Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle...
-
Upload
whitney-flynn -
Category
Documents
-
view
229 -
download
0
Transcript of Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle...
![Page 1: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/1.jpg)
Pediatric DermatologyPediatric Dermatology
Dr. Jerald E. Hurdle
Kennebec Medical Consultants
Dr. Jerald E. Hurdle
Kennebec Medical Consultants
![Page 2: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/2.jpg)
Learning ObjectivesLearning Objectives
To review common congenital & acquired skin lesions,
To recognize rashes that present in childhood, and
To manage the kids and their parents.
![Page 3: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/3.jpg)
Vascular LesionsVascular Lesions
Commonly seen in pediatric population
Need to distinguish hemangioma from vascular malformation
Commonly seen in pediatric population
Need to distinguish hemangioma from vascular malformation
![Page 4: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/4.jpg)
HemangiomaHemangioma
Normally not present at birth
Grows rapidly in first few months
Then involute
Rx: nothing, steroids, laser & surgery
Normally not present at birth
Grows rapidly in first few months
Then involute
Rx: nothing, steroids, laser & surgery
![Page 5: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/5.jpg)
HemangiomaHemangioma
Gradual Involution Gradual Involution
![Page 6: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/6.jpg)
Vascular MalformationVascular Malformation
Present at birth
Abnormal size & number of vascular structures
Salmon patch or stork bite
Present at birth
Abnormal size & number of vascular structures
Salmon patch or stork bite
![Page 7: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/7.jpg)
Vascular MalformationVascular Malformation
Port Wine Stains
Much less common
Hypertrophy with time
If V1/V2 rule out Sturge Weber Syndrome
Rx: laser
Port Wine Stains
Much less common
Hypertrophy with time
If V1/V2 rule out Sturge Weber Syndrome
Rx: laser
![Page 8: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/8.jpg)
Pigmented LesionsPigmented 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
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
![Page 9: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/9.jpg)
Giant Congenital NeviGiant Congenital Nevi
>5% BSA in infants
8.5% MM risk in 1st 15 years
Rx: surgical excision, tissue expanders, flaps & grafts
>5% BSA in infants
8.5% MM risk in 1st 15 years
Rx: surgical excision, tissue expanders, flaps & grafts
![Page 10: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/10.jpg)
Case 1Case 1
9/12 old baby 3/7 of fever Febrile fit Fever defervesces with
this rash
Diagnosis?
9/12 old baby 3/7 of fever Febrile fit Fever defervesces with
this rash
Diagnosis?
![Page 11: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/11.jpg)
Case 1: RoseolaCase 1: Roseola
HHV6
2/3 of patients get erythematous papules mucosa of soft palate (Nagayama spots)
HHV6
2/3 of patients get erythematous papules mucosa of soft palate (Nagayama spots)
![Page 12: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/12.jpg)
Case 2Case 2
3 yr old girl
Slightly irritable for a few days
Presents with this rash!
Diagnosis?
3 yr old girl
Slightly irritable for a few days
Presents with this rash!
Diagnosis?
![Page 13: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/13.jpg)
Case 2: Fifth Disease or Erythema Infectiosum
Case 2: Fifth Disease or Erythema Infectiosum
Classical Slapped cheeks appearance
Caused by Parvovirus B19
Aplastic Anemia
Arthritis
Hydrops Fetalis
Classical Slapped cheeks appearance
Caused by Parvovirus B19
Aplastic Anemia
Arthritis
Hydrops Fetalis
![Page 14: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/14.jpg)
Case 2: Fifth Disease or Erythema Infectiosum
Case 2: Fifth Disease or Erythema Infectiosum
Classical Slapped cheeks appearance
Caused by Parvovirus B19
Aplastic Anemia
Arthritis
Hydrops Fetalis
Classical Slapped cheeks appearance
Caused by Parvovirus B19
Aplastic Anemia
Arthritis
Hydrops Fetalis
![Page 15: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/15.jpg)
Case 3:Case 3:
10 year old boy
Sore throat , myalgia for 3 days before presentation with this rash
Rash feels like sandpaper
10 year old boy
Sore throat , myalgia for 3 days before presentation with this rash
Rash feels like sandpaper
![Page 16: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/16.jpg)
Case 3:Case 3:
10 year old boy
Sore throat , myalgia for 3 days before presentation with this rash
Rash feels like sandpaper
10 year old boy
Sore throat , myalgia for 3 days before presentation with this rash
Rash feels like sandpaper
![Page 17: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/17.jpg)
Case 3: Scarlet FeverCase 3: Scarlet Fever
Group A Strep
Erythrogenic toxin
Culture potential bacterial reservoirs (throat commonest)
Rx: penicillin
Watch out for post-streptococcal glomerulonephritis
Group A Strep
Erythrogenic toxin
Culture potential bacterial reservoirs (throat commonest)
Rx: penicillin
Watch out for post-streptococcal glomerulonephritis
![Page 18: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/18.jpg)
Case 4Case 4
7 yr old girl
Ring like lesions on the back of her hands for 3 months
PCP tried antifungals
Diagnosis?
7 yr old girl
Ring like lesions on the back of her hands for 3 months
PCP tried antifungals
Diagnosis?
![Page 19: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/19.jpg)
Case 4Case 4
![Page 20: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/20.jpg)
Case 4: Granuloma Annulare (GA)Case 4: Granuloma Annulare (GA)
Localized GA
Self limiting
Tends to spontaneously resolve
Can try potent topical steroids
Link with DM (controversial)
Localized GA
Self limiting
Tends to spontaneously resolve
Can try potent topical steroids
Link with DM (controversial)
![Page 21: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/21.jpg)
Case 5Case 5
2 yr old boy presents with 2/7 of this non- itchy rash
Affects his hands & feet
Had diarrhea 1/52 ago
2 yr old boy presents with 2/7 of this non- itchy rash
Affects his hands & feet
Had diarrhea 1/52 ago
![Page 22: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/22.jpg)
Case 5: Gianotti-Crosti SyndromeCase 5: Gianotti-Crosti Syndrome
Originally described in conjunction with Hep B in 1955
Other associations: EBV, RSV, Coxsackie, echo, Parainfluenzae, CMV etc etc.
Originally described in conjunction with Hep B in 1955
Other associations: EBV, RSV, Coxsackie, echo, Parainfluenzae, CMV etc etc.
![Page 23: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/23.jpg)
Case 6Case 6
4/12 baby girl Febrile & irritable for
2/7 Developed rash on
face yesterday Now red all over Father noticed some
blistering
4/12 baby girl Febrile & irritable for
2/7 Developed rash on
face yesterday Now red all over Father noticed some
blistering
![Page 24: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/24.jpg)
Case 6: Staphylococcal scalded skin syndrome (SSSS)
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
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
![Page 25: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/25.jpg)
Atopic Dermatitis: CausesAtopic Dermatitis: Causes
Genetics (filaggrin gene)
Staph acting as super antigen
Extremes of climate
Food as allergen controversial
Aeroallergens & house dust mite
Genetics (filaggrin gene)
Staph acting as super antigen
Extremes of climate
Food as allergen controversial
Aeroallergens & house dust mite
![Page 26: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/26.jpg)
Atopic dermatitisAtopic dermatitis
Itch & scratch
Sleep deprivation for the whole family
Worsening weeping eczema think Staph
Sudden painful eczema think herpes
Itch & scratch
Sleep deprivation for the whole family
Worsening weeping eczema think Staph
Sudden painful eczema think herpes
![Page 27: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/27.jpg)
Atopic DermatitisAtopic Dermatitis
![Page 28: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/28.jpg)
Atopic dermatitisAtopic dermatitis
![Page 29: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/29.jpg)
Atopic dermatitisAtopic dermatitis
Secondarily Infected Eczema with Staph
![Page 30: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/30.jpg)
Atopic dermatitisAtopic dermatitis
Secondarily Infected Eczema with Herpes: Eczema
herpeticum
![Page 31: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/31.jpg)
TreatmentTreatment
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
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
![Page 32: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/32.jpg)
Treatment: SteroidsTreatment: 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
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
![Page 33: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/33.jpg)
Treatment: SteroidsFinger Tip Units (FTU)
Treatment: SteroidsFinger Tip Units (FTU)
Squeeze ointment DIP crease = 1 FTU
Covers 2 hands of skin
2FTUs = 1g
(http://www.patient.co.uk/showdoc/27000762/)
Squeeze ointment DIP crease = 1 FTU
Covers 2 hands of skin
2FTUs = 1g
(http://www.patient.co.uk/showdoc/27000762/)
![Page 34: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/34.jpg)
Treatment: calcineurin inhibitorsTreatment: calcineurin inhibitors
Pimecrolimus cream limited efficacy
Tacrolimus ointment 0.1 & 0.03%
No atrophy
Pimecrolimus cream limited efficacy
Tacrolimus ointment 0.1 & 0.03%
No atrophy
![Page 35: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/35.jpg)
Treatment: AntihistaminesTreatment: Antihistamines
No role for non-sedating
Use benadryl, atarax will make patient more drowsy
No role for non-sedating
Use benadryl, atarax will make patient more drowsy
![Page 36: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/36.jpg)
Treatment: AntibioticsTreatment: Antibiotics
Take cultures, lesion & nares
Culture other members of family if recurrent
Treat for likely Staph
Review patient when cultures are back
Take cultures, lesion & nares
Culture other members of family if recurrent
Treat for likely Staph
Review patient when cultures are back
![Page 37: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/37.jpg)
Treatment: Eczema herpeticumTreatment: Eczema herpeticum
Acyclovir p.o.
Analgesia
May need Staph coverage as well
Acyclovir p.o.
Analgesia
May need Staph coverage as well
![Page 38: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/38.jpg)
Pitryriasis Alba (PA)Pitryriasis Alba (PA)
1/3 of kids in USA may have PA
Occurs in all races
♂ > ♀
More problematic in darker skin
1/3 of kids in USA may have PA
Occurs in all races
♂ > ♀
More problematic in darker skin
![Page 39: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/39.jpg)
Pitryriasis Alba (PA)Pitryriasis Alba (PA)
Associated with Atopic Dermatitis
3 stages Papular erythematous Papular hypochromic Smooth hypochromic
Associated with Atopic Dermatitis
3 stages Papular erythematous Papular hypochromic Smooth hypochromic
![Page 40: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/40.jpg)
Pitryriasis Alba (PA): RxPitryriasis Alba (PA): Rx
Gentle Skin care
1% Hydrocortisone Cream
Sunscreen
Reassurance
Gentle Skin care
1% Hydrocortisone Cream
Sunscreen
Reassurance
![Page 41: Pediatric Dermatology Dr. Jerald E. Hurdle Kennebec Medical Consultants Dr. Jerald E. Hurdle Kennebec Medical Consultants.](https://reader036.fdocuments.net/reader036/viewer/2022062315/5697bfc31a28abf838ca5374/html5/thumbnails/41.jpg)
Learning ObjectivesLearning Objectives
To review common congenital & acquired skin lesions,
To recognize rashes that present in childhood, and
To manage the kids and their parents.