Paediatric dermatology

By Emily
 Objectives

 By the end of this session we should

be able to:
• Recognise common rashes in infants and
children and know how to treat them
• Manage common paediatric infestations
(scabies, head lice)
• Treat eczema and know when to refer
 Quiz
 2 teams
 Shout when you know the rash
 Extra bonus points available
 Prize for winners!
What's that rash?
 Milia

 Epidermal inclusion cysts

 Pearly, yellow, 1-3mm diameter
papules
 Face, chin, forehead
 50% newborns
 Usually resolve in first month without
treatment, but may persist for several
months
What's this?
 Hemangioma
 Most common benign tumours of
infancy
 Begin as barely visible telangiectasia
or red macules and grow into 0.5-4cm
bright red partially compressible
tumours
 60% occur on head and neck area
 Virtually all gone by age 5yrs
What's this?
 Capillary malformations

2 common types
Salmon patch (naevus simplex)
• Common (40% newborns)
• Small flat patches pink or red, poorly defined
borders
• Nape of neck (stork mark), forehead (angel kiss),
eyelids and sacrum
• Worse with crying
• Not associated with extracutaneous findings
Capillary malformations
 Port wine stain
• Less common
• Large flat patch of
purple or dark red
skin with well
defined borders
• Persist in childhood
then darkens and
thickens
• Extracutaneous
defects
What's that rash?
 Nappy rash
 Caused by combination of factors, irritation
to the skin by urine and faeces, occlusion
and candida
 Intertriginous areas usually spared
 Secondary staph inf = thin-walled pustules
on erythematous base
 If persistent and creases involved think
seborrheic dematitis, psoriasis, and
candidiasis
 Resolves when stop wearing nappies
Nappy Rash - prevention and
treatment
 Nappy off!
 Change nappy frequently
 Wash bottom at each change, can use
aqueous cream
 Use emollient (aqueous cream) and barrier
(zinc oxide)
 Low potency topical steroid (hydrocortisone)
 Candida - antifungal eg nystatin, can add
low potency steroid for few days
 Sebhorrhoeic dermatitis - Emollients and
steroid help, can add ketoconazole
What's that rash?
 Cradle cap
 Greasy, yellow scaly patches over the scalp
 Seborrheic dermatitis of newborn
 possibly due to overactive sebaceous glands in the
skin of newborn babies
 Possible relationship with skin yeasts (malassezia)
 Not itchy
 Treatment with mild baby shampoos. Wash
regularly and brush softly to remove scales
 Baby oil can help soften scales (not olive oil!)
 Resolves by 6-12mths
 If fails to improve can try medicated shampoo with
ketoconazole or low potency steroids
What's that rash?
 Chicken pox
 Begins as an itchy red papules progressing to
vesicles on bright red base (dew drops on a rose
petal) on the stomach, back and face, and then
spreading to other parts of the body
 Central umbilication of blisters follows rapidly,
crusting and desquamation within 10 days
 Fever, sore throat, anorexia, malaise may precede
rash by several days
 Incubation 7-21 days
 symptomatic treatment only in immunocompetent
• Cool compress, calamine lotion, antihistamines
 ?Vaccinate
What's that rash?
 Meningococcus
 What every parent worries about
 Rash is seldom early sign
 Classically non-blanching haemorrhagic rash
 In early stages rash may be blanching and
macular or maculopapular (sometimes
confused with flea bites)
 Important to search whole body for small
petechiae
 Give IM Ben Pen and refer
What that rash?
 Impetigo
 Superficial bacterial skin infection
 Strep pyogenes or staph aureus
 Round/oval lesions, begin as small pustular
areas and rapidly extend
 Lesions rupture, oozy surface with honey-
covered crust
 Advice about avoiding spread
 Localised lesion- topical antibiotic eg Fucidin
cream
 Widespread infection - oral flucloxacillin or
erythromycin
What's that rash?
 Molluscum
 Viral skin infection Pox virus
 aka ‘dimple wart’
 Clusters of small round flesh-coloured
umbilicated papules
 Often on face, trunk, axillae (warm moist
places)
 Harmless but can persist for months,
occasionally a couple of years
 No treatment necessary
 Can refer for cryotherapy/curratage
What's that rash?
 Measles
 Prodrome; fever, malasie, dry cough, coryza,
conjunctivitis, photophobia
 Koplik spots on buccal mucosa
 Rash 3-4th day of illness
 Starts on face as blanching red macules and
papules, non itchy
 Spreads down trunk and extremities
 Rash coincides with high fever
 Lesions become confluent, older lesions
develop rusty hue
 Contagious 4 days before rash and 4 days
after
What's that rash?
 Hand, Foot and Mouth
 Common, mild, viral infection caused by
Coxsackie A16
 Occurs in young children in summer/autumn
 1-2 day fever, anorexia, sore throat followed
by development of 3-6mm elongated, gray,
thin-walled vesicles
 May be asymptomatic or severe pruritus and
burning
 Symptomatic treatment
 Lasts < 1 week
What's that rash?
 Eyrthema infectiosum
 Fifth disease, slapped cheek, Parvovirus
B19
 First sign is firm red cheeks, which feel
burning hot
 Rash follows 1-4 days later with a lace
pattern on the limbs and then the trunk
 Fades over 2-3wks
 Usually well, may have slight fever or
headache
 Rare complications
• Arthritis in teenagers/adults, aplastic crisis,
miscarriage
What's that rash?
 Herpes simplex
 Gingivostomatitis commonest manifestation
of primary herpes infection in kids
 Clusters of red papules, evolve into vesicles
and often pustules in 24-48hrs. Vesicles
rupture and crust over. Heal in 10-14days
 Cool compress, analgesia, consider aciclovir
 Monitor hydration when oral lesions
 Can be recurrent
 Head Lice
 Infest clean and dirty hair
 Adult lice are size of sesame seed,
brownish grey, and wiggle their legs
 Only adult lice contagious
 Spread by head to head contact
 They don’t jump/fly
 Normally asymptomatic
 Can present with itchy scalp
 Head Lice- Treatment
 Insecticides - malathion, phenothrin,
permethrin, carbaryl
 Local policy?
 2 applications 7 days apart
 Shampoos not effective
 Wet-comb conditioned hair with fine
tooth comb until lice removed and rpt
at 3-4 day intervals for 2/52
 Electric combs, tea tree - no evidence
What that rash?
 Scabies
 Sarcoptes scabiei mite
 Pruritic burrows pathognomic
(irregular, tortuous, and slightly scaly)
 In infants, burrows are widespread with
involvement of trunk, scalp,
extremities, palms and soles
 Consider in infants with widespread
dermamtosis that involves the palms
and soles
 Scabies - treatment

 Permethrin (malathion)
 Ivermectin in combination for
‘norwegian scabies’
 Not after hot bath
 All family members at same time
 Whole body treatment inc, scalp, neck,
face, ears and under nails
 Rpt week later
Infantile eczema
 Eczema
 Infants
• Infants less than one year old often have
widely distributed eczema.
• The skin is often dry, scaly and red with
small scratch marks made by sharp baby
nails
• The cheeks of infants are often the first
place to be affected by eczema.
• The napkin area is frequently spared due
to the moisture retention of nappies (but
they can still get nappy rash)
Childhood eczema
 Eczema
 Toddlers and pre-school
• As children begin to move around, the
eczema becomes more localised and
thickened.
• Toddlers scratch vigorously and the
eczema may look very raw and
uncomfortable
• Often affects the extensor aspects of joints,
particularly the wrists, elbows, ankles and
knees. It may also affect the genitals
• As the child becomes older the pattern
frequently changes to involve the flexor
surfaces of the same joints
• The affected skin often becomes lichenified
 Eczema
 School children
• Older children tend to have the flexural
pattern of eczema and it most often affects
the elbow and knee creases. Other
susceptible areas include the eyelids,
earlobes, neck and scalp.
• Many children develop a 'nummular'
pattern of atopic dermatitis. This refers to
small coin-like areas of eczema scattered
over the body. These round patches of
eczema are dry, red and itchy and may be
mistaken for ringworm
• Mostly improves during the school years
 Treatment of eczema
 Advice - loose cotton clothes, avoid wool,
keep cool, nails short, gloves in bed
 Emollients
 Antihistamines
 Topical steroids
 Topical immunosuppressant
 Bandages (zinc/ ichthammol/ Tar)
 Wet wrapping - weeping eczema
 ?Oral steroids
 Immunosuppressant
 Phototherapy