Pediatrics

• Skin


  Largest organ in the body, with epidermis, dermis, and subcutaneous layers. Blood vessels are present in the dermis.

  
• Epstein pearls


  • Whitish-yellow cysts that form on the gums and roof of the mouth in newborn babies
  • Caused by entrapped epithelium during palate development
  • Occur in approximately 80% of newborns
  • Disappear within 1-2 weeks of birth
  • Do not affect breastfeeding
• Erythema toxicum


  • Common, noncancerous skin condition seen in newborns
  • May appear in 50% or more of normal newborn infants
  • Cause is unknown
  • Rash of small, yellow-to-white-colored papules surrounded by red skin
  • Rash can change rapidly and usually clears within 2 weeks
• Milia


  • Tiny white bumps that most commonly appear on a baby's nose, chin or cheeks
  • Develop when skin flakes become trapped in small skin pockets
  • Common in newborns, up to 50% develop milia
  • Typically disappear on their own within several weeks
• Mongolian spots


  • Flat, blue or blue-gray skin markings near the buttocks that appear at birth or shortly after
  • Common in people of Asian, East Indian, and African descent
  • Often mistaken for bruises, can raise child abuse concerns
  • No treatment necessary, spots fade in a few years and are usually gone by adolescence
• Port wine stain


  • Birthmark caused by swollen blood vessels, creating a reddish-purplish discoloration
  • Occurs in about 3 out of 1,000 people
  • Associated with neurocutaneous conditions
  • Flat and pink at first, can darken and thicken over time
  • Laser therapy is the most successful treatment
• Strawberry naevus


  • Haemangioma (capillary overgrowth) that occurs in infancy, usually on the face
  • May be present at birth or develop in the first few weeks
  • Begins as a small flat red area, then develops into a raised dimpled lesion
  • Very common, occurring in 3-5% of babies
  • Usually disappears within the first year of life, but some do not
• Bullous impetigo


  • Cutaneous condition caused by Staphylococcus aureus bacterial infection, presenting with bullae
  • Can cause deaths in fewer than 3% of infected children
  • Bacteria produce a toxin that reduces cell-to-cell adhesion, causing skin layers to separate
  • Antibiotic creams are the preferred treatment for mild cases

  
• Giant congenital nevus


  • Dark-colored, often hairy patch of skin present at birth or in the first year of life
  • Usually associated with a neurocutaneous disorder
  • Commonly found on the back, abdomen, or other areas
  • Skin biopsy may be needed to check for cancer cells
• Giant congenital nevus


  A congenital pigmented or melanocytic nevus is a dark-colored, often hairy patch of skin. It is present at birth or appears in the first year of life.
• Giant congenital nevus


  • Usually associated with a neurocutaneous disorder
  • Melanocytes are part of the histopathologic finding
  • Skin biopsy may be needed to check for cancer cells
  • MRI of the brain might be done if the nevus is over the spine
• Diaper rash


  Rash secondary to diaper, caused by infection with a yeast (fungus) called Candida
• Diaper rash


  • Bright red rash that gets bigger
  • Very red and scaly areas on the scrotum and penis in boys
  • Red or scaly areas on the labia and vagina in girls
  • Pimples, blisters, ulcers, large bumps, or sores filled with pus
  • Smaller red patches (called satellite lesions) that grow and blend in with the other patches
  • Older infants may scratch when the diaper is removed
• Cradle cap


  An oily, yellow scaling or crusting on a baby's scalp. It is the normal build-up of sticky skin oils, scales, and sloughed skin cells.
• Treating cradle cap


  1. Rub baby's scalp with baby oil, mineral oil, or petroleum jelly to help lift the crusts and loosen scales

  2. Scrub scalp with a gentle scrub
• Infant acne vulgaris


  Baby acne is usually seen on the cheeks, chin, and forehead. It occurs when hormonal changes in the body stimulate oil glands in the baby's skin.
• Infant acne vulgaris


  • Can be present at birth but usually develops around 3 to 4 weeks of age
  • Condition can look worse when the baby is crying or fussy, or any other instance that increases blood flow to the skin
  • Acne is harmless and usually resolves on its own within several weeks
• Atopic dermatitis (AD)


  The most chronic relapsing skin disease seen in infancy and childhood. It is an inflammatory, relapsing, non contagious and itchy condition.

  
• Atopic dermatitis (AD)


  • Dry and scaly - crack, swell and crust
  • History of atopy
  • Diagnosed based on pruritus, eczematous dermatitis, and chronic or chronically relapsing course
  • Treated with moisturizers, topical corticosteroids, and lukewarm baths

  
• Atopic dermatitis (AD) affects 10-30% of children worldwide and frequently occurs in families with other atopic diseases.

  
• Atopic dermatitis (AD) at different ages

  • Infants: mainly on the face and extensor surface of the limbs, trunk might be affected, but the napkin area is typically spared
  • Age 1-2 yr onward: polymorphous manifestations with different types of skin lesions, particularly in flexural folds
  • Adolescents and adults: often present with lichenified and excoriated plaques at flexures, wrists, ankles, and eyelids; in the head and neck type, the upper trunk, shoulders, and scalp are involved
  • Adults: might have only chronic hand eczema or present with prurigo-like lesions

  
• Chickenpox


  Highly contagious viral skin rash with itchy, raw pockmarks
• Treating chickenpox


  1. Quarantine measures

  2. Varicella zoster vaccine

  3. Anti-histamine & calamine lotion (zinc oxide)

  4. Acyclovir can be helpful - reduces the duration of condition
• Measles


  Infection of respiratory system, immune system and skin, caused by a paramyxovirus. Characterized by maculopapular, erythematous rash and Koplik's spots.
• Measles treatment


  1. Supportive care

  2. Measles vaccine at 9 months; During epidemic, earliest is at 6 months

  3. MMR vaccine at 12 to 15 months
• Measles


  • 3Cs: Coryza, Cough (last to disappear) and Conjunctivitis
  • Incubation period: 3 to 4 days before the appearance of rashes and 7 days after the appearance of rashes
  • Rash appears on the height of the fever
  • +ve measles IgM antibodies
  • Complications: pneumonia (most common cause of death), bronchitis obliterans, bronchitis, encephalitis and ear infections (most common complication: Otitis media)
• Viral warts


  Common in children, usually on the fingers and soles. Caused by HPV.
• Treating viral warts


  1. Salicylic acid and lactic acid paint or glutaraldehyde can be used

  2. Cryotherapy can also be used
• Molluscum contagiosum


  Virally caused lesion, with small, skin coloured, pearly papules with central umbilication.
• Treating molluscum contagiosum


  1. Topical antibacterial can be applied to prevent or treat secondary bacterial infections

  2. Cryotherapy can be used in older children
• Tinea capitis


  Fungal infection of the scalp, also called ringworm of the scalp.
• Tinea capitis


  • Areas appear bald with small black dots, due to hair that has broken off
  • May have round, scaly areas of skin that are red or swollen (inflamed)
  • May also have pus-filled sores
• Epstein's

  Whitish-yellow cysts that form on the gums and roof of the mouth in a newborn baby
• Molluscum contagiosum lesions


  • Often widespread but tend to disappear spontaneously within a year
  • Can apply topical antibacterial to prevent or treat secondary bacterial infections
  • Cryotherapy can be used in older children to clear lesions for aesthetic purposes
• Tinea capitis


  Fungal infection of the scalp, also called ringworm of the scalp
• Tinea capitis


  • Appears as bald areas with small black dots due to broken off hair
  • May have round, scaly, red or swollen areas of skin
  • May have pus-filled sores called kerions
  • Almost always causes itching of the scalp
  • Can cause hair loss and lasting scars
• Wood's lamp test


  Special lamp that can help diagnose a fungal scalp infection
• Medications for tinea capitis

  • Griseofulvin, terbinafine, and itraconazole
  • Medicated shampoo containing ketoconazole or selenium sulfide
• Scabies


  Skin condition caused by the Sarcoptes scabei parasite that burrows under the skin, causing intense itching
• Scabies


  • Lesions occur in the interdigits
  • Treated with topical permethrin or oral ivermectin
  • Everyone in the home should be treated and bedding should be disinfected