Objectives Pediatric Visual Dermatological Diagnosisfaculty.washington.edu › fvega › HIHIM2010 › Class Notes... · • High fever without source and irritabilityHigh fever without
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• Macules, Papules, Nodules• Patches and Plaques• Vesicles Pustules Bullae• Vesicles, Pustules, Bullae• Colour• Erosions – when bullae rupture• Ulcerations and excoriations
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Atopic Dermatitis
• 3-5% of children 6 mo to 10 yr• Described in 1935• Ill defined red pruritic papules/plaques• Ill-defined, red, pruritic, papules/plaques• Diaper area spared• Acute: erythema, scaly, vesicles, crusts• Chronic: scaly, lichenified, pigment
changes
Atopic Dermatitis
Hints to diagnosis• Generalized dry skin• Accentuation of skin markings on palms• Accentuation of skin markings on palms
and soles• Dennie-Morgan lines• Fissures at base of earlobe• Allergic history
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Atopic DermatitisTreatment
• Moisturize• Baths only• Anti histamine• Anti-histamine• Topical steroids to red and rough areas
– Prevex HC– Desacort
• Immune modulators
Superinfected Eczema
• Red and crusty• Usually S. aureus• Cephalexin 40 mg/kg/day divided TID for 10 p g g y
days• More potent topical steroid• Topical antibiotic – Fucidin• Anti-histamine• Refer to Dermatology
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Scabies
• Intense pruritus• Diffuse, papular rash
– Between fingers, flexor aspects of wrists, g , p ,anterior axillary folds, waist, navel
• May be vesicular in children < 2 years– Head, neck, palms, soles– Hypersensitivity reaction to protein of
parasite
ScabiesTreatment
• 5% permethrin cream for infants, young children, pregnant and nursing mother– Kwellada-P or NixKwellada P or Nix– Cover entire body from neck down– Include head and neck for infants– Wash after 8-14 hours
• Can use Lindane for older children
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Tinea corporisRingworm
• Face, trunk or limbs• Pruritic, circular, slightly erythematous• Well-demarcated with scaly, vesicular orWell demarcated with scaly, vesicular or
pustular border• Id reaction• Mistaken for atopic, seborrheic or
• Supportive• NSAIDs may control the pain and do not
increase the risk of bleeding• Steroids – controversial
– Efficacy not proven re: abdo pain– No effect on purpura, duration of the illness or the
frequency of recurrences– Unclear of protective effect on renal disease
HSPIndications for admission
• R/O intussusception• Severe GI bleed• Severe renal disease• Severe renal disease • Need for renal biopsy• Hypertension• Pulmonary hemorrhage
Acute Hemorrhagic Edema of Infancy
• 4-24 months• Recent URI or antibiotics• Non toxic• Non-toxic• Resolves in 1-3 weeks• small- vessel, leukocytoclastic vasculitis• Annular or targetoid pupura and edema
on face and extremities
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Conclusions
• Not all that itches is eczema• Treatment is often supportive for viral
exanthemsexanthems• Remember rashes as a sign of systemic