at sacrum • Size can vary • Typically resolve by pre- http://www.intermix.org.uk/health school /health_bluespots.asp Hemangiomas http://www.whattoexpect.c om/first-year/baby- • Vascular tumors / care/baby-skin- lesions care/hemangioma.aspx • Often has a period of growth followed by period of involution • Propranolol – Till age 12-15 mos • Laser tx or excisional • Usually much improved by age 5-10 Hemangiomas • Systematic review (2013) – n = 1264 • 74% female • 30% w other tx prior to propranolol • Mean age of intiation 6.6 mos • Mean duration of tx 6.4 mos • Mean dose 2.1 mg / kg / day • 98% response rate – *any* response to propranolol • Rebound growth in 17% • ADRs n=371 – Changes in sleep (136) – Acrocyanosis (61) – Symptomatic hypotension (6) – Hypoglycemia (4) – Symptomatic bradycardia (1) Hemangioma • Multiple cutaneous hemangiomas should cue imaging to look for hemangiomas in solid organs Nevus Flammeus • Port Wine Stain • Sturge-Weber Syndrome – V1-V2 – Seizures • Klippel-Trénaunay Syndrome http://www.childrenshosp – Vascular malformations ital.org/az/Site2944/main pageS2944P6.html – Varicosities – Unilateral hypertrophy Nevus Flammeus Nuchae • Stork bite – Around 40% of kids, though may be up to 70% – Mostly Caucasian kids – Often at neck – Can also be on eyelids and between eyes /on forehead Are you still showing baby pictures?! Srsly… Next slide, dude!! Erythema Toxicum Neonatorum http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/ image_article_collections/mcgraw_hill_skin_atlases/childhood_skin_problems/CAPD _erythema_toxicum_neonatorum.jpg • Benign • Self-limited • Small pustules with surrounding erythema • Face, trunk, buttocks, limbs – If palmar / plantar, consider other dxs • Not seen in preterm babies • Typically within 48 hrs of age but may be delayed up to two weeks • Eosinophils http://www.skinsight.com/images/dx/webInfant/erythemaToxicumNeonatorum_17955_lg.jpg • Infants – Diaper dermatitis – Viral exanthem • Roseola • Parvovirus B-19 • Measles • Varicella Diaper Dermatitis Ouch! • Often due to contact irritant (feces / urine) • May be related to dietary changes • Fungal a possibility • Myriad tx based on etiology – Steroid vs antifungal vs both! – Consider thrush – Prevention w/ barrier cream – Wipes can be irritating – Spray Maalox on it! http://dermis.net/bilder/CD050/550px/img0040.jpg Cradle Cap • Seborrheic dermatitis • Usu in the first 3 mos • Can also see behind ears, at eyebrows • Overactive sebaceous glands http://www.cheekymaidensoap.com/_blog/Cheeky_Maiden_Blog/post/Treating_Cradle_Cap/ • Occasionally fungal • Tx with baby oil, gentle brushing to loosen • No olive / coconut oils as can worsen fungal http://upload.wikimedia.org/wikipedia/commons/5/50/Baby_With_Cradle_Cap.jpg Viral Exanthem: Roseola • HHV-6 • aka Roseola Infantum • Typical hx is fever x 72 hrs without other etiology (eg ears, teething) • When defervesce, a rash appears • Self-limited Viral Exanthem: Parvovirus-B19 http://health.allrefer.com/health/fifth-disease-fifth- disease.html • aka 5th Disease or Erythema Infectiosum • “Slapped cheek rash with lacy reticular pattern on trunk” after URI symptoms • May also have arthralgias w/ rash http://www.cixip.com/index.p • Careful—can cause SAB hp/page/content/id/939 in pregnant women Viral Exanthem--Measles • Increasing #s due to poor vaccination rates • Prodrome 2-4 days – Stepwise fever to Tm http://upload.wikimedia.o 103-105 rg/wikipedia/commons/e/ e0/Measles_enanthema.j pg – 4Cs • Rash http://www. atsu.edu/fac ulty/chambe rlain/images/ https://jdc325.files.wordpress.com/2011/04/measles_2.jpg koplik_spots 2.jpg http://bchdmi.org/uploade d_images/measles1.jpg Viral Exanthem--Varicella • Crops of lesions – Prodrome of fever, anorexia, malaise (1-2d) – Lesions in varying states simultaneously – Starts centrally then moves peripherally http://s ocialhea lthboxx. com/wp - content /upload s/2014/ 04/chic http://research.fuseink.com/artifactimg/MTMxOTc5NjQ3ODMyMjFfMg.jpg ken.jpg • Children – Contact dermatitis – Drug eruptions • Urticaria • Erythema multiforme • SJS • TEN • DRESS (bit of a stretch!) – Warts – Traction alopecia – Mycoplasma pneumonia associated mucositis Contact Dermatitis http://blog.saintsabrinas.c om/wp- content/uploads/2011/01 • Allergic or Irritant /belt-buckle-allergy.jpg • Remove the source – Or try to control it (!) • Mild topical http://eso- cdn.bestpractice.bmj.com corticosteroid may help /best- practice/images/bp/en- gb/90-3_default.jpg http://www.skinsight.com/infa nt/irritantContactDermatitis.ht m Drug Eruption: Urticaria • Look for – Wheal = edema, and – Flare = erythema • History is most helpful • NB: Of course one can have urticaria for other reasons! http://allergyasthmamichigan.com/web%20site%20contents/hives.jpg Drug Eruption: Erythema Multiforme • History is key – Penicillins – Sulfa – Anti-epileptics (eg Dilantin) • Look for well- circumscribed lesions w/ central clearing • No oral lesions! http://www.huidziekten.nl/afbeeldingen/erythema-exsudativum-multiforme-7.jpg Drug Eruption: SJS • History • Offending agent • Fever, fatigue www.rightdiagnosis.com/phil/images/4650.jpg • Skin lesions and mucous membrane involvement – Including eyes! • May require ICU admission http://www.portalesmedicos.com/imagenes/publicaciones/0803_Sindrome_Stevens_Johnson/lesiones_eritemato_papulo_bullosas.jpg http://syndromepictures.com/wp-content/uploads/2011/10/Steven-Johnson-Syndrome-rash.jpg SJS: Treatment • Removal of offending agent • Analgesia • Topical steroids – Eyes – Skin • No real role for systemic steroids • Occasionally IVIg • Also of interest – Cyclosporine – Tacrolimus – NAC – Biologics – Plasmapheresis • Tincture of time • Specialty consult Drug Eruption--TEN • Occurs in response to infection or drugs • Spectrum is EMSJSthis – TEN >30% BSA • Apoptosis of keratinocytes leads to skin sloughing – Nikolsky sign • Admission to burn unit • Mortality 30-50% http://www.skincareguide.ca/images/glossary/toxic_epidermal_necrolysis.jpg – SCORTEN Drug Eruption--DRESS • Drug Reaction with Eosinophilia and Systemic Symptoms – Delayed reaction – High fever – Morbiliform (measles) rash – Rash and lymphadenopathy – Eosinophila and lymphocytosis – Elevated LFTs – Rare renal involvement – Myocarditis / pericarditis – HHV6 activation also implicated • Offending agents – AEDs – Sulfa – Ziprasidone (Geodon) – Allopurinol – Atenolol! http://archderm.jamanetwork.com/article.aspx?articleid=1733354 Warts • Verrucae • Varied morphology • Location = anywhere! • Tx varies http://medicalpicturesinfo.com/wp-content/uploads/2011/10/Verruca-Vulgaris-3.jpg – Cryo – TCA – Curettage – Excision http://0.tqn.com/d/foothealth/1/0/-/2/-/-/DSC_3339.JPG Traction Alopecia • Tension from tight braids, ponytails, weaves / http://hairlos sgeeks.com/t raction- alopecia- extensions causes-and- treatment/ • No loss of eyebrows / body hair • Areas usually not circumferential • Can be permanent http://dermnet nz.org/common • Treatment in peds is scalp /image.php?pat h=/hair-nails- sweat/img/trac rest tion.jpg – Occ Rogaine in adults MPAM (Mycoplasma Pneumonia Associated Mucositis) • Mucosal-only – Oral – Ocular – Urogenital • If skin involved, MASJS (Mp-associated SJS) • MPAM has better prognosis • Auto-antibodies against Mp attack mucosal cells MPAM Meyer Sauteur et al. (2012). https://doi.org/10.1016/j.jtumed.2016.12.002 https://doi.org/10.1177/1203475419874444 MPAM • Treatment – Abx – Steroids – Occasionally IVIg – Early specialist involvement if ocular involvement • Adolescents – Acne – Tinea versicolor – Tinea corporis – Keratosis pilaris Acne http://www.skinfoto.com/skin-facts/acne.html • Open comedones = blackheads • Closed comedones = whiteheads • Cystic acne http://www.skinsight.com/child/acne – Oral abx Vulgaris.htm – Accutane • Must be on OCP • Topicals http://www.dermnet.com/topics/acn – Salicylic acid e/physical-findings/ – Benzoyl peroxide – Retinoids Tinea Versicolor • Aka Pityriasis Versicolor • Malassezia furfur • Fungal • Often see in summertime • Topical selsun blue / nizoral • Oral tx not http://www.health-writings.com/img/mi/tinea-versicolor-treatment/Tinea-Versicolor.jpg recommended currently Tinea Corporis • Fungal • Topical anti-fungal (eg Lamisil) • Extend tx just past borders of lesion http://medicalpictures.net/wp- content/uploads/2011/10/tinea-corporis-
Load more

Recommended publications
  • Skin Manifestation of SARS-Cov-2: the Italian Experience
    Journal of Clinical Medicine Article Skin Manifestation of SARS-CoV-2: The Italian Experience Gerardo Cazzato 1 , Caterina Foti 2, Anna Colagrande 1, Antonietta Cimmino 1, Sara Scarcella 1, Gerolamo Cicco 1, Sara Sablone 3, Francesca Arezzo 4, Paolo Romita 2, Teresa Lettini 1 , Leonardo Resta 1 and Giuseppe Ingravallo 1,* 1 Section of Pathology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; [email protected] (G.C.); [email protected] (A.C.); [email protected] (A.C.); [email protected] (S.S.); [email protected] (G.C.); [email protected] (T.L.); [email protected] (L.R.) 2 Section of Dermatology and Venereology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; [email protected] (C.F.); [email protected] (P.R.) 3 Section of Forensic Medicine, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; [email protected] 4 Section of Gynecologic and Obstetrics Clinic, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; [email protected] * Correspondence: [email protected] Abstract: At the end of December 2019, a new coronavirus denominated Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was identified in Wuhan, Hubei province, China. Less than three months later, the World Health Organization (WHO) declared coronavirus disease-19 (COVID-19) to be a global pandemic. Growing numbers of clinical, histopathological, and molecular findings were subsequently reported, among which a particular interest in skin manifestations during the course of the disease was evinced. Today, about one year after the development of the first major infectious foci in Italy, various large case series of patients with COVID-19-related skin Citation: Cazzato, G.; Foti, C.; manifestations have focused on skin specimens.
    [Show full text]
  • HIV and the SKIN • Sudden Acute Exacerbations • Treatment Failure DR
    2018/08/13 KEY FEATURES • Atypical presentation of common disorders • Severe or exaggerated presentations HIV AND THE SKIN • Sudden acute exacerbations • Treatment failure DR. FREDAH MALEKA DERMATOLOGY UNIVERSITY OF PRETORIA:KALAFONG VIRAL INFECTIONS EXANTHEM OF PRIMARY HIV INFECTION • Exanthem of primary HIV infection • Acute retroviral syndrome • Herpes simplex virus (HSV) • Morbilliform rash (exanthem) : 2-4 weeks after HIV exposure • Varicella Zoster virus (VZV) • Typically generalised • Molluscum contagiosum (Poxvirus) • Pronounced on face and trunk, sparing distal extremities • Human papillomavirus (HPV) • Associated : fever, lymphadenopathy, pharyngitis • Epstein Barr virus (EBV) • DDX: drug reaction • Cytomegalovirus (CMV) • other viral infections – EBV, Enteroviruses, Hepatitis B virus 1 2018/08/13 HERPES SIMPLEX VIRUS(HSV) • Vesicular eruption due to HSV 1&2 • Primary lesion: painful, grouped vesicles on an erythematous base • HIV: attacks are more frequent and severe • : chronic, non-healing, deep ulcers, with scarring and tissue destruction • CLUE: severe pain and recurrences • DDX: syphilis, chancroid, lymphogranuloma venereum • Tzanck smear, Histology, Viral culture HSV • Treatment: Acyclovir 400mg tds 7-10 days • Alternatives: Valacyclovir and Famciclovir • In setting of treatment failure, viral isolates tested for resistance against acyclovir • Alternative drugs: Foscarnet, Cidofovir • Chronic suppressive therapy ( >8 attacks per year) 2 2018/08/13 VARICELLA • Chickenpox • Presents with erythematous papules and umbilicated
    [Show full text]
  • Experience with Molluscum Contagiosum and Associated Inflammatory Reactions in a Pediatric Dermatology Practice the Bump That Rashes
    STUDY ONLINE FIRST Experience With Molluscum Contagiosum and Associated Inflammatory Reactions in a Pediatric Dermatology Practice The Bump That Rashes Emily M. Berger, MD; Seth J. Orlow, MD, PhD; Rishi R. Patel, MD; Julie V. Schaffer, MD Objective: To investigate the frequency, epidemiol- (50.6% vs 31.8%; PϽ.001). In patients with molluscum ogy, clinical features, and prognostic significance of in- dermatitis, numbers of MC lesions increased during the flamed molluscum contagiosum (MC) lesions, mollus- next 3 months in 23.4% of those treated with a topical cum dermatitis, reactive papular eruptions resembling corticosteroid and 33.3% of those not treated with a topi- Gianotti-Crosti syndrome, and atopic dermatitis in pa- cal corticosteroid, compared with 16.8% of patients with- tients with MC. out dermatitis. Patients with inflamed MC lesions were less likely to have an increased number of MC lesions Design: Retrospective medical chart review. over the next 3 months than patients without inflamed MC lesions or dermatitis (5.2% vs 18.4%; PϽ.03). The Setting: University-based pediatric dermatology practice. GCLRs were associated with inflamed MC lesion (PϽ.001), favored the elbows and knees, tended to be Patients: A total of 696 patients (mean age, 5.5 years) pruritic, and often heralded resolution of MC. Two pa- with molluscum. tients developed unilateral laterothoracic exanthem– like eruptions. Main Outcome Measures: Frequencies, characteris- tics, and associated features of inflammatory reactions Conclusions: Inflammatory reactions to MC, including to MC in patients with and without atopic dermatitis. the previously underrecognized GCLR, are common. Treat- ment of molluscum dermatitis can reduce spread of MC Results: Molluscum dermatitis, inflamed MC lesions, and via autoinoculation from scratching, whereas inflamed MC Gianotti-Crosti syndrome–like reactions (GCLRs) oc- lesions and GCLRs reflect cell-mediated immune re- curred in 270 (38.8%), 155 (22.3%), and 34 (4.9%) of sponses that may lead to viral clearance.
    [Show full text]
  • Shingles (Herpes Zoster) Hives (Urticaria) Psoriasis
    Shingles (Herpes Zoster) Shingles starts with burning, tingling, or very sensitive skin. A rash of raised dots develops into painful blisters that last about two weeks. Shingles often occurs on the trunk and buttocks, but can appear anywhere. Most people recover, but pain, numbness, and itching linger for many -- and may last for months, years, or the rest of their lives. Treatment with antiviral drugs, steroids, antidepressants, and topical agents can help. Hives (Urticaria) A common allergic reaction that looks like welts, hives are often itchy, and sometimes stinging or burning. Hives vary in size and may join together to form larger areas. They may appear anywhere and last minutes or days. Medications, foods, food additives, temperature extremes, and infections like strep throat are some causes of hives. Antihistamines can provide relief. Psoriasis A non-contagious rash of thick red plaques covered with white or silvery scales, psoriasis usually affects the scalp, elbows, knees, and lower back. The rash can heal and recur throughout life. The cause of psoriasis is unknown, but the immune system triggers new skin cells to develop too quickly. Treatments include medications applied to the skin, light therapy, and medications taken by mouth, injection or infusion. Eczema Eczema describes several non-contagious conditions where skin is inflamed, red, dry, and itchy. Stress, irritants (like soaps), allergens, and climate can trigger flare-ups though they're not eczema's exact cause, which is unknown. In adults, eczema often occurs on the elbows and hands, and in "bending" areas, such as inside the elbows. Treatments include topical or oral medications and shots.
    [Show full text]
  • BETA Betamethasone Valerate Cream 0.1% W/W Betamethasone Valerate Ointment 0.1% W/W
    NEW ZEALAND CONSUMER MEDICINE INFORMATION BETA Betamethasone valerate cream 0.1% w/w Betamethasone valerate ointment 0.1% w/w discoid lupus Some of the symptoms of an What is in this leaflet erythematosus (recurring allergic reaction may include: scaly rash) shortness of breath; wheezing or This leaflet answers some common prickly heat skin reaction difficulty breathing; swelling of the questions about BETA Cream and insect bite reactions face, lips, tongue or other parts of Ointment. prurigo nodularis (an itching the body; rash, itching or hives on and thickening of the skin the skin. It does not contain all the available with lumps or nodules) information. It does not take the contact sensitivity reactions Do not use BETA Cream or place of talking to your doctor or an additional treatment for Ointment to treat any of the pharmacist. an intense widespread following skin problems as it reddening and inflammation could make them worse: All medicines have risks and of the skin, infected skin (unless the benefits. Your doctor has weighed when milder topical corticosteroids infection is being treated the risks of you using BETA Cream cannot treat the skin condition with an anti-infective or Ointment against the benefits effectively. medicine at the same time) they expect it will have for you. acne BETA Cream is usually used to rosacea (a facial skin If you have any concerns about treat skin conditions on moist condition where the nose, taking this medicine, ask your surfaces; BETA Ointment is usually cheeks, chin, forehead or doctor or pharmacist. used to treat skin conditions on dry, entire face are unusually scaly skin.
    [Show full text]
  • Erythema Annulare Centrifugum ▪ Erythema Gyratum Repens ▪ Exfoliative Erythroderma Urticaria ▪ COMMON: 15% All Americans
    Cutaneous Signs of Internal Malignancy Ted Rosen, MD Professor of Dermatology Baylor College of Medicine Disclosure/Conflict of Interest ▪ No relevant disclosures ▪ No conflicts of interest Objectives ▪ Recognize common disorders associated with internal malignancy ▪ Manage cutaneous disorders in the context of associated internal malignancy ▪ Differentiate cutaneous signs of leukemia and lymphoma ▪ Understand spidemiology of cutaneous metastases Cutaneous Signs of Internal Malignancy ▪ General physical examination ▪ Pallor (anemia) ▪ Jaundice (hepatic or cholestatic disease) ▪ Fixed erythema or flushing (carcinoid) ▪ Alopecia (diffuse metastatic disease) ▪ Itching (excoriations) Anemia: Conjunctival pallor and Pale skin Jaundice 1-12% of hepatocellular, biliary tree or pancreatic cancer PRESENT with jaundice, but up to 40-60% eventually develop it World J Gastroenterol 2003;9:385-91 For comparison CAN YOU TELL JAUNDICE FROM NORMAL SKIN? JAUNDICE Alopecia Neoplastica Most common report w/ breast CA Lung, cervix, desmoplastic mm Hair loss w/ underlying induration Biopsy = dermis effaced by tumor Ann Dermatol 26:624, 2014 South Med J 102:385, 2009 Int J Dermatol 46:188, 2007 Acta Derm Venereol 87:93, 2007 J Eur Acad Derm Venereol 18:708, 2004 Gastric Adenocarcinoma: Alopecia Ann Dermatol 2014; 26: 624–627 Pruritus: Excoriation ▪ Overall risk internal malignancy presenting as itch LOW. OR =1.14 ▪ CTCL, Hodgkin’s & NHL, Polycythemia vera ▪ Biliary tree carcinoma Eur J Pain 20:19-23, 2016 Br J Dermatol 171:839-46, 2014 J Am Acad Dermatol 70:651-8, 2014 Non-specific (Paraneoplastic) Specific (Metastatic Disease) Paraneoplastic Signs “Curth’s Postulates” ▪ Concurrent onset (temporal proximity) ▪ Parallel course ▪ Uniform site or type of neoplasm ▪ Statistical association ▪ Genetic linkage (syndromal) Curth HO.
    [Show full text]
  • Genes in Eyecare Geneseyedoc 3 W.M
    Genes in Eyecare geneseyedoc 3 W.M. Lyle and T.D. Williams 15 Mar 04 This information has been gathered from several sources; however, the principal source is V. A. McKusick’s Mendelian Inheritance in Man on CD-ROM. Baltimore, Johns Hopkins University Press, 1998. Other sources include McKusick’s, Mendelian Inheritance in Man. Catalogs of Human Genes and Genetic Disorders. Baltimore. Johns Hopkins University Press 1998 (12th edition). http://www.ncbi.nlm.nih.gov/Omim See also S.P.Daiger, L.S. Sullivan, and B.J.F. Rossiter Ret Net http://www.sph.uth.tmc.edu/Retnet disease.htm/. Also E.I. Traboulsi’s, Genetic Diseases of the Eye, New York, Oxford University Press, 1998. And Genetics in Primary Eyecare and Clinical Medicine by M.R. Seashore and R.S.Wappner, Appleton and Lange 1996. M. Ridley’s book Genome published in 2000 by Perennial provides additional information. Ridley estimates that we have 60,000 to 80,000 genes. See also R.M. Henig’s book The Monk in the Garden: The Lost and Found Genius of Gregor Mendel, published by Houghton Mifflin in 2001 which tells about the Father of Genetics. The 3rd edition of F. H. Roy’s book Ocular Syndromes and Systemic Diseases published by Lippincott Williams & Wilkins in 2002 facilitates differential diagnosis. Additional information is provided in D. Pavan-Langston’s Manual of Ocular Diagnosis and Therapy (5th edition) published by Lippincott Williams & Wilkins in 2002. M.A. Foote wrote Basic Human Genetics for Medical Writers in the AMWA Journal 2002;17:7-17. A compilation such as this might suggest that one gene = one disease.
    [Show full text]
  • Bronchiolitis Obliterans • Mycoplasma Induced Asthma/Wheezing • Resistant Mycoplasma Infection
    CROSS CANADA ROUNDS - Long Case Mandeep Walia Clinical Fellow BC Children’s Hospital 21 June, 2018 Long Case History • 10 Y, Boy Feb 8th • Fever- low-moderate grade, rhinorrhea, cough (dry), mild sore throat • Nausea, non bilious vomiting Day 5- worsening cough -dry, sleep disturbance. • Walk in clinic- no wheeze. Prescribed ventolin. Minimal improvement Day 8- redness eyes, purulent discharge, blisters on lips, ulcers on tongue & buccal mucosa. Difficulty to swallow solids. History- cont • No headache, abnormal movements, visual or hearing loss • No chest pain/stridor/ • No diarrhoea. Vomiting stopped after D3 • No hematuria/dysuria. Feb 17 (D10)- BCCH ED : • concerns for extensive oral mucositis, new onset skin rash. Past Hx • Healthy pregnancy. No complications. • Born by SVD, no neonatal resuscitation/NICU stay. • Recurrent OM- evaluated by ENT-not required myringotomy tubes. • Mild eczema. Development - milestones normal Immunization- upto date Allergies- no known Treatment Hx- Tylenol/benadryl/Ventolin. No antibiotics/NSAIDS FHx- Caucasian descent. unremarkable. Social Hx- active in sports. No exposure to pets/smoke Physical exam • Weight- 37.9kg(77centile) Skin- • HR-96/min, RR-30/min , • pink papules, 2-3mm, central • SPO2 94% RA, T-39.2ᵒc, BP115/64 erosion, about 15-20 on trunk, • HEENT- upper & lower extremities. Sparing palms & soles. • B/L conjunctival injection, • purulent discharge MSK-no arthritis • • Lips, buccal mucosa , soft & hard Perianal skin, glans- normal palate-scattered vesicles & superficial erosions. No crusting (serous/hemorrhagic) • B/L ears-normal • No clubbing/lymphadenopathy Systemic Examination • Respiratory - tachyapnea. No retractions/indrawing. B/L air entry decreased. No wheeze/crackles. • CVS-S1 S2 normal. no murmur • PA- no HSM • Neurological - conscious.
    [Show full text]
  • Cutaneous Manifestations of Newborns in Omdurman Maternity Hospital
    ﺑﺴﻢ اﷲ اﻟﺮﺣﻤﻦ اﻟﺮﺣﻴﻢ Cutaneous Manifestations of Newborns in Omdurman Maternity Hospital A thesis submitted in the partial fulfillment of the degree of clinical MD in pediatrics and child health University of Khartoum By DR. AMNA ABDEL KHALIG MOHAMED ATTAR MBBS University of Khartoum Supervisor PROF. SALAH AHMED IBRAHIM MD, FRCP, FRCPCH Department of Pediatrics and Child Health University of Khartoum University of Khartoum The Graduate College Medical and Health Studies Board 2008 Dedication I dedicate my study to the Department of Pediatrics University of Khartoum hoping to be a true addition to neonatal care practice in Sudan. i Acknowledgment I would like to express my gratitude to my supervisor Prof. Salah Ahmed Ibrahim, Professor of Peadiatric and Child Health, who encouraged me throughout the study and provided me with advice and support. I am also grateful to Dr. Osman Suleiman Al-Khalifa, the Dermatologist for his support at the start of the study. Special thanks to the staff at Omdurman Maternity Hospital for their support. I am also grateful to all mothers and newborns without their participation and cooperation this study could not be possible. Love and appreciation to my family for their support, drive and kindness. ii Table of contents Dedication i Acknowledgement ii Table of contents iii English Abstract vii Arabic abstract ix List of abbreviations xi List of tables xiii List of figures xiv Chapter One: Introduction & Literature Review 1.1 The skin of NB 1 1.2 Traumatic lesions 5 1.3 Desquamation 8 1.4 Lanugo hair 9 1.5
    [Show full text]
  • Erythema Marginatum
    Figurative Erythemas Michelle Goedken, DO Affiliated Dermatology Scottsdale, AZ Figurative Erythemas • Erythema annulare centrifugum • Erythema marginatum • Erythema migrans • Erythema gyratum repens • Erythema multiforme Erythemas • Erythemas represent a change in the color of the skin that is due to the dilation of blood vessels, especially those in the papillary and reticular dermis • The color is blanchable and most last for days to months • Figurative erythemas have an annular, arciform or polycyclic appearance ERYTHEMA ANNULARE CENTRIFUGUM ERYTHEMA ANNULARE CENTRIFUGUM • Pathogenesis: EAC represents a reaction pattern or hypersensitivity to one of many antigens – IL-2 and TNF-alpha may have a role – Most patients do not have an underlying disease identified ERYTHEMA ANNULARE CENTRIFUGUM • Associated with: – Infection » Dermatophytes and other fungi (Candida and Penicillium in blue cheese) » Viruses: poxvirus, EBV, VZV, HIV » Parasites and ectoparasites – Drugs: diuretics, antimalarials, gold, NSAIDs, finasteride, amitriptyline, etizolam, Ustekinumab (2012) ERYTHEMA ANNULARE CENTRIFUGUM – Foods – Autoimmune endocrinopathies – Neoplasms (lymphomas and leukemias) – Pregnancy – Hypereosinophilic syndrome – Lupus (2014) ERYTHEMA ANNULARE CENTRIFUGUM http://www.dermaamin.com Rongioletti, F., Fausti, V., & Parodi, A ERYTHEMA ANNULARE CENTRIFUGUM • 2 major forms: – Superficial: classic trailing scale, may have associated pruritus – Deep: infiltrated borders, usually no scale, edges are elevated, usually not pruritic ERYTHEMA ANNULARE CENTRIFUGUM
    [Show full text]
  • Drug Eruptions.Pdf
    Drug eruptions & reactions What are drug eruptions? Drug reactions are unwanted and unexpected reactions occurring in the skin (and sometimes other organ systems) that may result from taking a medication for the prevention, diagnosis or treatment of a medical problem. They may appear after the correct use of the medication or drug. It may also appear due to overdose (wrong dose is taken), following accumulation of drugs in the body over time, or by interactions with other medications being taken or used by the person. Drug eruptions could be caused by an allergy or hypersensitivity to the drug, by a direct toxic effect of the drug or medication on the skin, or by other mechanisms. Drug eruptions vary in severity – from a minor nuisance to a more severe problem – and may even cause death. Drug eruptions occur in up to 15% of courses of drug prescribed by medical or natural therapy practitioners. What causes drug eruptions? Drug eruptions are caused by medications which are prescribed by your doctor, purchased over-the- counter or purchased as compounded herbal/naturopathic medicines. Drugs taken orally, injected, delivered by patch application, rubbed onto the skin (e.g. creams, ointments and lotions) can all cause reactions. The potential to develop an adverse reaction to a drug is influenced by the age, gender and genetic makeup of the person; the nature of the condition being treated; and the possible interactions with other medications being taken. Some classes of drugs are known to cause drug eruptions more commonly than others. What do drug eruptions look like in the skin? The appearance of drug eruptions varies depending on the mechanism of the drug reaction.
    [Show full text]
  • Diagnosis, Classification, and Management of Erythema
    Arch Dis Child 2000;83:347–352 347 Diagnosis, classification, and management of Arch Dis Child: first published as 10.1136/adc.83.4.347 on 1 October 2000. Downloaded from erythema multiforme and Stevens–Johnson syndrome C Léauté-Labrèze, T Lamireau, D Chawki, J Maleville, A Taïeb Abstract become widely accepted that EM and SJS, as Background—In adults, erythema multi- well as toxic epidermal necrolysis, are all part of forme (EM) is thought to be mainly a single “EM spectrum”. In both EM and SJS, related to herpes infection and Stevens– pathological changes in the earliest skin lesion Johnson syndrome (SJS) to drug reac- consist of the accumulation of mononuclear tions. cells around the superficial dermal blood Aims—To investigate this hypothesis in vessels; epidermal damage is more characteris- children, and to review our experience in tic of EM with keratinocyte necrosis leading to the management of these patients. multilocular intraepidermal blisters.5 In fact, Methods—A retrospective analysis of 77 there is little clinical resemblance between paediatric cases of EM or SJS admitted to typical EM and SJS, and recently some authors the Children’s Hospital in Bordeaux be- have proposed a reconsideration of the “spec- tween 1974 and 1998. trum” concept and a return to the original Results—Thirty five cases, inadequately description.15–17 According to these authors, the documented or misdiagnosed mostly as term EM should be restricted to acrally urticarias or non-EM drug reactions were distributed typical targets or raised oedema- excluded. Among the remaining 42 pa- tous papules. Depending on the presence or tients (14 girls and 28 boys), 22 had EM (11 absence of mucous membrane erosions the EM minor and 11 EM major), 17 had SJS, cases may be classified as EM major or EM 16 and three had isolated mucous membrane minor.
    [Show full text]