finalPEDIATRIC DERMATOLOGY

PEDIATRIC DERMATOLOGY
Annalyn Piedad-echavez. MD.

OBJECTIVES
1.To be able to discuss the common
dermatological problems in the pediatric age
group.
2.To be able to discuss the appropriate

diagnostics and treatment for each
dermatological problems.
Olusola A, Oluwaseun P, &, Shakirat G-O. Pattern of skin diseases amongst children attending a dermatology clinic in Lagos, Nigeria. Pan African Medical Journal. 2018; 29:162
doi:10.11604/pamj.2018.29.162.14503
CUTANEOUS BACTERIAL
INFECTIONS
IMPETIGO
2 Types:
 Bullous Impetigo
 Non Bullous Impetigo
Etiology: Staphylococcus aureus

group A β-hemolytic streptococci
BULLOUS IMPETIGO
Clinical manifestations:
• vesicle or pustule that develops into a honey-
colored crusted plaque <2 cm in diameter
Complications:
• Acute poststreptococcal glomerulonephritis
– osteomyelitis, septic arthritis, pneumonia, and
septicemia
• Treatment:
• Topical therapy with mupirocin
• Oral Antibiotics
CELLULITIS
• characterized by infection and inflammation
of loose connective tissue, with limited
involvement of the dermis and relative sparing
of the epidermis.
Etiology: Streptococcus pyogenes (group A

streptococcus)
S. aureus
Clinical Manifestations:
• area of edema, warmth, erythema, and
tenderness
• Regional adenopathy, fever, chills, and malaise
Complications:
• subcutaneous abscess, bacteremia, osteomyelitis,
septic arthritis, thrombophlebitis, endocarditis,
and necrotizing fasciitis
Diagnosis:
– Aspirates from the site of inflammation
– Skin biopsy
– Blood cultures
Treatment
– Antibiotics
STAPHYLOCOCCAL SCALDED
SYNDROME
Etiology:
 caused epidermolytic toxin -->Staphylococcus
aureus
 recovered from nasopharynx, eye, umbilicus,
pustules
• spreads hematogenously
• Epidemiology:
• occurs in infants and children younger than 5 yr
of age
• caused by epidermolytic toxins
• the toxins likely acts as proteases that target the protein
desmoglein (Dg-1)
Clinical Manifestations
• onset of rash
– Scarlatiniform erythema
• Tissue paper wrinkling skin

• Circumoral erythema
(Nikolsky sign)
Treatment
– Semisynthetic penicillinase-resistant penicillin or
Vancomycin
– Clindamycin - to inhibit bacterial protein (toxin)
synthesis
– Application of an emollient provides lubrication
and decreases discomfort.
FURUNCLES & CARBUNCLES
FURUNCLES
• are skin abscesses which involve a hair follicle
and surrounding tissue.
CARBUNCLES
• Infection of a group of contiguous follicles, with
multiple drainage points, accompanied by
inflammatory changes in surrounding connective
tissue
• CA: Staphylococcus aureus
• Treatment:
–Proper hygeine and wearing of loose-fitting
clothing.
–Application of a hot, moist compress.
–Large lesions may be drained by a small incision.
–Antibiotics
CUTANEOUS VIRAL INFECTIONS
Common warts
(Verruca vulgaris)
Etiology:
• caused by HPV type 2 and 4
• occur most frequently on the fingers, dorsum of
the hands, paronychial areas, face, knees, and
elbows.
• They are well-circumscribed papules with an
irregular, roughened, keratotic surface.
• When the surface is pared away, many black dots
are often visible.
COMMON WARTS
PERIUNGAL WARTS
PLANTAR WARTS
Condylomata
acuminata
Treatment
• Cautery
• Topical Salicylic acid
• Cryotherapy
MOLLUSCUM CONTANGIOSUM
Etiology:
• caused by a pox virus
• transmission - direct contact with an infected
person or from fomites, autoinoculation
• charcacterized as discrete, pearly, skin-colored,
smooth, dome-shaped, papules vary in size from
1-5 mm.
Treatment
• Cantharidin (blister beetle extract) 0.9% in
flexible collodion very effective, safe when
used correctly
• Cryotherapy and curettage
CUTANEOUS FUNGAL INFECTIONS
TINEA VERSICOLOR
• caused by the dimorphic
yeast Malassezia globosa
• typically reddish brown,
either hypopigmented or
hyperpigmented
• characteristic macules are
covered with a fine scale-->
confluent patches
Treatmentt
• Selenium 2% shampoo, Ketoconazole 2%
shampoo or Terbinafine spray
• Antifungal creams
• Oral therapy with Ketoconazole or Fluconazole
TINEA CORPORIS
Etiolology: T. rubrum and Trichophyton
mentagrophytes
Treatment: Topical antifungal agents
TINEA PEDIS
• Etiology: T. rubrum, T. mentagrophytes, and E.
floccosum
• Most commonly, the lateral toe webs (3rd to 4th and
4th to 5th interdigital spaces)
• with maceration and peeling of the surrounding skin
• Severe tenderness, itching, and a persistent foul odor
• Laboratory work up
– Microscopic examination of a KOH preparation or

by culture - Fungal mycelia
Treatment
–Avoidance of occlusive footwear
–Careful drying between the toes after bathing
–Use of an absorbent antifungal powder
–Topical therapy with an imidazole
ECZEMATOUS DISORDER
ATOPIC DERMATITIS
ATOPIC DERMATITIS
Major clinical features Minor clinical features
• Itching/pruritus • Early age of onset
• Typical dermatitis with a • Dry skin/xerosis
chronic or relapsing history • Keratosis pilaris
• Patient or family members • Ichthyosis vulgaris
with atopy • Lip dermatitis
• Typical distribution and age- • Hand eczema
specific patterns • Lichenification
• Elevated IgE level
• Itching on sweating
• Recurrent infections
• Pityriasis alba
• Dermatographism
• Eye symptoms: cataracts,
keratoconus, inflammation
PATHOGENESIS
TREATMENT
• Skin-directed therapies should be the first
approach to management.
(1) Maintenance skin care, designed to repair and
maintain a healthy skin barrier
(2) Topical antiinflammatory medications, to
suppress the inflammatory response
(3) Itch control
(4) Managing infectious triggers, recognition and
treatment of infection-related flare
TREATMENT
• Topical corticosteroids
• Topical Calcineurin Inhibitors
• Adjunctive Therapy - Anti histamines
SEBORRHEIC DERMATITIS
• Scaly, greasy patches
form on the baby’s
scalp
• disappear between 6
months to 1 year of
age
• TX: Mineral oil and
fine tooth comb
DIAPER DERMATITIS • CANDIDAL DIAPER
DERMATITIS
• Beefy red erythematous, sharply
demarcated, elevated rim and
variable scaling along the border
INFESTATIONS
SCABIES
• caused by burrowing and release of toxic or
antigenic substances by the female mite
Sarcoptes scabiei var. hominis
• TRANSMISSION
–Direct skin-to-skin contact.
–Contact with an infested object such as a towel,
bedding, or upholstered furniture.
SCABIES
• Rash: 1-2 mm red
papules,
– Threadlike burrows
• Itching, mainly at night
• Sores
• Thick crusts on the skin
SCABIES
• Diagnosis:
– Visually examining a patient’s skin from head to
toe
– Microscopic identification of mites, ova
• Treatment:
– 5% permethrin cream
– 10% crotamiton cream
– 25% benzyl benzoate lotion
– Sulfur (5%-10%) ointment
– 1% lindane lotion
PEDICULOSIS
• Pediculosis capitis
• Treatment
• Pyrethrin and
permethrin
ACNE (1) abnormal keratinization
of the follicular epithelium,
VULGARIS keratinized cells within the
follicular lumen
(2) increased sebaceous
gland production of sebum
(3) proliferation of
Propionibacteriumacnes
within the follicle
(4) inflammation
VASCULAR DISORDERS
Vascular Malformation
– Capillary Malformation
Vascular Tumor
– Infantile Hemangioma
CAPILLARY MALFORMATION
CAPILLARY MALFORMATION
• Consist of mature dilated dermal capillaries
• The lesions are macular, sharply circumscribed,
pink to purple, and varied in size
• The head and neck region - most common site of
predilection
• Most lesions are unilateral
• Tx: Pulsed dye laser
INFANTILE HEMANGIOMA
INFANTILE HEMANGIOMA
• Proliferative, benign vascular tumors of vascular
endothelium that present at birth
• Risk factors include prematurity, low birthweight,
female sex, and white race.
• 3 Types:
a. Superficial
b. Deep
c. Fixed
TREATMENT
• Observation
• Oral systemic corticosteroids
• Surgical removal
• Laser therapy
• Vincristine
• Propranolol
Summary
• Skin disorders
– Infections
a.Bacterial
b.Viral
c. Fungal
– Eczematous skin disorders
– Infestations
– Acne
– Vascular disorders

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PEDIATRIC DERMATOLOGY

Annalyn Piedad-echavez. MD.

2.To be able to discuss the appropriate

Etiology: Staphylococcus aureus

Etiology: Streptococcus pyogenes (group A

• Tissue paper wrinkling skin

– Microscopic examination of a KOH preparation or

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