Common pediatric skin problems Viruses may involve the skin either by dissemination to skin during a systemic viral infection accompanied by viral replication in skin (viral exanthem) or by producing a virus-induced skin tumor. viral exanthems are commonest.
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Common pediatric skin problems
Viruses may involve the skin either by dissemination to skin during a systemic viral infection accompanied by viral replication in skin
(viral exanthem) or by producing a virus-induced skin tumor.
viral exanthems are commonest.
Viral Exanthems
Viral Exanthems…
• Important causes of child morbidity• Overlooked
• Exanthems: – Symmetric, diffuse skin eruptions caused by viral illnesses.– Macules, papules, pustules, vesicles, wheals or purpura.
• Enanthems: – Oral mm eruptions– Papules, vesicles, erosions, ulcerations or petechiae
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Viral exanthems• Classification Scheme of childhood exanthems
• Infection of antigen-presenting cells ⇨immunosuppression.
• Following infection ⇨ shift from CMI to Humoral immunity occurs.
Measles…Clinical Features• The course divided into three distinct phases:
I. Asymptomatic period– IP of 10 or 11 days following exposure
II. Prodrome phase – Lasts 3 to 4 days– Coryza, fever a striking palpebral conjunctivitis with photophobia, and a “barking” cough.
Measles…
III. Onset of the rash– Persists longer than 5 to 6 days.– As exanthem progress, systemic signs subside
– Koplik's spots • Pathognomonic lesions • Tiny bluish white spots with red background/halo• On buccal mucosa opposite lower 2nd molars/inner lip• Usually appear 24 to 48 hrs before the rash (2nd febrile
day)
The exanthem• Begins on the fourth febrile day
• Erythematous macules and papules– Behind ears, forehead at hairline– Spread: centrifugally and inferiorly– Face, trunk, extremities, palms and soles– Reach the feet ~ 3rd day
• Lesions fade away in order of appearance• Resolution: 4 – 6 days
• Retoauricular, • Post. cervical and • sub. occipital.
Rubella…• Exanthems
– Erythematous, maculopapular rash– 1st day ~ spreads to the face, trunk and extremities– 2nd day ~ facial exanthem fades.– 3rd day ~ exanthem fades completely with out residual pigmentary Δ
• Enanthems – Rose colored spots or petechiae on soft palate: Forchheimer’s sign
• Systemic signs – LAP– Splenomegally– Arthritis
Rubella…DDx
– Other exanthems– Drug reactions
Diagnosis– Clinical ~ especially during epidemic– Laboratory
• Serology
• Culture
Rubella…Management
– Symptomatic treatment– PEP: IV IG ~ for non immune, pregnant women who refuse abortion
– Immunization• Live attenuated virus
• Schedule– At 12 to 15 months of age– All non-immune prepubescent– All non immune postpubescent females NOT conceiving in 3 months
Prognosis– Post natal: usually mild and with no consequence
Chicken Pox
• Etiology: – VZV, infects 98% of adult population
• Age of onset– ~90% of cases in children younger than 10 yrs; – ~5% in persons greater than 15 yrs
• Transmission– Routes:
• Airborne droplets• Direct contact
– Pts are contagious: several days before rashes till last crop of vesicles.
– Crusts are NOT infectious– IP~14 dys; range 10 to 23 days– Varicella is 3x more infectious than Zoster.
Pathogenesis
• Mucosa of URT and oropharynx
⇊• Local replication and 10 viremia AND replicates in cells of RES
⇊• Dissemination to the skin and mm
⇊• During the course of the varicella, the virus passes from the
skin lesion to the sensory nerves ⇛ ⇛ travels to the sensory ganglia ⇛ ⇛ establishes local infection.
Clinical Features
• Prodrome– Chracterstically absent in children OR mild
• Exanthems appear with in 2-3 days after prodrome.
• Skin lesions– Usually quite pruritic– Vesicular lesions seen in successive crops– Scanty in children Vs much more dense in adults
• Certain viruses, such as human papillomaviruses and molluscum contagiosum viruses, do not destroy keratinocytes but induce keratinocyte proliferation, resulting in benign tumors of skin.
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Molluscum Contagiosum
Clinical features
• White or yellow-white 1-6 mm discrete papules with a central umbilication are seen
• Caused by a poxvirus that induces epidermal cell proliferation.
• Molluscum type I is believed to be responsible for common lesions on the extremities, head, and neck.
• Types 2 and 3 are most often associated with genital lesions in the adolescent or young adult.
The child is contagious as long as active lesions are present.
Untreated molluscum may require 1-5 years to resolve.
Treatment :- Removal of a papule is curative.04/12/23 73