Terminology Macule – flat lesion,usually a circumscribed change of colour Papule – small, solid, elevated lesion Nodule – a large, solid, palpable and elevated lesion Plaque – a lesion slightly raised over a larger area Blister – an elevated lesion,fluid filled Ulcer – depressed lesion with loss of surface epithelium Atrophy – a depressed lesion with intact surface epithelium Crust – a mixture of scale and serum – yellowish accretions on the surface of a lesion Petechiae – non raised red-brown non blanchable lesions
Summary of Paediatric Skin Rashes: Adapted from Paediatric Handbook 6th Ed. Royal Children's Hospital, Melbourne
Name the rash What causes this condition Name 2 types of this condition How do you treat this condition
References Pictures – Derm atlas Oxford Handbook of Dermatology for primary care,Saxe,Jessop Topics in Paediatrics,Basson& Ginsberg
SLIDE 1 1-Chicken-pox, Varicella zoster virus 2-Crops of vesicles mainly on the trunk and head. -Pass through various stages of papule, vesicle, pustule and crust. 3-Symptomatic :analgesia – paracetamol for discomfort and pyrexia. -pruritis – antihistamine or calamine lotion - acyclovir only for those at risk of complications or immunocompromised.
SLIDE 2 1-Impetigo 2-staph areus and streptococcal pyogenes 3-Thin–roofed vesicles or bullae surrounded by narrow margin of erythema. The vesicles /bullae rupture to release thin cloudy yellow fluid. This fluid dries to form thick yellow crusts. 4-topical-bactroban(mupirocin) ointment/betadine cream - antibiotics – flucloxacillin or erythromycin
SLIDE 4 1-Kawasaki Disease, systemic vasculitis 2- Classical features of Kawasaki disease Fever lasting ≥5 days Marked irritability of the child Erythema, swelling and desquamation affecting the skin of the extremities Bilateral conjunctivitis Rash Inflammation of the lips, mouth and/or tongue Cervical lymphadenopathy 3- coronary artery aneurysms 4 -Intravenous Immune Globulin 2g/kg x1 Aspirin: –80-100 mg/kg/day until fever x 14 day, then –3-5mg/kg/day x ≥ 6-8 weeks echocardiograms
SLIDE 5 1-Scabies 2-Mite –sarcoptes scabeii 3 -Clothes, towels, and bed linen should be machine-washed (at 50 degrees Celsius or above) to prevent re-infestation and transmission. Items that cannot be washed can be kept in plastic bags for at least 72 hours to contain the mites until they die. -benzyl benzoate lotion,apply for 24hours,may be repeated in 1 week -permethrin cream Antiscabial soap alone is not an effective treatment Babies <2 months -5% sulphur ointment
SLIDE 6 1-Measles 2-single stranded RNA Morbillivirus from the paramyxovirus family. 3- Symptoms Prodrome - lasts 2-4 days with fever, runny nose, mild conjunctivitis and diarrhoea. Koplik spots are pathognomic and appear on the buccal mucosa opposite the second molar teeth as small, red spots each with a bluish-white speck (sometimes compared to a grain of rice) in the centre.6 They occur in 60-70% of patients during the prodrome and for up to 2-3 days before the onset of the rash.6 Rash - (morbilliform = measles-like) first seen on forehead and neck and spreads, involves trunk and finally limbs over 3-4 days. It may become confluent in some areas. Rash then fades after 3-4 days in the order of its appearance. It leaves behind a brownish discoloration sometimes accompanied by fine desquamation. 4-Uncomplicated measles is usually self-limiting and treatment is mainly symptomatic with paracetamol or ibuprofen and plenty of fluids. Patients should remain at home to limit disease spread. It is a notifyable disease
SLIDE 7 1- erythema infectiosum, slapped cheek disease, slapped cheek syndrome, fifth disease, Parvovirus B19 (PV-B19), Sticker's disease 2- Parvovirus B19 3- After 3-7 days, the classic 'slapped cheek' rash appears as erythema on the cheeks, sparing the nose, peri-oral and peri-orbital regions.6 This disappears after 2-4 days.6 About 1-4 days after the facial rash appears, an erythematous macular/morbilliform rash develops on the extremities, mainly on the extensor surfaces.7 It is usually not itchy in young children, but may be itchy in older children and adults. This gradually fades over the next 3-21 days, but may recur in reaction to various stimuli such as exercise, heat and sunlight7 4- It is usually mild and self-limiting in healthy people. It may also cause fetal loss or fetal hydrops, reactive arthritis in adults, and severe anaemia in those with haematological conditions or immunocompromise.Detection in pregnancy is important for monitoring and possible treatment.
SLIDE 8 1-Napkin /Daiper dermatitis 2- Contact dermatitis prolonged exposure to urine and faeces, friction mild erythematous,glazed appearance -Seborrhoeic dermatitis salmon coloured greasy lesions and a predilection for intertriginous areas. -Candidiasis beefy red in colour with pin point pustulo-vesicular satellite lesion 3- frequent daiper changes barrier cream zinc and caster oil apply hydrocortisone 1% in aqueous cream bd if candidiasis suspected -10% steriod and nystatin 20% in zinc cream
SLIDE 9 1- tinea capitis 2- fungal infection by a group of organisms called dermatophytes 3-griseofulvin for 6 weeks,10mg/kg
SLIDE 11 1-Molluscum contagiosum 2-From direct innoculation of pox virus 3-tend to heal spontaneously within 6 months – 1 year -liquid nitrogen 2-3 weeks -express contents with sharp curette -benzoyl peroxide cream apply daily
SLIDE 12 1-Miliaria 2-Miliaria is a common disorder of the eccrine sweat glands that often occurs in conditions of increased heat and humidity. It is thought to be caused by blockage of the sweat ducts, which results in the leakage of eccrine sweat into the epidermis or dermis. 3-Two types -miliaria crystallina-clear superficial pinpoint vesicles -miliaria rubra –(prickly heat )-small discrete red papules,vesicles,papulovesicles 4-No compelling reason to treat miliaria crystallina exists because this condition is asymptomatic and self-limited. he prevention and treatment of miliaria primarily consists of controlling heat and humidity so that sweating is not stimulated. Measures may involve treating a febrile illness; removing occlusive clothing; limiting activity; providing air conditioning. Topical treatments that have been advocated involve lotions containing calamine