RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants...

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RASH DECISIONS ETHAN PETTIT, D.O. FAAP

Transcript of RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants...

Page 1: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

RASH DECISIONSETHAN PETTIT, D.O. FAAP

Page 2: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
Page 3: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

ERYTHEMA TOXICUM

Up to 60% of Term infants

Healthy infants

Vesicles/pustues with ring of red around

E=E

• Erythema toxicum=Eosinophils

Typically gone by 7 days

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PUSTULAR MELANOSIS

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Page 8: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

NEONATAL HSV?

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INFANT NEVUS

Dilated fetal capillaries

• 40% of newborns

Flat, dull, pink

Front and back

• 95% of front will fade• 50% of back will fade

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PORT WINE STAIN

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Page 18: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

NEVUS FLAMMEUS

Caution to Face distribution

Laser treatment

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HEMANGIOMAS

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HEMANGIOMAS

Benign Proliferation of endothelial cells.

1-3% at birth

10% Caucasians by 1 year

More females than males

More common in preterm or SGA

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Page 22: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
Page 23: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
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Page 25: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

HEMANGIOMAS

Proliferation

• Up to year

Stabalization

Involution

• Typically after 2

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HEMANGIOMAS TREATMENT

Location

• Cosmetic vs Dangerous

Large

Ulcerated

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ECZEMAATOPIC DERMATITIS

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TINEA VS ECZEMA

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ECZEMA TREATMENT

Moisture, Moisture, Moisture

• Eucerin, Aquaphor, Cedophil, Aveeno, Vanicream• RIGHT out of the bath

Wet to dry wraps

Page 33: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

ECZEMA TREATMENT

Steroids

• Creams:• Hydrocortisone 1%, 2.5%• Triamcinolone• Desonide

• Sometimes oral steroids

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ECZEMA TREATMENT

Secondary infections

Cut nails short

Bleach water baths (1/2 cup per tub)

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ECZEMA HERPETICUM

Page 36: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

ECZEMA HERPETICUM TREATMENT

Treat the HSV,

Watch for bacterial infection as well

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Page 38: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

SEBORRHEA

Cradle cap

Scaly

Greasy

Usually not itchy

Page 39: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
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Page 41: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

SEBORRHEA TREATMENT

Dandruff shampoo

Antifungal cream

Low potency steroid cream

Page 42: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

KERATOSIS PILARIS

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HIVES

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Page 46: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
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Page 48: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

HIVES TREATMENT

Steroids can help in extreme cases

Antihistamines

• Benadryl• Zyrtec• Hydroxizine

Page 49: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

CHRONIC HIVES

May or may not have an identifiable trigger

Allergy testing

Most resolve within a few years

Page 50: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

PITYRIASIS ALBA

Page 51: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

PITYRIASIS ALBA

Often starts with erythematous lesions

Leaves behind hypopigmented lesions

Limited treatment options

• If topical steroids used with initial lesions, may prevent hypopigmented

• UV sun protection

Page 52: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
Page 53: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
Page 54: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

PITYRIASIS ROSEA

Benign

Self limited

• Sometimes 6-8 weeks

Herald Patch

Christmas Tree pattern

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Page 56: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
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INFECTION RASHES

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IMPETIGO

Page 59: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

IMPETIGO

Staph and Strep

Typically honey crusted

Often the face

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Page 61: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
Page 62: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

IMPETIGO TREATMENT

Topical

• Mupirocen• Don’t forget the nose

Topical not enough

• Cephalexin

Sometimes MRSA

Page 63: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

HERPES SIMPLEX

Page 64: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

SCARLET FEVER

Page 65: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

VIRAL EXANTHEM

Page 66: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

SSSS

Page 67: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

STAPH SCALDED SKIN SYNDROME

Toxin mediated

Tender skin

Shearing skin

Lack of mucosal involvement

compared to SJS or TEN (deeper)

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Page 69: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
Page 70: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

MENINGOCOCCEMIA

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Page 72: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

HENOCH SCHONLEIN PURPURA

Page 73: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

Tinea CorporisVs

Granuloma Annulare

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Page 75: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
Page 76: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

KOH

Page 77: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

TINEA VERSICOLOR

Page 78: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
Page 79: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

TINEA VERSICOLOR

KOH (spaghetti and meatballs)

Treatment

Selenium Sulfide

Topical antifungal

Page 80: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

ACNE

Gentle Cleanser

Benzoyl Peroxide

Epiduo

Topical Retinoids

Retin A

may take 6-8 weeks

Page 81: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

BUG BITES

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SCABIES

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Page 84: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
Page 85: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

SCABIES TREATMENT

5% Permethrin

Bedding cleaned in AM

Treat all family members (even if not symptomatic)

Page 86: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

BED BUGS

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FLEAS

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Page 92: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

STINGS

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LOCAL REACTION

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Page 95: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

WARTS

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Page 97: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
Page 98: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

WART TREATMENT

Cryotherapy

care to nail beds

Salicylic Acid

Tape

Abrasion

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CALLUS

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MOLLUSCUM

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Page 102: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.
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NEUROCUTANEOUS

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NEUROFIBROMATOSIS TYPE 1

Café au lait macules

6 or more

Neurofibromas

often not until after puberty

Lisch nodules

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CAFÉ AU LAIT

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NEUROFIBROMAS

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LISCH NODULES

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TUBEROUS SCLEROSIS

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TS ANGIOFIBROMAS

Page 111: RASH DECISIONS ETHAN PETTIT, D.O. FAAP. ERYTHEMA TOXICUM Up to 60% of Term infants Healthy infants Vesicles/pustues with ring of red around E=E Erythema.

ACKNOWLEDGMENTSKelly McClean MD, Michigan Board Review

Robert Colman MD, Whitney Molis MD, Pediatric and Adult allergy P.C.

http://www.onlinedermclinic.com

http://hardinmd.lib.uiowa.edu/pictures22/dermnet/

http://www.skinsight.com/images

http://dermatlas.com

http://dermnet.com

http://dermatologyoutlines.com

http://www.allergyasthmamichigan.com

http://0.tqn.com/w/experts/Dermatology

Google images