Sajjad -Arabic board slide.ppt

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Visual DiagnosisVisual Diagnosis

ofofPediatric DisordersPediatric Disorders © ©

Charles M. Ginsburg, M.D.

Marilyn R. Corrigan Distinguished Chair in Pediatric Research

Professor and Chairman of Pediatrics

UT outh!estern Medical Center

Dallas Te"as



#nde" to Visual Diagnoses of

Pediatric Disorders

Grou$ #% Case &istories '( )*

Grou$ ##% Case &istories )'( +*

Grou$ ###% Case &istories +'( *

Grou$ #V% Case &istories '( -*

Grou$ V% Case &istories -'( '**

Visual tlas

/ou may $roceed through the $rogram in se0uential order

by utili1ing the Right and 2eft cursor arro!s or you may single

clic3 the mouse on the s$ecific Grou$ to go to the first slide in

the res$ecti4e grou$. To return to the #nde", single clic3 the

#nde" button in the u$$er right corner of each slide.



DEX

Case &istory '

T!o year old !ho has had fe4er and

decreased a$$etite for $ast +- hours5

!as difficult to arouse this .M..



Cao gio $ic



DEX

Differential Diagnosis

'. &enoch chonlein Pur$ura

). Child abuse

6. Cao Gio

+. chamberg7s Disease



DEX


'. &enoch chonlein Pur$ura

). Child abuse

6. Cao Gio

+. chamberg7s Disease



DEX

• Cutaneous lesions resembling those seen in

inflicted trauma but $roduced by emotionally

nurturant fol3 $ractices

• Vietnamese fol3 medicine $ractice

• 8ften confused !ith child abuse

• 3in is al!ays intact5 no brea3s in barrier

• R"% counseling

Cao Gio 9:cratch the ;ind7<

9=actitial Dermatitis5 Coin Rubbing<



DEX

Case &istory )

>ight year old !ho has had rash on!rists and 3nees for se4eral !ee3s5

has no! s$read to $enis. 8ther!ise

!ell. Maternal grandmother has

acti4e tuberculosis.



2ichen niditus $ic



DEX


'. 2ichen ?itidus

). 2ichen Planus

6. 2ichen crofulosorum

+. =lat !arts



DEX


'. 2ichen ?itidus

). 2ichen Planus

6. 2ichen crofulosorum

+. =lat !arts



DEX

2ichen ?itidus

• n uncommon, asym$tomatic chronic eru$tion that onthe arms, legs, $enis and, occasionally on the trun3

• >tiology is not 3no!n

• Characteri1ed by small, shar$ly defined, flesh(colored

locali1ed $a$ules• Common sites%

– e"tensor surface of elbo!, !rists, 3nees

– $enis

– occasionally on trun3R"% Reassurance



DEX

Case &istory 6

i" !ee3 old !ho had small $ea(si1ed :3not@ on eyebro! at birth5

has increased o4er $ast '* days.



Dermoid cyst eye $ic



DEX


'. 2acrimal gland cyst

). Dermoid cyst

6. >nce$halocoele

+. =ibrosarcoma



DEX


'. 2acrimal gland cyst

). Dermoid cyst

6. >nce$halocoele

+. =ibrosarcoma



DEX

Dermoid Cyst

• Cysts that are lined by an e$idermis that contains 4ariouse$idermal a$$endages

• 8ccur along embryonic fusion lines

• Most common sites%

– lateral one(third of orbital ridge

– nose

– scal$

– midline of nec3

• May be $resent at birth or a$$ear in early childhood

• >"cision5 if on scal$, RA8 intracranial e"tension



DEX

Case &istory +

=irst(born child of a 6- year oldmother !ith 2u$us. #nfant de4elo$ed

rash on face at B) hours and the rash

:seems to be !orse@.



>rythema to"icum $ic



DEX


'. #nfantile acne

). ?eonatal lu$us

6. ta$hylococcal $ustules

+. >rythema to"icum



DEX


'. #nfantile acne

). ?eonatal lu$us

6. ta$hylococcal $ustules

+. >rythema to"icum



DEX

>rythema To"icum

• Transient blotchy erythema seen in infants during

first !ee3 to ten days of life

• >rythematous macules )(6 cm in diameter !ith '(

)mm $in$oint 4esicles

• Primarily on face but but occurs on trun3 on

trun3 and e"tremities

• 8ccur in a$$ro"imately one(half of neonates• Generally occur in first )+ ( B) days of life



DEX

Case &istory

i" month old infant !ho has beeninconsolable throughout the night5

!hen changing first morning dia$er,

mother noted that $enis !as s!ollen.



&air tourni0uet $enis $ic



DEX


'. alano$osthitis

). Para$himosis

6. &air tourni0uet syndrome

+. &enoch chonlein Pur$ura



DEX


'. alano$osthitis

). Para$himosis

6. &air tourni0uet syndrome




DEX

&air Tourni0uet yndrome

• Rare condition $rimarily occurring in

infants

• May occur on any digit or, rarely, $enis

• trand of hair or strand from an article of

clothing may be res$onsible

• The hair or fiber strand may be difficult to

4isuali1e



DEX

Case &istory

&ealthy neonate !hose ado$ti4emother noticed lesion on $enis at

the time of the first dia$er change.



DEX




'. &er$es $rogenitalis

). #nclusion cyst

6. >bstein $earl

DEX




'. &er$es $rogenitalis

). #nclusion cyst

6. >bstein $earl

DEX



#nclusion Cyst

• lso called Milium or retention cysts

• May occur at any anatomic site

• Common in ne!borns on $alate 9>bstein7s Pearls<,

on eyelids or on gingi4a

• Distinct, '(6 mm solitary lesions

• u$erficial, globoid, $early(!hite firm $a$ules

• Resol4e s$ontaneously

DEX



Case &istory B

=i4e day old !hose mother noticedlesions on face this .M.5 is breast(

fed baby !ho has been doing terrific

since birth.



?eonatal acne $ic

DEX




'. Miliaria crystallina

). ta$hylococcal $ustules

6. >rythema to"icum

+. ?eonatal acne

DEX




'. Miliaria crystallina


6. >rythema to"icum

+. ?eonatal acne

DEX



?eonatal cne

• Defined as acne that occurs in the first 6* daysafter birth

• Common5 has been estimated to occur in u$ to

*E of all ne!borns

• Rare in immediate neonatal $eriod5 generally

first a$$ears bet!een ) and + !ee3s of age

•8ften has a $ustular a$$earance

• Resol4es s$ontaneously

DEX



Case &istory -

Rash on thigh of child !ho has had

similar lesions, off and on, in

different $arts of the body in the

$ast. #s asym$tomatic5 classmate

has ring!orm.



2ichen s$inulosis $ic

DEX




'. 2ichen s$inulosis

). Tinea cor$oris

6. 2ichen nitidus

+. 2ichen $lano$ilaris

DEX




'. 2ichen s$inulosis

). Tinea cor$oris

6. 2ichen nitidus

+. 2ichen $lano$ilaris

DEX



2ichen $inulosis

• enign, recurring disorder

• Primarily occurs in mid(childhood

• =emale $redominance• Characteri1ed by grou$s of s$iny(feeling,

3eratotic $a$ules

• Primarily occurs on e"tensor as$ects of

arms, legs, thighs and buttoc3s

DEX



Case &istory F

do$ted child !ho is brought to you

for $hysical e"am. Parents ha4e

little medical information on child but

ha4e been told that he is !ell e"ce$t

for ha4ing bro3en his arm.



8to7s ne4us $ic

DEX




'. ;ilson7s Disease

). #ncontinentia Pigmenti

6. =rancheschetti(adassohn yndrome

+. ?e4us of 8to

DEX




'. ;ilson7s Disease


6. =rancheschetti(adassohn yndrome

+. ?e4us of 8to

DEX



?e4us of 8to

98culodermal Melanocytosis<

• Congenital, non(hereditary lesion

• Generally $resent at birth but may occur during first fe!

!ee3s of life• =emale $redominance

• Unilateral, flat, blue(blac3 or slate colored lesions in

distribution of the first and second branches of the

Trigeminal ner4e

• Density of the $igment may 4ary

DEX



Case &istory '*

i" year old !ho has had rash on

face for o4er t!o months5 is slo!ly

getting !orse.



Pityriasis alba $ic

DEX

ff




'. Tinea Versicolor

). Tinea Cor$oris

6. Pityriasis lba

+. ?umular >c1ema

DEX

Diff i l Di i




'. Tinea Versicolor

). Tinea Cor$oris

6. Pityriasis lba

+. ?umular >c1ema

DEX

Pityriasis lba



Pityriasis lba

• 8ne of the &y$omelanosis yndromes5 un3no!n etiology

• enign but esthetically dis$leasing

• 8ccurs $rimarily in young school(aged children5 F*E in children H ')

years

• #nitial lesion is a $in3 to light(bro!n macule !ith indistinct margins5 o4er

time, lesion looses $igment and a fine, fla3y scale a$$ears

• i1e of lesions is highly 4ariable

• 2esions may be multi$le or solitary5 generally there are )(6

• Chee3s, forehead and $erioral regions are the most common sites

• Resol4es s$ontaneously o4er years

• Corticosteroids may be beneficial

DEX



Case &istory ''

Three !ee3 old !hose mother has

noticed $eriodic :discharge@ from

umbilicus5 during the $ast se4eral

days, the to$ of the dia$ers ha4e had

blood on them.



Umbilical granuloma $ic

DEX

Diff ti l Di i




'. Patent urachus

). Persistent 4itelline duct and $oly$

6. Pyogenic granuloma

+. Umbilical granuloma

DEX

Diff ti l Di i




'. Patent urachus

). Persistent 4itelline duct and $oly$


+. Umbilical granuloma

DEX



Umbilical Granuloma

• Condition thought to be secondary to lo!(

grade infection andAor e"cessi4e moisture

• Polymor$hic a$$earance5 lesion can be4ascular in a$$earance or ha4e crusted

lesions

• May ha4e serous or serosanguinousdischarge

R"% Drying and sim$le cauteri1ation

DEX



Case &istory ')

Child has had :sores@ on hands for

se4eral months5 mother thin3s that

they first a$$eared after child !as

bitten by fireants.



Verruca 4ulgaris $ic

DEX




'. =ibrous &istiocytoma

). cro3eratitis 4errucoformis


+. Verruca 4ulgaris

DEX




'. =ibrous &istiocytoma

). cro3eratitis 4errucoformis


+. Verruca 4ulgaris

DEX



Verruca Vulgaris

• caly rough $a$ules or nodular lesions

that can be found on any s3in surface

• May be $olymor$hic in a$$earance

• Caused by strains of the Pa$illoma4iruses

• 8ccur $rimarily in children and youngadults5 has been estimated that '*E of

school(age children ha4e !arts

DEX



Case &istory '6

2esion on face of infant !ho !as

ado$ted on the fifth day of life5ado$tion agency states that they

don7t recall seeing the lesion before

the child !as gi4en to the ado$ti4e$arents.



?e4us flammeus $ic

DEX




'. Port(!ine stain

). ?e4us flammeus

6. turge(;eber yndrome

DEX




'. Port(!ine stain

). ?e4us flammeus

6. turge(;eber yndrome

DEX

? =l



?e4us =lammeus

• 8ther terms% tor3 bite, almon $atch, ca$illaryhemangioma

• 2ight(red flat hemangiomas that most commonly occur on

the eyelids, gabella and na$e of nec35 may be $resent on

any anatomic site

• >"tremely common5 H)*E of ne!borns ha4e a lesion on

the eyelids or gabella and H +*E ha4e one on na$e of nec3

• ll fade to some degree5 lesions on eyelids generally

resol4e com$letely by ' year !hile those on na$e of nec3tend to $ersist into adulthood

DEX



Case &istory '+

Ten year old !ho has had headache,

fe4er, UR# sym$toms and sore throat

for $ast t!o days. Three days ago,

he ate some $e$$ers that :burned

his tongue@.



Geogra$hic tongue $ic

DEX





'. Ca$aicin inIury

). carlet fe4er

6. 2ichen $lanus

+. Geogra$hic tongue

DEX





'. Ca$aicin inIury

). carlet fe4er

6. 2ichen $lanus

+. Geogra$hic tongue

DEX

Geogra$hic Tongue



g $ g

• >stimated to occur in J)E of $o$ulation

• i1arre condition that has areas of de$a$illation

on the dorsal surface of the tongue

• ?ormal mucosa !ith areas of de$a$illation thatare surrounded by areas !ith a !hite rim

• enign, lifelong condition

• $$ro"imately +*E of $atients !ill also ha4e afissured tongue

DEX



Case &istory '

Mother noted :!hite s$ots@ in mouth

of fi4e day old infant !ho is ha4ing

difficulty breastfeeding.



>bstein7s $earls $ic

DEX




'. >bstein7s Pearls

). Mucocoele

6. Cysts of $heno$alatine =oraminae

+. uction inIury

DEX




'. >bstein7s Pearls

). Mucocoele

6. Cysts of $heno$alatine =oraminae

+. uction inIury

DEX



>bstein7s Pearls

• Milium or retention cysts that occur on

$alate or oral mucosa of ne!borns

• Distinct, '(6 mm solitary lesions

• u$erficial, globoid, $early(!hite firm

$a$ules

• Resol4e s$ontaneously

DEX



Case &istory '

=irst time 4isit for month old !ho

is other!ise normal. Parents states

that they ha4e al!ays thought that

one e"tremity !as larger than the

other but former $ediatricianassuaged their concerns



Milroy7s disease $ic

DEX

Diff ti l Di iDifferential Diagnosis



Differential DiagnosisDifferential Diagnosis

'. =ilariasis

). Milroy7s Disease

6. &emihy$ertro$hy

+. Kli$$el(Trenaunay(;eber syndrome

DEX




'. =ilariasis

). Milroy7s Disease

6. &emihy$ertro$hy

+. Kli$$el(Trenaunay(;eber syndrome

DEX



Milroy7s Disease

• Condition characteri1ed by non($itting edema of the

lo!er e"tremities5 generally unilateral

• =emale $redilection

• May be ina$$arent at birth5 slo!ly $rogressi4e during

infancy

• >tiology not 3no!n but $resumed to be secondary to

a de4elo$mental abnormality of lym$hatic 4essels

• May be familial

DEX



Case &istory 'B

i" year old !ith :lum$@ on !rist

that Iust :$o$$ed(u$@ se4eral !ee3s

ago. ?ot $ainful but bothers him.

8ther!ise !ell e"ce$t for ha4ing had

ring !orm se4eral months ago thatlasted for se4eral !ee3s.

DEX



Ganglion cyst $ic

DEX




'. 8steogenic sarcoma

). Rheumatoid nodule

6. Ganglion cyst

+. Granuloma nnulare

DEX




'. 8steogenic sarcoma

). Rheumatoid nodule

6. Ganglion cyst

+. Granuloma nnulare

DEX

Ganglion Cysts



Ganglion Cysts

• yno4ial(filled cysts• Generally asym$tomatic

• Dorsal as$ect of the !rist is most common anatomic site

• #n contrast to adults, are not associated !ith

degenerati4e Ioint disease

• Most li3ely the result of trauma

• Most are benign and !ill resol4e o4er time

• hould not be as$irated

DEX



Case &istory '-

Thirteen year old !ho decided to get

her hair cut short5 has ne4er had hair

cut before. Mother states that she

had a yello!ish rash in scal$ !hen

she !as a baby.



haddasohns ne4us $ic

DEX




'. ?e4us ebaceous of adassohn

). Kerion

6. Condyloma accuminata

+. eborrheic dermatitis

DEX




'. ?e4us ebaceous of adassohn

). Kerion

6. Condyloma accuminata

+. eborrheic dermatitis

DEX

?e4us ebaceous of adassohn



?e4us ebaceous of adassohn

• Predilection for scal$ but may be $resent in any anatomic

site including mucous membranes

• Usually solitary

• /ello! to yello!ish bro!n !a"y(a$$earing lesion duringthe neonatal $eriod5 becomes 4errucoid as child ages

• May increase in si1e and become more 4errucoid during

$uberty

• &as $otential to undergo malignant degeneration

• R"% >"cision

DEX



Case &istory 'F

dolescent !ith t!o day history of

rash on face that is $ainful and:getting !orse@. ;as on cam$ing tri$

o4er the !ee3end before the rash

de4elo$ed5 one of friends has had coldsores. &as been !ell5 had rashes

during first year of life.



to$ic dermatitis $ic

DEX




'. to$ic dermatitis

). =actitial dermatitis

6. Rhus Dermatitis

+. &er$es sim$le"

DEX




'. to$ic dermatitis

). =actitial dermatitis

6. Rhus Dermatitis

+. &er$es sim$le"

DEX

to$ic Dermatitis



to$ic Dermatitis

• Chronically rela$sing s3in disorder !ith no singledistinguishing characteristic

• Clinical e"$ression is generally age de$endent5 more

generali1ed in infancy and more fle"ural in adolescents

• Pruritis is in4ariable concomitant of disease

• Prurigo, lichenification and ec1emati1ation are

hallmar3s of disease5 e"foliation and

hy$er$igmentation also occur but are more 4ariable

• >tiology is un3no!n

DEX



Case &istory )*

8ther!ise healthy child !ho has

had :something@ on her tongue for$ast se4eral months that is

:gro!ing@5 doesn7t hurt but :feels

funny@.



Pa$illoma $ic

DEX




'. Condyloma ccuminata

). 2ym$hangioma

6. Rhabdomyosarcoma

+. enign $a$illoma

DEX




'. Condyloma ccuminata

). 2ym$hangioma

6. Rhabdomyosarcoma

+. enign $a$illoma

DEX

Pa$illomas



Pa$illomas

• >"o$hytic, usually small, $a$illary gro!ths

• More common in adolescence and early adulthood

than in childhood


• Generally asym$tomatic

• lmost al!ays the same color and te"ture of the

adIacent mucosa

• >tiology not 3no!n5 relationshi$ to &PV has been

0uestioned but ne4er $ro4en

DEX



Case &istory )'

=irst 4isit for an eight year old !ho

had been in the care of another$ractitioner. sym$tomatic e"ce$t

for :rash@ on nec3 that has been

$resent since he !as a baby5 therash is asym$tomatic.



hagreen $atch $ic

DEX





'. =lat !arts

). hagreen $atch

6. Tinea cor$oris

+. 2ichen s$inulosis

DEX





'. =lat !arts

). hagreen $atch

6. Tinea cor$oris

+. 2ichen s$inulosis

DEX

hagreen Patch



• 8ne of the characteristic cutaneous

manifestations of Tuberous clerosis

• Most often occurs on trun3 or in lumbosacral area

but can occur on any glabrous s3in

• Discrete, usually flesh(colored, flat to slightlyele4ated lesions !ith a :$ig(s3in@ or :orange($eel@

a$$earance

• &ighly 4ariable in si1e

• re $la0ues of sube$idermal fibrosis

DEX



Case &istory ))

2esion on the bac3 of a si" month

old infant !ho is other!ise normal5there is a dis$ute !ithin the family as

to !hether or not the lesion has been

$resent at birth or first a$$earedse4eral months ago.



sh leaf s$ot $ic

DEX




'. sh(leaf s$ot

). chromic ne4us

6. ?e4us anemicus

+. Vitiligo

DEX




'. sh(leaf s$ot

). chromic ne4us

6. ?e4us anemicus

+. Vitiligo

DEX

sh 2eaf $ot



• 8ne of the characteristic s3in lesions of Tuberous clerosis

• Present in -E( F*E of all $atients !ith Tuberous clerosis

• Present at birth or in early infancy

• Difficult to see in light(s3inned indi4iduals5 ;ood7s light is

hel$ful to 4isuali1e

• &y$omelanotic macules that are in a linear orientation5 4ary in

number

• &a4e a rounded end and a $ointed end 9ash leaf

configuration<

DEX



Case &istory )6

>ight year old !ho began de4elo$ing

acne se4eral years ago5 slo!ly getting!orse des$ite antibiotics and multi$le

$rescri$tion and o4er(the(counter anti(

acne medications.



denoma sebaceum $ic

DEX





'. denoma sebaceum

). Cystic acne

6. Multi$le trichoe$itheliomas

+. Rosacea

DEX





'. denoma sebaceum

). Cystic acne

6. Multi$le trichoe$itheliomas

+. Rosacea

DEX

denoma ebaceum



• 8ne of the characteristic cutaneous lesions of Tuberousclerosis

• Present in a$$ro"imately *Eof $atients !ho are L four

years old5 unusual before + years of age

• >arliest manifestations are erythema that slo!ly$rogresses to flesh(colored to $in3 lesions at nasolabial

folds, malar region, chin, forehead and, sometimes, the

scal$

• 8ften confused !ith acne

• re actually angiofibromas

DEX



Case &istory )+

i"teen year old child !ith sei1ure

disorder !ho first noticed lesion onhis nail !hen he !as '6 years old5

has slo!ly increased in si1e but

doesn7t hurt.



Periungual fibroma $ic

DEX




g

'. 8nychomycosis

). Periungual =ibroma

6. Charcot(Marie(Tooth yndrome

DEX




g

'. 8nychomycosis

). Periungual =ibroma

6. Charcot(Marie(Tooth yndrome

DEX

Periungual =ibroma



• lso called Koenen tumors

• 8ne of the characteristic cutaneous lesions of

Tuberous clerosis

• May be solitary or multi$le lesions

• 8ccur in $eriungual or subungual regions

• Generally do not manifest until $uberty

• May in4ol4e and e4entually destroy the entire nail

DEX

C &i t )



Case &istory )

i" month old !ho has been

irritable and crying for $ast )+

hours. Mother noted s!elling on

gums this morning.

> ti t i



>ru$tion cyst $ic

DEX





'. ngiofibroma

). >$ulis

6. Gumboil

+. >ru$tion cyst

DEX





'. ngiofibroma

). >$ulis

6. Gumboil

+. >ru$tion cyst

DEX

>ru$tion Cysts



• Common5 $recise incidence not 3no!n

• 8ften o4erloo3ed or not noticed

• Painful

• 8ccasionally, there may be blood in the cyst5

a$$ears as a hematoma of gingi4a

• elf(limited5 sym$tomatic thera$y

• Don7t as$irate

DEX

C &i t )



Case &istory )

2esion that has been $resent since

birth5 originally thought to besecondary to an infected scal$

electrode site but has ne4er had hair

regro!th.

DEX

l i ti i



$lasia cutis $ic

DEX




'. Pyogenic Granuloma

). ?e4us ebaceus of adassohn

6. $lasia Cutis

+. Tinea Cor$oris

DEX




'. Pyogenic Granuloma

). ?e4us ebaceus of adassohn

6. $lasia Cutis

+. Tinea Cor$oris

DEX

$lasia Cutis



• De4elo$mental failure of s3in closure

• 8ccurs in '%6*** ( '%*** li4e births

• May in4ol4e e$idermis or all s3in layers

• har$ly demarcated, hairless lesion generally in the$osterior midline of scal$ although other anatomic

sites may be in4ol4ed

• May be de$ressed, ulcerated or co4ered by thin

abnormal a$$earing s3in

• May be associated !ith other de4elo$mental defects

DEX

Case &istory )B



Case &istory )B

Thirteen year old $ost($ubertal

female !ho has noticed that one ofher feet has gro!n larger during the

$ast fe! months5 doesn7t hurt and

tends to get better during the day.

DEX

2ym$hedema $raeco" $ic



2ym$hedema $raeco" $ic

DEX





'. Milroy7s Disease

). Thrombo$hlebitis

6. 2ym$hedema Praeco"

+. 2ym$hedema Tardum

DEX





'. Milroy7s Disease

). Thrombo$hlebitis

6. 2ym$hedema Praeco"

+. 2ym$hedema Tardum

DEX

2ym$hedema Praeco"



• Curious condition that $resents around

$uberty5 $rimarily in females

• Generally unilateral

• #nsidious onset

• >arly on the edema is $itting5 edemabecomes non$itting if condition does

not s$ontaneously resol4e

DEX

Case &istory )-



Case &istory )-

=irst 4isit for child !ho has had life(

long abnormalities of leg. Pre4ious$hysician told them that it !ould go

a!ay o4er time but is no! ha4ing

bac3 and hi$ $ain5 $atient thin3sthat one leg is longer.

Kli$$el treunanay $ic



Kli$$el treunanay $ic

DEX




'. turge(;eber(Dimitri yndrome

). Milroy7s Disease

6. McCune lbright yndrome

+. Kli$$el(Trenauney(;eber yndrome

DEX




'. turge(;eber(Dimitri yndrome

). Milroy7s Disease

6. McCune lbright yndrome

+. Kli$$el(Trenauney(;eber yndrome

DEX

Kli$$el(Trenauney(;eber yndrome



• yndrome characteri1ed by unilateral

abnormal angiomatosis of an e"tremity,

usually a lo!er limb

• Generally $resent at birth

• May result in limb o4ergro!th and

une0ual leg length

• Prone to infection

DEX

Case &istory )F



Case &istory )F

Three month old !ith t!o !ee3 history

of s!elling of Ia!s, associated !ithmar3ed irritability and fe4er. &ad been

doing !ell since birth.

Caffey7s disease $ic



Caffey s disease $ic

DEX




e e t a ag os s

'. 22

). #nfantile Dermatomyositis

6. Ka!asa3is yndrome

+. Caffey Disease

DEX




g

'. 22

). #nfantile Dermatomyositis

6. Ka!asa3is yndrome

+. Caffey Disease

DEX

Caffey Disease



• lso termed #nfantile Cortical &y$erostosis yndrome

• i1arre condition of un3no!n etiology that has

become rare for reasons that ha4e ne4er been

identified

• Characteri1ed by mar3ed s!elling of soft tissues of Ia!s and soft tissues of face

• Progressi4e cortical thic3ening of long bones of

e"tremities5 characteristic radiogra$hic lesions

• >"acerbations and remissions are common

DEX

Case &istory 6*



Case &istory 6*

Ten month old !ho has Iust started

:cruising@ !hose mother noticed as!elling in bac3 of 3nee that !as not

$resent the $re4ious day5 does not

seem $ainful and the child isother!ise !ell.

a3ers cyst $ic



a3ers cyst $ic

DEX




'. Dermoid cyst

). a3er7s cyst

6. 2i$oma

+. Disseminated ?euroblastoma

DEX




'. Dermoid cyst

). a3er7s cyst

6. 2i$oma

+. Disseminated ?euroblastoma

DEX

a3er7s Cyst



• Uncommon condition in childhood

• Distention of the gastrocnemius and

semimembranosus bursa along the $osterior

as$ect of the 3nee

• =illed !ith syno4ial fluid

• Generally s$ontaneously resol4e in $re$ubertal

children

• ?ot a surgical condition in $re$ubertal children

DEX

Case &istory 6'



Case &istory 6'

8bese female !ith Iu4enile Diabetes

Mellitus !ho has noticed increasing:dar3ness@ of s3in under arms and

in groin.

canthosis nigricans $ic



canthosis nigricans $ic

DEX




'. Aspergillus niger infection

). canthosis ?igricans

6. ?ormal

+. Post(inflammatory hy$er$igmentation

DEX





). canthosis ?igricans

6. ?ormal

+. Post(inflammatory hy$er$igmentation

DEX

canthosis ?igricans



• trange condition manifested by

hy$er$igmentation

• ymmetric 4el4ety gray(bro!n to blac3

$igmentation of locali1ed areas of s3in

• Most common sites% a"illa, groin, base of nec3

and antecubital fossa

• ssociated !ith a 4ariety of disorders% obesity,Diabetes Mellitus, malignancies, 4arious

malignancies

DEX

Case &istory 6)



Case &istory 6)

i" month old $re4iously health

child !ho has suddenly de4elo$edmulti$le lesions at multi$le anatomic

sites5 lesions are non$ainful, soft

and com$ressible.

DEX

lue Rubber bleb $ic



lue Rubber bleb $ic

DEX




'. acillary ngiomatosis

). Ca$illary &emangiomas

6. Diffuse ?eonatal &emangiomatosis

+. lue Rubber leb ?e4us yndrome

DEX




'. acillary ngiomatosis

). Ca$illary &emangiomas

6. Diffuse ?eonatal &emangiomatosis

+. lue Rubber leb ?e4us yndrome

DEX

lue Rubber leb yndrome



• rare disorder that consists of grou$s of abnormalblood 4essels 9ca4ernous hemangiomas< affecting

the s3in and internal organs of the body

• 8ccurs at birth or !ithin a fe! years after birth

• 2esions seem to gro! !ith body gro!th and rarely

regress

• The lesions are sometimes tender to $al$ation5 can

be $artially em$tied of blood if firm $ressure isa$$lied5 do not s$ontaneously bleed

DEX

Case &istory 66



y

2esion on the face of an eight year

old !ho has had the lesion sincebirth5 thin3s that it may be enlarging5

asym$tomatic.

Comedone ne4us $ic



$

DEX




'. cne

). 2inear ?e4us

6. Tinea Cor$oris

+. ?e4us Comedonicus

DEX




'. cne

). 2inear ?e4us

6. Tinea Cor$oris

+. ?e4us Comedonicus

DEX

?e4us Comedonicus



• >"tremely uncommon congenital lesion consisting of$ilosebaceous follicles

• #solated linear or o4al lesion that most commonly

occurs on face or scal$

• Characteri1ed by dilated follicular o$enings that are

often $lugged !ith 3eratin

• May ha4e inflammatory res$onse !ith $ustular lesions

R"% e"cision

DEX

Case &istory 6+



y

Ten !ee3 old infant !ho !as fussy

last e4ening5 a!a3ened multi$letimes throughout night !ith

sometimes inconsolable crying.

Mother noticed s!ollen, red toe this.M.

DEX

&air tourni0uet toe $ic



0 $

DEX




'. listering Distal Dactylitis

). Trauma

6. ubcutaneous =at ?ecrosis

+. &air Tourni0uet yndrome

DEX




'. listering Distal Dactylitis

). Trauma

6. ubcutaneous =at ?ecrosis

+. &air Tourni0uet yndrome

DEX

&air Tourni0uet yndrome



• Rare condition $rimarily occurring in

infants

• May occur on any digit or, rarely, $enis

• trand of hair or strand from an article of

clothing may be res$onsible

• The hair or fiber strand may be difficult to

4isuali1e

DEX

Case &istory 6



y

Ten year old !ho has been in good

health until last e4ening !hen hesuddenly felt something :funny@ on

his li$ that didn7t really hurt but !as

uncomfortable.

DEX

Mucocoele $ic



DEX




'. Mucocoele

). &emangioma

6. Herpes Simplex

+. Ranula

DEX




'. Mucocoele

). &emangioma

6. Herpes Simplex

+. Ranula

DEX

Mucocoele

• ometimes referred to as a :mucous esca$e@ lesion



• ometimes referred to as a mucous esca$e lesion

• Common

• 8ccur s$ontaneously5 often there is a history of

antecedent trauma

• May occur on any $art of oral mucosa5 mostcommonly occurs on li$s

• Generally $ainless

• Tend to :come and go@ if not e"cised

DEX

Case &istory 6



?eonate !ith lesion that !as

$resent at birth5 other!ise normal.

>$ulis $ic



DEX




'. Dentiginous eru$tion cyst

). Congenital Rhabdomyosarcoma

6. >$ulis

+. Mucocoele

DEX




'. Dentiginous eru$tion cyst

). Congenital Rhabdomyosarcoma

6. >$ulis

+. Mucocoele

DEX

>$ulis



• lso termed Gingi4al =ibroma

• Rare at birth

• =irm, nonmobile lesion !ith normala$$earing gingi4al mucosa

• Variable in si1e

• Generally secondary to re$eated mildtrauma in older children and adults

DEX

Case &istory 6B



T!o year old !hose sister had ring

!orm se4eral !ee3s ago5 had onsetof rash on face a$$ro"imately one

!ee3 ago. &as had rashes off and

on on other $arts of body sinceinfancy.

DEX

?umular ec1ema $ic



DEX




'. Tinea Cor$oris

). ?umular ec1ema

6. Granuloma annulare

+. Candidiasis

DEX




'. Tinea Cor$oris

). ?umular ec1ema

6. Granuloma annulare

+. Candidiasis

DEX

?umular >c1ema



• Descri$ti4e term for a $eculiar coin(

sha$ed lesion of ato$ic dermatitis

• May be solitary or multi$le lesions

• 8ften confused !ith Tinea Cor$oris

• Res$onds to to$ical corticosteroids

DEX

Case &istory 6-



=our month old !ho has had red,

chaffed chee3s off and on since si"!ee3s of age5 se4eral days ago, mother

noted se4eral small blisters on both

sides of the face se4eral hours after

she $laced baby lotion of the red areas.

ibling has &er$es gingi4ostomatitis.

DEX

#nfantile ec1ema $ic



DEX




'. 2ocal reaction to baby lotion

). &er$es Gladiatorium

6. #nfantile >c1ema

+. cabies

DEX




'. 2ocal reaction to baby lotion

). &er$es Gladiatorium

6. #nfantile >c1ema

+. cabies



DEX

Case &istory 6F



>ight year old !ho has al!ays

com$lained of :funny feeling@ onbac3 of tongue and throat5 not

$ainful and is other!ise normal.

DEX

2ym$hangioma $ic



DEX




'. 2ym$hangioma

). Prominent Circum4allate Pa$illae

6. 2ingual Thyroid

+. &er$es im$le" Glossitis

DEX




'. 2ym$hangioma

). Prominent Circum4allate Pa$illae

6. 2ingual Thyroid

+. &er$es im$le" Glossitis

DEX

2ym$hangioma

• Malformation of lym$hatic 4essels that may be



y $ y

$resent at birth or suddenly become clinicallya$$arent during childhood

• Usually $ainless

• &ighly 4ariable in si1e and any anatomic site may be

in4ol4ed

• ?umerous 4esicle(li3e , sometimes 4errucous

lesions that 4ary in color

• May ha4e 4ascular com$onent

DEX

Case &istory +*



8ne month old !ho had small, red

:$im$le@ on li$ at the time of birth!hich has $rogressi4ely increased in

si1e5 other!ise !ell.

DEX

&emangioma $ic



DEX




'. Mucocoele

). acillary angiomatosis

6. &emangioma

+. Pyogenic granuloma

DEX




'. Mucocoele

). acillary angiomatosis

6. &emangioma

+. Pyogenic granuloma

DEX

&emangioma

b i l f bl d l



• benign neo$lasm of blood 4essels


• Present at birth but generally enlarge during first ') (

'- months of life

• Ca$illary hemangiomas tend to slo!ly in4olute during

early childhood

• Ca4ernous hemangiomas are dee$er and more

e"tensi4e and generally do not sho! much regression

DEX

Case &istory +'



=irst(time 4isit for child !ho has not

had longitudinal medical care.

Mil3 teeth $ic



DEX




'. 8steogenesis #m$erfecta

). Tetracycline to"icity

6. =lourosis

+. Mil3(bottle caries

DEX




'. 8steogenesis #m$erfecta

). Tetracycline to"icity

6. =lourosis

+. Mil3(bottle caries

DEX

Mil3(ottle Caries

• n e"tensi4e form of dental caries secondary to



• n e"tensi4e form of dental caries secondary to

slee$ing !ith a nursing bottle that contains

carbohydrates

• Precise incidence is not 3no!n but $articularly

common in medically underser4ed children• #ncidence is mar3edly diminished in infants !ho

are breast(fed or fed !ater at last e4ening feeding

• Clinically a$$arent in second year of life

DEX

Case &istory +)



8ther!ise healthy t!o year old.

Mother thin3s that the lesion hasbeen $resent since birth.

DEX

Pilondinal sinus $ic



DEX




'. Meningocoele

). Pilonidal sinus

6. Pilomatri"oma

DEX




'. Meningocoele

). Pilonidal sinus

6. Pilomatri"oma

DEX

Pilonidal inus



• Relati4ely common de4elo$mental

anomaly

• 8ften confused !ith a $ilonidal cyst

• Usually asym$tomatic

• Pro$ensity for infection in later life

DEX

Case &istory +6



=our year old !ho has had a rash on

her face since infancy5 has beentreated !ith a 4ariety of to$ical

agents !ithout a$$reciable change.

Rash is totally asym$tomatic.

DEX

2inear ne4us $ic



DEX




'. 2inear e$idermal ne4us

). 2ichen nitidus

6. 2ichen striaticus

+. to$ic dermatitis

DEX




'. 2inear e$idermal ne4us

). 2ichen nitidus

6. 2ichen striaticus

+. to$ic dermatitis

DEX

2inear >$idermal ?e4us



• Uncommon lesion

• May be $resent at birth5 may enlarge during

early childhood

• May be $olymor$hic5 some ha4e 4errucoid

com$onent

• Usually isolated lesions

• May be $ruritic and ha4e inflammatory

com$onent 9erythema, scaling<

DEX

Case &istory ++



>ighteen month old !ho has been

healthy e"ce$t for a lot of dia$errashes during the first year of life.

ynechiae 4ul4a $ic



DEX




'. ?ormal

). drenogenital yndrome

6. ynechiae 4ul4a

+. Precocious $uberty



DEX

ynechiae Vul4a 92abial dhesions<

• Central line of adherence of the labia from the



fourchette to the inferior as$ect of the clitoris

• lso referred to as labial adhesions

• Generally asym$tomatic

• ?ot rare

• Generally secondary to local inflammation and

hy$oestrogenemia

• May be associated !ith urinary tract infections

DEX

Case &istory +



=irst(time 4isit for a four year old

!hose mother has lost his medicalrecords. Mother states that child has

had a scaly rash o4er entire body

since birth5 has been treated !ith

multi$le to$ical drugs !ithout much

effect.



DEX




'. to$ic dermatitis

). Refsum7s Disease

6. 2amellar #chthyosis

+. #chthyosis Vulgaris

DEX




'. to$ic dermatitis

). Refsum7s Disease

6. 2amellar #chthyosis

+. #chthyosis Vulgaris

DEX

2amellar #chthyosis• 8ne of the more se4ere, life(long forms of ichthyosis

• Presents at birth 9Collodian aby<



• Characteri1ed by large $archment ty$e scales o4er entire body

surface area5 ha4e e"cessi4e shedding throughout life

• bnormal hair, nails and s!eat glands

• Virtually all ha4e ectro$ion5 distinguishes it from other forms of

ichthyosis• Com$lications%

– recurrent hy$er$yre"ia

– recurrent bacterial infections

– dehydration

DEX

Case &istory +



Ten year old !ho has had rash on

abdomen for $ast si" months5 hasnot res$onded to the 4arious to$ical

agents that ha4e been a$$lied.



DEX




'. ?umular ec1ema

). cabies

6. to$ic dermatitis

+. llergic contact dermatitis

DEX




'. ?umular ec1ema

). cabies

6. to$ic dermatitis

+. llergic contact dermatitis

DEX

llergic Contact Dermatitis

• cute form% erythema, edema, $a$ules, 4esicles, or



y

bullae

• Chronic form% $a$ular ( $a$ulo4esicular, lichenified,

sometimes scaly

• Rarely in4ol4es $alms and soles

• 84er 6*** en4ironmental sensiti1ers ha4e been

identified5 most are sim$le chemicals that must lin3 to

$roteins before they can sensiti1e

• ?ic3el sulfate is the most common cause of CD inthe U..

DEX

Case &istory +B



i" month old !ho has been in the

care of neighbor !hile $arents ha4ebeen a!ay. ?eighbor states that the

s!elling Iust a$$eared se4eral hours

before $arents came to $ic3 the child

u$.

#mmersion inIury $ic



DEX




'. Primary irritant dermatitis

). ullous im$etigo

6. K!ashior3or

+. #mmersion inIury

DEX





). ullous im$etigo

6. K!ashior3or

+. #mmersion inIury

DEX

#mmersion #nIury



• #nIury that occurs !hen body $art is

e"$osed to $rolonged cold or, most

commonly, !ater that is L ')** =

• May be accidental but child abuse should

al!ays be considered

• May be difficult to initially define the full

e"tent of the inIury !hen the inIury hasbeen caused by hot !ater

DEX

Case &istory +-



T!o year old !ho has had re$eated

courses of antibiotics for

subma"illary cer4ical adenitis thathas not been associated !ith fe4er

or constitutional signs or sym$toms.

&as no! de4elo$ed drainage fromthe s3in o4er the gland has s!elling

and discoloration in front of the ear.

crofula $ic



DEX




'. Cer4icofacial ctinomycosis

). Cat cratch Disease

6. ?ocardiosis

+. crofula

DEX




'. Cer4icofacial ctinomycosis

). Cat cratch Disease

6. ?ocardiosis

+. crofula

DEX

crofula

• Most common e"tra$ulmonic manifestation of M. tuberculosis

infection



• lo!ly $rogressi4e, non(tender lym$hadeno$athy5 usuallyunilateral

• #n4ol4ed nodes are usually discrete but the o4erlying s3in is

discolored, usually indurated and feels fi"ed to underlying tissues

• T. s3in test is $ositi4e but Chest N( Ray is only abnormal in +*E(BE of cases

• May resol4e s$ontaneously if untreated but generally $rogresses

!ith chronic s3in changes and s$read to adIacent nodes5 often

forms cutaneous fistula !ith chronic drainage

DEX

Case &istory +F



Rash in an eight month old

un4accinated child !ho has hadgenerali1ed irritability, fe4er and

:3nots@ in the bac3 of the head for

the $ast +- hours.

DEX

Rubella



DEX




'. Rubella

). Measles

6. >ntero4irus B'

+. Ka!asa3i7s yndrome

DEX




'. Rubella

). Measles

6. >ntero4irus B'

+. Ka!asa3i7s yndrome

DEX

Rubella

• Vaccine($re4entable acute e"anthematous 4iral

disease



• #ncubation $eriod% '+ ( )' days

• Mild $rodrome often antedates the fe4er and rash

• Rash begins on face and mo4es ce$halad o4er +- ( B)

hours5 usually macular but may be maculo$a$ular

• deno$athy is an in4ariable concomitant5

subocci$ital lym$h nodes are almost al!ays enlarged

• Resol4es o4er 6( days

DEX

Case &istory *



>ighteen month old !hose mother is

concerned about the child7s breastde4elo$ment. Child is other!ise

normal5 height and !eight are at

*E, res$ecti4ely and ha4e follo!ed

the gro!th cur4e since birth.

Premature adrenarche $ic



DEX


' # l i b



'. #sose"ual $recocious $uberty

). rain tumor

6. ?ormal 4ariant

+. Premature thelarche

DEX


' # l i b t




). rain tumor

6. ?ormal 4ariant

+. Premature thelarche

DEX

Premature Thelarche

• enign, s$oradic condition that generally first a$$ears in the

first t!o years of life



first t!o years of life• Characteri1ed by%

– isolated breast de4elo$ment

– normal gro!th and osseous maturation

– genitalia sho! no e4idence of estrogeni1ation

• reast de4elo$ment is non($rogressi4e and generally

$rogresses after )(6 years

• #f tested, 2& and estradiol are belo! limits of assays5 =& is

normal or slightly ele4ated

DEX

Case &istory '



=i4e year old !hose mother has

noticed increasing amount of $ubic

hair5 is other!ise normal. Gro!thhas been consistently at the BE and

she has no e4idence of breast

de4elo$ment.

DEX

Premature adrenarche $ic



DEX


' # l i b t




). :Missed@ mild congenital adrenal

hy$er$lasia

6. Premature adrenarche

+. rain tumor

DEX


' # l i b t




). :Missed@ mild congenital adrenal

hy$er$lasia

6. Premature adrenarche

+. rain tumor



DEX

Case &istory )



>le4en year old !ho has had some

$ain and redness of u$$er eyelid for$ast se4eral days5 had become

!orse and is no! s!ollen and more

$ainful.

DEX

&ordeolum $ic



DEX


' Chala1ion



'. Chala1ion

). 2acrimal gland abscess

6. Dacrocystitis

+. >"ternal hordeolum

DEX


' Chala1ion



'. Chala1ion

). 2acrimal gland abscess

6. Dacrocystitis

+. >"ternal hordeolum

DEX

&ordeolum

• cute, often recurrent, $ainful inflammatory lesion of

eyelid



• Caused by occlusion of the glands of eiss and Moll

• l!ays at lid margin, in4ol4es eyelashes

• May ru$ture and drain s$ontaneously

• R"%

– !arm com$resses

– e"cision only for recalcitrant lesions

DEX

Case &istory 6



Child !ho has been in care of father

for $ast '* days. Dro$$ed off by

father !ho is no! una4ailable. Childstates that he has had sore on mouth

for se4eral days and !as ta3en to

doctor by father. Mother has &er$esTy$e ).

DEX

>lectrical cord $ic



DEX


' >cthyma gangrenosa



'. >cthyma gangrenosa

). &er$es sim$le"

6. ?oma

+. >lectrical cord inIury

DEX


' >cthyma gangrenosa



'. >cthyma gangrenosa

). &er$es sim$le"

6. ?oma


DEX

>lectrical Cord #nIury

• #nIury sustained !hen child bites an



• #nIury sustained !hen child bites anelectrical cord

• #nitial inIury is $ainful and caused by

coagulation necrosis

• leeding may occur at B('* days !hen

eschar falls off

• econdary infection is rare

DEX

Case &istory +



Toddler !ho has de4elo$ed :!hite@

lesions on chest and arm o4er the$ast fe! months. 2esions began as

small $atches that ha4e become

larger and ha4e coalesced. Mother

thin3s that he can7t feel in area of

lesions.

#ncontinentia achromians $ic



DEX


' #ncontinentia Pigmenti chromians



'. #ncontinentia Pigmenti chromians


6. Tinea Versicolor

+. 2e$rosy

DEX


' #ncontinentia Pigmenti chromians



'. #ncontinentia Pigmenti chromians


6. Tinea Versicolor

+. 2e$rosy

DEX

#ncontinentia Pigmenti chromians

• neurocutaneous disorder characteri1ed by

$olymor$hic hy$o$igmented lesions of trun3 and

e"tremities



e"tremities

• e$arate entity from #ncontinentia Pigmenti

• &y$o$igmented lesions are generally $resent at birth

and slo!ly enlarge and coalesce5 '*E of childrende4elo$ cutaneous lesions after years of age

• 2arge incidence of associated neurologic abnormalities

• Presumed to be a genetic disorder of melanocyte

migration

DEX

Case &istory



>ight year old !hose mother has

noticed some gradually increasingbald s$ots on scal$ for $ast se4eral

!ee3s. #s other!ise !ell. =riend had

ring !orm on face se4eral !ee3s

ago.

DEX

lo$ecia aereata $ic



DEX


' lo$ecia aereata



'. lo$ecia aereata

). $lasia cutis

6. Tinea ca$itis

+. Traction alo$ecia

DEX


' lo$ecia aereata



'. lo$ecia aereata

). $lasia cutis

6. Tinea ca$itis




DEX

Case &istory



=our year old !ho had a cold

a$$ro"imately '* days ago but hasother!ise been healthy. !o3e this

.M. !ith ill(defined generali1ed

abdominal $ain, a $ainful ear and

bruises on lo!er leg !hich areasym$tomatic.

DEX

&enoch chonlein $ic



DEX


'. Trauma



'. Trauma

). Meningococcemia

6. #TP


DEX


'. Trauma



'. Trauma

). Meningococcemia

6. #TP


DEX

&enoch chonlein Pur$ura• trange condition of un3no!n etiology that $rimarily effects $reschool(age

children

• Characteri1ed by $ur$uric lesions $rimarily on buttoc3s and lo!er e"tremities

but may in4ol4e any $ortion of body5 lesions are sometimes $al$able



• Generally $receded by nons$ecific 4iral infection

• May in4ol4e multi$le organ systems%

– G#% *(B*E5 abdominal $ain is most fre0uent

– Renal% 6*(+*E, $rimarily hematuria – Musculos3eletal% )*(6E, arthralgia(arthritis

– C?% rare

• Resol4es s$ontaneously in -*(F*E of $atients

DEX

Case &istory B



#nfant !ho !as normal at birth !ho

has de4elo$ed a $ersistent :rash@ on

trun3 and abdomen that changes ina$$earance. ?ormally loo3s li3e this

but occasionally gets red and loo3s

li3e hi4es !hich last '*(' minutes

and then disa$$ear lea4ing bro!nish

lesions.

Urticaria $igmentosa $ic



DEX


'. Pa$ular urticaria





6. &enoch chonlein Pur$ura

+. Urticaria Pigmentosa

DEX







6. &enoch chonlein Pur$ura

+. Urticaria Pigmentosa

DEX

Urticaria Pigmentosa

• Most common s3in manifestation of Mastocytosis

• Most infants and children ha4e cutaneous form only



y

unassociated !ith malignancies or malignant disease

• 2esions a$$ear as discrete yello!ish(tan to reddish(bro!n

macules that flare and urticate !hen rubbed

• =ace, scal$, $alms and soles are generally s$ared

• 2esions become $ruritic !hen flared

• #nfants and children rarely ha4e systemic disease

• May res$ond to mast cell stabili1ers 9Cromolyn sodium<

DEX

Case &istory -



>ighteen month old !ho !as $laying

in yard !ith older siblings !hen he

began to cry. Mother noted that li$s

are s!ollen and child drools and

!on7t ta3e fluids.

DEX

Caustic burn $ic



DEX


'. Caustic inIury



I y

). &er$es gingi4ostomatitis

6. Ka!asa3i7s yndrome


DEX


'. Caustic inIury



I y

). &er$es gingi4ostomatitis

6. Ka!asa3i7s yndrome


DEX

Caustic #nIury

• Term a$$lied to inIuries caused by chemicals !ith either

4ery lo! 9H< or 4ery high 9L-< $&7s



• Cause tissue damage on contact

• cids cause coagulation necrosis and al3alis cause

liguification necrosis

• ;hen ingested, the earliest signs are erythema, edema,

drooling and refusal to s!allo!

• Must rule out eso$hageal and laryngeal in4ol4ement if

there is any e4idence of oral burn, regardless of se4erity

DEX

Case &istory F



=indings on $hysical e"amination of

the abdomen of a si" month old !ho

has had 4omiting and diarrhea for

$ast +( days. &e has had decreased

oral inta3e for $re4ious t!o !ee3s.

DEX

Dehydration $ic



DEX


'. Prune elly yndrome



y y

). Marasmus

6. &y$ertonic dehydration

+. Cutis 2a"a

DEX


'. Prune elly yndrome



y y

). Marasmus

6. &y$ertonic dehydration

+. Cutis 2a"a

DEX

Dehydration(3in Changes

• Mild 9HE<% fe!, if any, s3in findings

• Moderate 9('*E<% slight decrease s3in turgor5



Moderate 9 '*E<% slight decrease s3in turgor5

delayed ca$illary refill

• e4ere 9L'*E<% mar3ed decrease in s3in turgor

9tenting of s3in of the abdomen<5 mar3edly delayedca$illary refill

• Difficult to distinguish dehydration from

malnutrition5 s3in doesn7t tent in malnutrition

unless $atient is also dehydrated

DEX

Case &istory *

t ld h h d h d



e4enteen year old !ho had had

recurrent bouts of $arotitis since

childhood. Characteri1ed by $ainfuls!elling of $arotid gland, subIecti4e

fe4er that lasts for 6(+ days5 almost

al!ays treated !ith antibiotics !hich

seem to hel$.

DEX

Calculous $arotitis $ic



DEX


'. #mmune deficiency



y

). Recurrent $arotitis

6. Cystic fibrosis

+. 2ym$hosarcoma

DEX


'. #mmune deficiency



). Recurrent $arotitis

6. Cystic fibrosis

+. 2ym$hosarcoma

DEX

Recurrent Parotitis

• trange condition of un3no!n etiology

characteri1ed by recurrent bouts of $arotid s!elling

and tenderness !ith or !ithout associated fe4er



• 8ften $reci$itated by blo!ing !ind instruments,

blo!ing balloons or anything that increases

intraoral $ressure

• May de4elo$ calculi that cause ductal or $arencymal

obstruction

• ?o s$ecific thera$y5 antibiotics of no $ro4en 4alue

DEX

Case &istory '



=i4e year old !ho has been in good

health de4elo$ed sudden onset of

blisters on legs5 lesions are $ruritic

but not $ainful. ?o mucous

membrane in4ol4ement.

Chronic bullous dermatitis $ic



DEX


'. Multi$le insect en4enomations



). ta$hylococcal calded 3in yndrome

6. ullous Pem$higoid

+. Chronic ullous Disease of Childhood

DEX


'. Multi$le insect en4enomations




6. ullous Pem$higoid

+. Chronic ullous Disease of Childhood

DEX

Chronic ullous Disease of Childhood

• Uncommon condition

• Generally first de4elo$s bet!een 6 and '* years of age

• udden onset of tense, firm bullae that $redominately



occur on lo!er e"tremities but may in4ol4e any anatomic

site5 mucous membrane in4ol4ement is rare

• Pruritis is a $rominent $art of the disease although not

intense

• 2inear de$osition of #g on bio$sy

• Resol4es s$ontaneously $rior to $uberty

• Ra$id res$onse to Da$sone

DEX

Case &istory )

e4en year old !ho !as in good health



e4en year old !ho !as in good health

until yesterday !hen he de4elo$ed a red,

$ruritic rash on face and u$$er $ortion

of nec35 he is afebrile and !ithout other

com$laints. ?o e"$osure to sic3

contacts or unusual acti4ities in $ast fe!

days. $$ro"imately one !ee3 ago, hehel$ed father !ith yard !or3.

DEX

Rhus dermatitis $ic



DEX


'. #m$etigo



). Rhus dermatitis

6. #nsecticide burn

+. Pem$higus

DEX


'. #m$etigo



). Rhus dermatitis

6. #nsecticide burn

+. Pem$higus

DEX

Rhus 9Poison #4y, 8a3, umac< Dermatitis

• Urushiol is an almost colorless oil that is the $rimary offending

agent5 induces local 9cell mediated< sensiti1ation

• Uncommon in children H years of age

• $$ro"imately -E of the merican $o$ulation of adults can be

sensiti1ed5 4arying degrees of sensiti4ity



sensiti1ed5 4arying degrees of sensiti4ity

• Re0uires $rimary sensiti1ation5 doesn7t ha$$en on first e"$osure

• Clinical syndrome de$ends on%

• concentration and indi4idual7s sensiti4ity to urushiol

• $re4ious e"$osures

• mechanism of e"$osure

• Clinical sym$toms first a$$ear hours9 -(') < to days 9H '+< after

e"$osure5 de$ends on $rior e"$osure history

• Clinical signs are highly 4ariable% from erythema, edema, 4esicles,

bullae

DEX

Case &istory 6



i" month old child !hose $arents

ha4e noticed that one of his eyes

seems to be different than the other.

There is disagreement among the

$arents as to !hether or not this has

been $resent since birth or Iusta$$eared.

DEX

2eu3ocoria $ic



DEX


'. Toxacara canis



). Congenital glaucoma

6. Retinoblastoma

+. Cataract

DEX


'. Toxacara canis



). Congenital glaucoma

6. Retinoblastoma

+. Cataract

DEX

2eu3ocoria

• ;hite o$acity

• Multi$le causes( 4irtually all bad

– cataracts

– $ersistent 4itreous



– $ersistent 4itreous

– retrolental fibro$lasia

– retinoblastoma

– Toxacara canis infection

• ometimes difficult to differentiate

• hould be considered as an o$hthalmologic emergency

DEX

Case &istory +



=our month old !ho had 4esicular

lesions on trun3 in immediate

neonatal $eriod that !as clinically

diagnosed as &er$es sim$le". ;as

treated !ith anti4iral thera$y and

lesions ha4e slo!ly resol4ed butno! has dar3 areas on s3in.

DEX

#ncontinentia $igmenti $ic



DEX


'. Congenital sy$hilis



). Postinflammatory hy$er$igmentation

6. to$ic dermatitis

+. #ncontinentia $igmenti

DEX


'. Congenital sy$hilis



). Postinflammatory hy$er$igmentation

6. to$ic dermatitis

+. #ncontinentia $igmenti

DEX

#ncontinentia Pigmenti

9loch(ul1berger yndrome<

Rare N(lin3ed dominant multisytem disease clinically obser4ed in

females5 almost al!ays lethal in males.

Generally $resents as an erythematous linear 4esicular eru$tion



on fle"or surfaces during the first ) months of life. Vesicles

s$ontaneously clear follo!ed by 4errucous lesions that resol4e

lea4ing areas of hy$er$igmentation or de$igmentation.

– Dental malformations ( E – lo$ecia ( 6E

– 8cular lesions ( 6)E

– C? abnormalities ( 6*E

– Mental retardation ( 'E

DEX

Case &istory



=irst(time 4isit for a t!el4e year old

!ho has been recei4ing treatment

from another $hysician5 lesions are

tender and slightly $ruritic. Parents

became concerned and re0uested an

emergency a$$ointment !ith you.

DEX

Rabies 4accine $ic



DEX


'. Chronic, recurrent giant urticaria



). Rela$sing $anniculitis

6. Rabies 4accination sites

+. >rythema nodosum

DEX


'. Chronic, recurrent giant urticaria



). Rela$sing $anniculitis

6. Rabies 4accination sites

+. >rythema nodosum

DEX

Rabies Vaccine• e4eral different 4accines a4ailable5 &uman di$loid

cell9&DCV< is $referred

• #ntramuscular administration of fi4e doses on days

',6,B,'+Q )-5 #ntradermal administration is no longer



',6,B,'+Q )-5 #ntradermal administration is no longer

recommended

• d4erse reactions are far less fre0uent !ith &DCV than

!ith older 4accines5 local and systemic9non(allergic<reactions in J)*E and )E of reci$ients, res$ecti4ely

• Chec3 !ith local $ublic health authorities before

ma3ing decision to administer

DEX

Case &istory



T!o year old !ith history of ato$ic

dermatitis since infancy de4elo$ed

fe4er and 4esicles on face that ha4e

ra$idly $rogressed and become

crusted and !ee$ing during the $ast

)+ hours5 acts :sic3@ .

Ka$osi7s $ic



DEX


'. #m$etigo



). Ka$osi7s 4aricelliform eru$tion

6. econdarily infected 4aricella

+. te4ens ohnson yndrome

DEX


'. #m$etigo



). Ka$osi7s 4aricelliform eru$tion

6. econdarily infected 4aricella


DEX

Ka$osi7s Varicelliform >ru$tion

• Primary &er$es 4irus infection of the s3in of$atients !ith chronic s3in disorders, most

l



commonly ec1ema

• Course is highly 4ariable5 ranges from mild

infection to $otentially life(threateningdisease

• =e4er and systemic to"icity are often $resent

R"% must be indi4iduali1ed

DEX

Case &istory B



=irst 4isit for a nine year old !ho has

a sei1ure disorder but is other!ise in

good health. &as had :birthmar3@

that has not changed o4er the years.

?e4us unilateris $ic



DEX


'. ?e4us unius lateris



). #ncontinentia $igmenti

6. ?e4us sebaceous of adassohn

+. 2ichen striaticus

DEX


'. ?e4us unius lateris



). #ncontinentia $igmenti

6. ?e4us sebaceous of adassohn

+. 2ichen striaticus

DEX

?e4us Unius 2ateris

• Most common form of e$idermal ne4us syndrome

•Uncommon lesion

• Usually $resent at birth



• May be $resent at any anatomic site

• Characteri1ed by hy$er$igmented, usually 4errucoid lesions in a

linear distribution

• 2arge incidence of associated abnormalities%

– C? 9sei1ures<% '(*E

– s3eletal% '(B*E

– ocular% '*(6*E

DEX

Case &istory -



>le4en year old !ho feels as though

: something is stuc3@ in the bac3 ofher throat5 other!ise healthy and

!ithout com$laints. &ad difficulty

!ith s!allo!ing as infant and toddler

but :outgre! it@.

2ingual tonsil $ic



DEX


'. Rhabdomyosarcoma



). 2ingual thyroid

6. 0uamous cell carcinoma

+. 2ingual tonsil

DEX


'. Rhabdomyosarcoma



). 2ingual thyroid

6. 0uamous cell carcinoma

+. 2ingual tonsil

DEX

2ingual Tonsil

• 8ne of three com$onents of ;aldeyers ring5 the

other t!o are the adenoids and the $alatine tonsils

• re normally $resent but not usually clinically

4isible



4isible

• May enlarge during u$$er res$iratory and

systemic infections

• Generally, cause no sym$toms

• hould be remo4ed if $atient is sym$tomatic

DEX

Case &istory F

?ine year old !ho has had chronic



rash on face that first a$$eared

during infancy. &as been treated

!ith to$ical steroids !ith some

res$onse but has fre0uent

recurrences and is beginning to get

more scars. eems to get !orse!hen she goes outdoors.

Por$hyria $ic



DEX


'. to$ic dermatitis



). >rythro$oetic $roto$or$hyria

6. &ydroa aesti4ale

+. =actitious dermatitis

DEX


'. to$ic dermatitis



). >rythro$oetic $roto$or$hyria

6. &ydroa aesti4ale

+. =actitious dermatitis

DEX

>rythro$oetic Proto$or$hyria

• utosomal dominant genetic disease

• 8nset in first years of life

• Photosensiti4ity is the hallmar3 of the disease



• Characteri1ed by burning, stinging and $ruritis of the s3in

on sun e"$osure

• >rythema, edema and sometimes 4esiculation occur !ithin)+ hours of e"$osure

• >ffected s3in undergoes scarring and thic3ening after

re$eated e$isodes

• OA( he$atic in4ol4ement

DEX

Case &istory B*

Three year old !ho has had



Three year old !ho has had

gradually increasing decrease in

a$$etite and irritability for the $astfe! months. Mother concerned

because stomach is large and his

eyes and feet are $uffy.

K!ashior3or $ic



DEX


'. ?e$hrotic yndrome



). Cystic =ibrosis

6. Menetrier7s Disease

+. K!ashior3or

DEX


'. ?e$hrotic yndrome



). Cystic =ibrosis

6. Menetrier7s Disease

+. K!ashior3or

DEX

K!ashior3or • yndrome resulting from se4ere deficiency of $rotein and

caloric inta3e

• Usually occurs after !eaning from the breast

• Characteri1ed by% – decreased gro!th



– a$athyAirritability

– loss of muscle mass

– edema

– susce$tibility to infection

– hair and s3in changes

– diarrhea

– myriad of metabolic abnormalities

• Treatment consists of $rotein and caloric re$letion

DEX

Case &istory B'

2 i id tifi d d i ti



2esion identified during routine

$hysical e"amination5 has se4eral

other similar lesions but child is

other!ise normal.

DEX

Caf au lait $ic



DEX


'. Postinflammatory hy$er$igmentation



). Melasma

6. 2entigo sim$le"

+. Caf au 2ait s$ot

DEX


'. Postinflammatory hy$er$igmentation



). Melasma

6. 2entigo sim$le"

+. Caf au 2ait s$ot

DEX

Caf au 2ait Macules

• Discrete, !ell(circumscribed uniformly bro!n lesions !ith

irregular border

• ) ( )* mm

• #solated lesions occur in '* ( )*E of $o$ulation5 F-E of

l i di id l h l th th l i



normal indi4iduals ha4e less than three lesions

• Multi$le lesions occur in a 4ariety of syndromes%

– ?eurofibromatosis

– lbright7s yndrome

– ;atson7s yndrome

– Russell(il4er yndrome

– loom7s yndrome

DEX

Case &istory B)

Genital area of a four year old child



Genital area of a four year old child

!ho has been other!ise healthy.

Mother first noted small area of $alediscoloration a$$ro"imately si"

months ago5 area has gradually

enlarged and become more :!hite@.

Vitiligo $ic



DEX


'. Vitiligo



). Postinflammatory hy$o$igmentation

6. Pityriasis alba

+. 2e$rosy

DEX


'. Vitiligo



). Postinflammatory hy$o$igmentation

6. Pityriasis alba

+. 2e$rosy

DEX

Vitilgo

• Reasonably common ac0uired or genetic disorder

characteri1ed by cutaneous lesions com$letely

de4oid of $igment• May be focal or generali1ed



• Congenital form is rare5 may occur at any age

• Multi$le etiologies ha4e been $ro$osed

• Multi$le treatment o$tions !ith 4ariable efficacy5

focal lesions may re0uire no thera$y if not

cosmetically disfiguring

DEX

Case &istory B6

ld h h d ti



e4en year old !ho had an o$eration

during infancy for a :tumor@ in the

nec3. &as been fine until a !ee3 ago

!hen the :tumor@ returned5 is

other!ise healthy.

Thyroglossal Duct Cyst $ic



DEX


'. Dermoid cyst



). Thyroid abscess

6. ranchial cleft cyst

+. Thyroglossal duct cyst

DEX


'. Dermoid cyst



). Thyroid abscess

6. ranchial cleft cyst

+. Thyroglossal duct cyst

DEX

Thyroglossal Duct Cyst

• Thyroglossal duct is a remnant of the

connection bet!een the =oramen Cecum and

the thyroid



• 6E and )E of cysts occur in the infrahyoid

and su$rahyoid regions, res$ecti4ely• lmost al!ays in the midline

• Recurrence rate is large if the fistula is not

totally e"cised at the time of $rimary e"cision

DEX

Case &istory B+

i" year old !hose mother has noticed



i" year old !hose mother has noticed

gradually increasing hair loss on right

side of head. #s other!ise !ell butmother is concerned that she finds hair

in the child7s bed almost e4ery

morning.

DEX

Trichotillomania $ic



DEX


'. Tinea ca$itis



). lo$ecia aereata

6. Trichotillomania

+. Cou$ de sabre

DEX


'. Tinea ca$itis



). lo$ecia aereata

6. Trichotillomania

+. Cou$ de sabre

DEX

Trichotillomania

• yndrome characteri1ed by com$ulsi4e t!istingor $ulling of hair that results in $atchy areas of

hair loss



• Most common sites are the cro!n and the

tem$oral and $arietal areas

• May also in4ol4e eyelashes and eyebro!s

• cal$ is normal

• Difficult to distinguish from lo$ecia ereata

DEX

Case &istory B

T!o year old !ho has had a rash in



y

scal$ since infancy that comes and

goes. ;as :bad@ during his first si"months of life but had gone a!ay

until a$$ro"imately three months

ago. Diagnosed as a :fungus@ butdid not res$ond to to$ical thera$y.

eb Derm $ic



DEX


'. Tinea ca$itis



). eborrheic dermatitis

6. 2etterer i!e disease

+. Tinea fa4osum

DEX

'. Tinea ca$itis




). eborrheic dermatitis

6. 2etterer i!e disease

+. Tinea fa4osum

DEX

eborrheic Dermatitis

• Common disorder during infancy and early

childhood5 affects )(E of $o$ulation• >tiology not 3no!n5 attributed to increased sebum

$roduction



$roduction

• cal$, face and ears are the most common sites

in4ol4ed

• Clinical $resentation 4aries from mild to se4ere

• ffected s3in is $in3, sometimes edematous and

co4ered !ith yello! !a"y $la0ue

DEX

Case &istory B



2esion that de4elo$ed on the chee3

of a t!o !ee3 old, other!ise normalinfant. The child is other!ise

healthy.

=uruncle $ic



DEX


'. =uruncle



). #nclusion cyst

6. Chloroma

+. Pilomatri"oma

DEX


'. =uruncle



). #nclusion cyst

6. Chloroma

+. Pilomatri"oma

DEX

=uruncle

• Dee$ necroti1ing form of folliculitis that contains

$us

• =uruncles coalesce to form carbuncles or

b



abscesses

• Primarily caused by strains of Staphylococcusaureus5 ho!e4er, can be caused by any $us(

forming bacteria

• May indicate nosocomial $roblem in the nursery

!hen they occur in neonates

DEX

Case &istory BB

>le4en year old !ho has had a slo!ly



increasing mass on ear for a$$ro"imately

si" months. The lesion is not tender butthe child has felt :!ea3@ since the lesion

first a$$eared.

Keloid $ic



DEX


'. Pyogenic granuloma

) Pil t i



). Pilomatri"oma

6. Desmoid tumor

+. Keloid

DEX


'. Pyogenic granuloma

) Pil t i



). Pilomatri"oma

6. Desmoid tumor

+. Keloid

DEX

Keloid

• Unchec3ed $roliferation of fibrous tissue that

occurs after trauma to the s3in

• =irm, sometimes slightly tender, mass



, so et es s g t y te de , ass

• Color 4aries from $in3 to dar3 bro!n

• More fre0uent in dar3(s3inned than in light(

s3inned indi4iduals

• May res$ond to intralesional steroids

DEX

Case &istory B-

=irst(time 4isit for this eight month

old Mother states that he has had a



old. Mother states that he has had a

:3not@ on his nec3 since birth butshe !as told that it !as nothing

serious and not to !orry about it.

DEX

ranchial Cleft Remnant $ic



DEX


'. ranchial arch remnant

) D id t



). Dermoid cyst

6. Thyroglossal duct cyst

+. ternocleidomastoid fibroma

DEX


'. ranchial arch remnant

) D id t



). Dermoid cyst

6. Thyroglossal duct cyst

+. ternocleidomastoid fibroma

DEX

ranchial rch Remnant

• Persistent remnant of branchial arch• Cartilaginous subcutaneous mass



•Generally lie anterior to thesternocleidomastoid muscle

• 8nly significance is cosmetic

• May be familial

DEX

Case &istory BF

Rash on the chest of an eight year old



!ho is other!ise !ell e"ce$t for a rash

on the arms, legs and chest that firsta$$eared t!o days ago. Mother thin3s

that his face is :flushed@. The rash is

non($ruritic.

DEX

=ifth7s Disease $ic



DEX


'. =ifth7s Disease

) >rythema multiforme



). >rythema multiforme

6. >rythema chronicum migrans

+. 2yme disease

DEX


'. =ifth7s Disease

) >rythema multiforme



). >rythema multiforme

6. >rythema chronicum migrans

+. 2yme disease

DEX

=ifth7s Disease

9>rythema #nfectiosum<

• Classic childhood disease caused by Par4o4irus 'F

• Characteristic clinical a$$earance%

– Mild to no $rodrome

– :la$$ed(chee3@ facial rash !ith circumoral $allor



la$$ed(chee3 facial rash !ith circumoral $allor

– ymmetric maculo$a$ular laceli3e rash on arms, legs and

trun3

– Rash comes and goes o4er B('* day $eriod5 e"acerbated

by heat and sunlight5 may itch

• rthritis and arthralgia are rare in $re$ubescent children but

common in adolescents and adults

DEX

Case &istory -*

Child is brought to you for a second

o$inion about a :birthmar3@



o$inion about a :birthmar3@.

Parents ha4e been told that it isnothing serious and !ill $robably go

a!ay as child gets older.

DEX

Giant ?e4us $ic



DEX


'. ?e4us of 8to

) Caf au lait macule



). Caf au lait macule

6. Congenital ne4omelanocytic ne4us

+. Giant lentigo

DEX


'. ?e4us of 8to

) Caf au lait macule



). Caf au lait macule

6. Congenital ne4omelanocytic ne4us

+. Giant lentigo

DEX

Congenital ?e4omelanocytic ?e4us

• re al!ays $resent at birth

• 8ccur in J'E of the $o$ulation

• Most are single and small 9F*E H6*mm<

• 2esions may contain hair

f i hi hl i bl f th t bbl t i



• urface is highly 4ariable from smooth to cobblestone in

a$$earance• Difficult to distinguish from other ne4i

• &a4e malignant $otential% treatment decisions must be

indi4iduali1ed

DEX

Case &istory -'

=our year old !ith sudden onset of

$ainf l lesion on chest ?o histor



$ainful lesion on chest. ?o history

of trauma but has had lo!(gradefe4er since the lesion first a$$eared.

ranchial cleft cyst $ic



DEX


'. #nsect bite

) ranchial cleft cyst infection



). ranchial cleft cyst infection

6. 8steomyelitis of cla4icle

+. #m$etigo

DEX


'. #nsect bite

) ranchial cleft cyst infection



). ranchial cleft cyst infection

6. 8steomyelitis of cla4icle

+. #m$etigo

DEX

ranchial Cleft Cyst

• Generally are secondary to failure to obliterate

the cer4ical sinus of the branchial arches

• May occur at any anatomic site from ear le4el to

b l th l i l



belo! the cla4icle

• Most common during infancy and early childhood

• 8ften not noticed until infected

• Treatment is surgical e"cision

DEX

Case &istory -)

>le4en year old !ho had rashes in

infancy but has been other!ise



healthy. Rash first de4elo$ed about

one !ee3 ago and has s$read o4er

trun3, arms and legs. Child states

that the rash is :itchy@.

Pityriasis rosae $ic



DEX


'. econdary sy$hilis

) Psorriasis



). Psorriasis

6. to$ic dermatitis

+. Pitryriasis rosae

DEX


'. econdary sy$hilis

) Psorriasis



). Psorriasis

6. to$ic dermatitis

+. Pitryriasis rosae

DEX

Pityriasis Rosae• n acute self(limited s3in eru$tion !ith distincti4e clinical

findings and course5 etiology un3no!n5 $resumably 4iral in origin

• Primary lesion is a o4oid $la0ue that is may be scaly or

$a$ulo4esicular 9herald $atch<5 most commonly on trun3.

=re0uently misdiagnosed as tinea cor$oris

• Ten ('+ days after onset of the $rimary lesion, secondary lesions

a$$ear on trun3 in Nmas tree distribution



a$$ear on trun3 in Nmas tree distribution

• econdary lesions are diffuse symmetrical often scaly$a$ulos0uamous lesions that follo! clea4age lines of s3in5 are

generally se$arated by normal s3in

• Resol4es !ithout treatment o4er )(6 !ee3s

DEX

Case &istory -6

=our month old !ho has had se4ere

rash on head !hich has im$ro4ed



$

since mother began a$$lying o4er(the(counter to$ical steroid cream.

Mother is concerned that he is

:going bald@.

DEX

Cradle Ca$ $ic



DEX


'. Tinea ca$itis

). Cutis a$lasia



). Cutis a$lasia

6. eborrheic dermatitis

+. to$ic dermatitis

DEX


'. Tinea ca$itis

). Cutis a$lasia



). Cutis a$lasia


+. to$ic dermatitis

DEX

Cradle Ca$

• Common disorder during infancy and early childhood5

affects )(E of $o$ulation

• >tiology not 3no!n5 attributed to increased sebum

$roduction

• cal$, face and ears are the most common sites in4ol4ed



cal$, face and ears are the most common sites in4ol4ed

• Clinical $resentation 4aries from mild to se4ere• ffected s3in is $in3, sometimes edematous and co4ered

!ith yello! !a"y $la0ue

• &air loss may occur !ith se4ere disease during infancy5

does not occur in older children

DEX

Case &istory -+

Thirteen year old $ost($ubertal child

!ho has had rash de4elo$ on feet



!ho has had rash de4elo$ on feet

o4er the $ast t!o !ee3s. Rash isslightly $ainful and some!hat

$ruritic5 other!ise !ell.

DEX

hoe dermatitis $ic



DEX



). Tinea $edis



$

6. >rythrasma

+. to$ic dermatitis

DEX



). Tinea $edis



$

6. >rythrasma

+. to$ic dermatitis

DEX

Primary #rritant Dermatitis

9hoeAandal Dermatitis<

• cute form% erythema, edema, $a$ules, 4esicles, or

bullae• Chronic form% $a$ular ( $a$ulo4esicular, lichenified,

sometimes scaly



• Caused by rubber in shoes or oils in leather sandals

• Rarely in4ol4es $alms and soles

• 84er 6*** en4ironmental sensiti1ers ha4e been

identified5 most are sim$le chemicals that must lin3

to $roteins before they can sensiti1e

DEX

Case &istory -

i" month old brought in for routine



!ell child e"am5 mother is concernedthat she has :caught ring !orm@ from

her baby(sitter.

DEX

Traction alo$ecia $ic



DEX


'. Tinea ca$itis

). lo$ecia aereata



$

6. Trichotillomania


DEX

'. Tinea ca$itis

). lo$ecia aereata




$

6. Trichotillomania


DEX

Traction lo$ecia

• Peculiar form of alo$ecia that results from

traction induced by hair styling• 2ocali1ed hair loss

• cal$ may ha4e inflammatory $a$ules at site of



hair follicle

• :Corn ro!@ and :$ony(tail@ are most common

hair styles that induce this syndrome

• &air generally regro!s if traction is not chronic

DEX

Case &istory -

Ten year old !ho a!o3e !ith :blac3(



eye@5 may ha4e been hit in the eye!ith a tennis ball !hile at recess the

day $rior.

all #nIury $ic



DEX


'. ?euroblastoma

). &enoch chonlein Pur$ura



6. 2eu3emia

+. Tennis ball inIury

DEX

'. ?euroblastoma

). &enoch chonlein Pur$ura




6. 2eu3emia

+. Tennis ball inIury

DEX

Pro$ulsion all >ye #nIuries

• 8ne of most common causes of eye inIuries

in children and adolescents

• Male $redominance



• Ru$tured globe, hy$hema and retinaldetachment are associated !ith $ro$ulsion

eye inIuries

• Protecti4e eye!ear should be encouraged for

children $laying :ball s$orts@

DEX

Case &istory -B

=our month old !hose !or3ing

mother is concerned about a dia$er



$

rash that :comes and goes@. eemsto clear on the !ee3ends and gets

!orse during !ee3days.

DEX

Primary #rritant Dia$er Derm$ic



DEX


'. Candidiasis

). Primary irritant dermatitis



6. Psorriasis

+. >rythrasma

DEX


'. Candidiasis

). Primary irritant dermatitis



6. Psorriasis

+. >rythrasma

DEX

Primary #rritant Dia$er Dermatitis

• 8ften confused !ith Candidal infection

• lightly tender

3i b d



• 3in may be red

• #n contrast to other forms of dia$er

dermatitis, $rimary irritant dermatitis s$ares

the creases

• Res$onds to good hygienic $ractices

DEX

Case &istory --

e4en month old !ho has had :cradle(

ca$@ for the $ast se4eral months that



is getting !orse and has s$read to theface and trun3.

#nfantile Psorriasis $ic



DEX


'. #nfantile $soriasis

). Tinea ca$itis




+. 2etterer(i!e disease

DEX


'. #nfantile $soriasis

). Tinea ca$itis




+. 2etterer(i!e disease

DEX

#nfantile Psoriasis

• imilar to disease in older children and adults5

early onset may $ortend more se4ere $rognosis

• caly $la0ues are the sine qua none

• cal$ in4ol4ement is common and may be the

only early manifestation5 often difficult to



only early manifestation5 often difficult to

distinguish from seborrheic dermatitis

• Cutaneous lesions are indistinguishable from

those that occur in the adult form of disease

DEX

Case &istory -F

dolescent !ho has had $ruritic

rash on hand for $ast '* days5 too3



some $enicillin !hich !as in thehouse but there has been no

im$ro4ement

DEX

cabies $ic



DEX


'. #m$etigo

). Rhus dermatitis



6. Dyshidrosis

+. cabies

DEX


'. #m$etigo

). Rhus dermatitis



6. Dyshidrosis

+. cabies

DEX

cabies

• #nfection caused by Sarcoptes scabiei

• Clinically manifests as an intensely $ruritic, $a$ulareru$tion caused by the burro!ing of the animal

• More of an intertriginal disease in older children

and adults



• urro!s are characteristic5 linear, gray(!hitetortuous lines that are usually obliterated by

scratching

• Prone to secondary bacterial infection

DEX

Case &istory F*

=irst 4isit for a nine year old obese

child !ith intellectual retardation.



Mother is concerned aboutincreasing number of :sores@ on his

arms.

DEX

Pinch Dermatitis $ic



DEX


'. Cigarette burns

). Cao Gio



6. #nsect bites

+. :Pinch dermatitis@

DEX


'. Cigarette burns

). Cao Gio



6. #nsect bites

+. :Pinch dermatitis@

DEX

Prader ( ;illi yndrome

• Contiguous gene syndrome is caused by deletion or

disru$tion of a gene or se4eral genes on the $ro"imal long

arm of the $aternal chromosome ' or maternal uni$arental

disomy ', because the gene9s< on the maternal

chromosome9s< ' are 4irtually inacti4e through im$rinting

• yndrome characteri1ed by diminished fetal acti4ity,



yndrome characteri1ed by diminished fetal acti4ity,

obesity, muscular hy$otonia, mental retardation, shortstature, hy$ogonadotro$ic hy$ogonadism, and small hands

and feet

• ometimes may ha4e $eculiar :$inch lesions@ on s3in

DEX

Case &istory F'

e4en year old !ho has had rash

on arms and legs since infancy. #s



asym$tomatic and the rash tendsto get better and !orse although

neither he nor the mother 3no!

!hy.

DEX

Keratosis Pilaris $ic



DEX


'. Keratosis $ilaris




6. 2ichen s$inulosis

+. cro3eratosis 4erruciformis

DEX


'. Keratosis $ilaris




6. 2ichen s$inulosis

+. cro3eratosis 4erruciformis

DEX

Keratosis Pilaris

• enign condition of un3no!n etiology

• Keratotic $a$ules of the hair follicles

• Characteri1ed by discrete 3eratotic, follicular

$a$ules !ith surrounding erythema



$ $ g y

• Primarily on the arms, legs and buttoc3s

• Generally more se4ere !hen s3in is dry

• Res$onds to emollient creams

DEX

Case &istory F)

T!o !ee3 old brought in for !ell



child e"am5 other!ise healthy andthri4ing.

DEX

2i4edo Reticularis $ic



DEX


'. Cutis marmorata

). 2i4edo reticularis



6. s$hy"ia reticularis

+. 2i4edo annularis

DEX


'. Cutis marmorata

). 2i4edo reticularis



6. s$hy"ia reticularis

+. 2i4edo annularis

DEX

2i4edo Reticularis

• trange condition that has many different names

• Most commonly occurs in neonates !ho are

e"$osed to cold

• Characteri1ed by reddish(blue mottling of the



Characteri1ed by reddish blue mottling of the

s3in in a :fishnet@ reticular $attern

• #n older children and adults, the condition may

be associated !ith systemic disease

DEX

Case &istory F6

8ther!ise healthy child !ho has had

multi$le :birthmar3s@ under her arm



since birth.

DEX

"illary =rec3les $ic



DEX


'. Urticaria $igmentosa

). Caf au lait s$ots



6. canthosis nigricans

+. "illary frec3les

DEX


'. Urticaria $igmentosa

). Caf au lait s$ots



6. canthosis nigricans

+. "illary frec3les

DEX

"illary =rec3ling

• mall 9*.cm< bro!n, !ell(circumscribedmacules

• Cutaneous manifestation of neurofibromatosis



• Generally go unnoticed

• &igh correlation !ith neurofibromatosis !hen

si" or more frec3les are $resent in the a"illa

DEX

Case &istory F+

e4en year old !ho has had numerous

UR#7s and se4eral e$isodes of sinusitis



in the the $ast. Doesn7t :feel !ell@.

DEX

llergic hiners $ic



DEX


'. ?euroblastoma

). llergic :shiners@



6. >thmoid sinusitis

+. Ca$illary fragility syndrome

DEX


'. ?euroblastoma

). llergic :shiners@



6. >thmoid sinusitis

+. Ca$illary fragility syndrome

DEX

llergic hiners

• Dar3 discoloration belo! the eyes in children

!ho ha4e chronic allergic rhinitis

• 8ften associated !ith other signs of allergy%

– mouth breathing



– :allergic salute@

– Dennie(Morgan folds 9Dennie lines<

– trans4erse nasal crease

DEX

Case &istory F

T!o !ee3 old !ho had $reci$itous

deli4ery and lo! initial $gar score.



Res$onded to con4entionalmeasures and had uncom$licated

nursery stay. Mother noted lesions

on leg and buttoc3s a$$ro"imately

three days ago.

DEX

S =at ?ecrosis $ic



DEX


'. 2i4edo reticularis

). >rysi$elis



6. ubcutaneous fat necrosis

+. >rythema nodosum

DEX

ubcutaneous =at ?ecrosis

'. 2i4edo reticularis

). >rysi$elis



6. ubcutaneous fat necrosis

+. >rythema nodosum

DEX

ubcutaneous =at ?ecrosis

• >rythematous or 4iolaceous firm lesions that

generally de4elo$ in the first fe! !ee3s of life• lmost e"clusi4ely in term infants

• 2ocali1ed but may be multifocal



• Most common on bac3, buttoc3s, thighs and

chee3

• Resol4e s$ontaneously o4er !ee3s to months

DEX

Case &istory F

Three year old !ho began com$laining

of a :stomach ache@ se4eral hours



ago. Mother Iust noticed a bulge that!as not $re4iously $resent.

DEX

>$igastric &ernia $ic



DEX


'. #nsect bite

). >$igastric hernia



6. Dermoid cyst

+. 2i$oma

DEX


'. #nsect bite

). >$igastric hernia



6. Dermoid cyst

+. 2i$oma

DEX

>$igastric &ernia

• result of a small rent in the linea alba

• l!ays midline

• May be e$isodic

• Can be induced by ha4ing the $atient $erform



a Valsal4a maneu4er

• Generally only contains fat, not $eritoneal sac

• Generally, are easily reducible

DEX

Case &istory FB

Three !ee3 old !ho has been $erfectly

normal5 mother noted that the :soft(s$ot@



!as bulging !hen infant a!a3ened thismorning. 8ther!ise asym$tomatic.

ulging =ontanel $ic



DEX


'. Meningitis

). 2e$tomeningeal cyst



6. &ydroce$halus

+. Vitamin to"icity

DEX


'. Meningitis

). 2e$tomeningeal cyst



6. &ydroce$halus

+. Vitamin to"icity

DEX

ulging =ontanel• Generally caused by increased intracranial $ressure

• Multi$le causes5 almost all bad

• ome relati4ely benign causes include the

follo!ing%

– le$tomeningeal cyst

b i i t i l h t i



– benign intracranial hy$ertension – Roseola

– &y$er4itaminosis

DEX

Case &istory F-

Ten year old !ho first noticed

discoloration of tongue se4eral

hours ago. side from the



discolored tongue, he is other!ise

healthy, feels !ell and is !ithout

com$laints.

2icorice Tongue $ic



DEX



). :Pe$to(ismol@ tongue



6. ribinofla4inosis

+. :2icorice@ tongue

DEX



). :Pe$to(ismol@ tongue



6. ribinofla4inosis

+. :2icorice@ tongue

DEX

Differential Diagnosis of

lac3 Tongue

'. s$ergillus niger infection

). :2icorice@ tongue



6. :Pe$tol ( ismol@ tongue

+. ribinofla4inois

DEX

Case &istory FF

Parents returned from 4acation and

found child loo3ing li3e this5

b b itt thi 3 th t h h



babysitter thin3s that he may ha4e:bum$ed his head@ !hile $laying.

Child is alert, oriented and !ithout

focal neurologic signs.

Dashboard #nIury $ic



DEX


'. Child abuse

). ?euroblastoma



6. :Dashboard@ inIury

+. :Tennis ball@ inIury

DEX


'. Child abuse

). ?euroblastoma



6. :Dashboard@ inIury

+. :Tennis ball@ inIury

DEX

Dashboard #nIury

• Characteristic inIury caused during a motor4ehicle im$act or sudden sto$ !hen an

unrestrained child is $ro$elled into

dashboard or rear4ie! mirror



• Generally associated !ith facial or orbital rim

fractures

• 2arge incidence of retinal detachment

DEX

Case &istory '**

T!el4e year old !ho !as !ell untilyesterday !hen he de4elo$ed fe4er

and some blisters on his face5

blisters ha e s$read to e es mo th



blisters ha4e s$read to eyes, mouthand the rest of his body. &ad a

:cold(sore@ on li$ a$$ro"imately one

!ee3 ago.

te4ens ohnson yndrome



DEX


'. Disseminated &er$es sim$le"




6. Polymor$hous light eru$tion


DEX


'. Disseminated &er$es sim$le"




6. Polymor$hous light eru$tion


DEX

te4ens ohnson yndrome

• yndrome characteri1ed by fe4er and blistering

lesions on s3in and mucous membranes

• Must ha4e t!o or more mucous membranes

in4ol4ed to meet criteria

• Multi$licity of $reci$itins5 Herpes simplex has been

associated !ith recurrent disease



associated !ith recurrent disease

• May be life(threatening

• Re0uires meticulous su$$orti4e care

DEX

Visual Atlas

• Acanthosis Nigricans

• Adenoma Sebaceum• Allergic Dermatitis

• Allergic Shiners

• Alopecia Aereata

• Aplasia Cutis

• !lue #ubber !leb Syndrome

• !ranchial Cleft Cyst• !ranchial Cleft #emnant

• !ulging Fontanel

• Caf$ au Lait %acule

• Caffey Disease



• Aplasia Cutis

• Ash Leaf Spot

• Atopic Dermatitis

• Axillary Frecles

• !aer"s Cyst

• Caffey Disease• Cao &io

• Caustic 'n(ury

• Chronic !ullous Dermatosis

• Cradle Cap

DEX

Visual Atlas

• Dashboard 'n(ury

• Dehydration• Dermoid Cyst

• )bstein"s *earls

• )c+ema Vaccinatum

• )lectrical Cord 'n(ury

• )rythropoetic *orphyria

• Fifth"s Disease• Furuncle

• &anglion Cyst

• &eographic -ongue

• &iant Ne.us



• )lectrical Cord 'n(ury• )pigastric ,ernia

• )pulis

• )ruption Cyst

• )rythema -oxicum

• &iant Ne.us• ,air -ourni/uet Syndrome

• ,air -ourni/uet Syndrome

• ,emangioma

• ,enoch Schonlein *urpura

DEX

Visual Atlas

• ,ordeolum

• 'mmersion 'n(ury• 'nclusion Cyst

• 'ncontinentia *igmenti

• 'ncontinentia *igmenti

Achromians

• 03ashioror

• Lamellar 'chthyosis• Leuocoria

• Lichen Nitidus

• Lichen Spinulosis

• Licorice -ongue



Achromians

• 'nfantile )c+ema

• 0eloid

• 0lippel1-renauney12eb

er Syndrome

• Licorice -ongue• Linear )pidermal Ne.us

• Lingual -onsil

• Li.edo #eticularis

• Lymphangioma

DEX

Visual Atlas

• Lymphedema *raecox

• %il1!ottle Caries• %ilroy"s Disease

• %ucocoele

• Neonatal Acne

N C d i

• Ne.us 6nius Lateris

• Numular )c+ema• *apilloma

• *eriungual Fibroma

• *ilonidal Sinus

• *inch Dermatitis



• Ne.us Comedonicus

• Ne.us Flammeus

• Ne.us of 4to

• Ne.us Sebaceous of 5adassohn

• *inch Dermatitis• *ityriasis Alba

• *ityriasis #osae

• *remature Adrenarche

• *remature -helarche

DEX

Visual Atlas

• Diaper Dermatitis

• *sorriasis• #abies Vaccination

• #ecurrent *arotitis

• #hus Dermatitis

• #ubella

• Shoe Dermatitis

• Ste.ens 5ohnson Syndrome• Subcutaneous Fat Necrosis

• Synechiae Vul.a

• -ennis !all 'n(ury

• -hyroglossal Duct Cyst



#ubella• Scabies

• Scrofula

• Seborrheic Dermatitis

• Shagreen *atch

-hyroglossal Duct Cyst• -raction Alopecia

• -richotillomania

• 6mbilical &ranuloma

• 6rticaria *igmentosa

DEX

Visual Atlas

• Verruca Vulgaris

• Vitiligo



DEX

;eb ite

• Visit the Visual Diagnosis ;eb ite%

Sajjad -Arabic board slide.ppt

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